癌症成年患者的经济毒性与心理困扰：基于治疗的分析
Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis.
作者信息
Yu Huihui, Li Hui, Zuo Tingting, Cao Li, Bi Xue, Xing Haiyang, Cai Lijuan, Sun Jianmin, Liu Yunyong
机构信息
Liaoning Office for Cancer Control and Research, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
Department of Nursing, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.
出版信息
Asia Pac J Oncol Nurs. 2022 Apr 20;9(9):100069. doi: 10.1016/j.apjon.2022.04.008. eCollection 2022 Sep.
OBJECTIVE
To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress.
METHODS
This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress.
RESULTS
Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity ( = 0.032) and psychological distress ( < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50-59 years ( = 0.035), 60-69 years ( = 0.007), and 70 years or older ( = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY ( < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) ( = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) ( = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years ( = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer ( = 0.009), the surgery group ( < 0.001) and adjuvant therapy group ( < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups.
CONCLUSIONS
The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.
目的
评估癌症患者在经济毒性和心理困扰方面因治疗方式不同而存在的差异，并揭示经济毒性与心理困扰之间的关系。
方法
这是一项多中心横断面研究。于2017年3月至2018年10月招募患者，并完成关于其人口统计学、经济毒性和心理困扰的问卷调查。采用多元线性回归模型来研究与经济和心理困扰相关的因素。
结果
分别有47.9%和56.5%的患者出现显著的经济毒性和心理困扰。在单纯化疗、辅助治疗和手术组中，经济毒性（P = 0.032）和心理困扰（P < 0.001）在统计学上存在差异。多变量分析显示，与年龄小于50岁的患者相比，50 - 59岁（P = 0.035）、60 - 69岁（P = 0.007）和70岁及以上（P = 0.002）的患者经济毒性综合评分（COST）更高。个人年收入>40,000元的患者报告的COST评分高于年收入<20,000元的患者（P < 0.001）。与城镇职工基本医疗保险（UEBMI）相比，参加城镇居民基本医疗保险（URBMI）（P = 0.030）或新型农村合作医疗（NRCMS）（P = 0.006）的患者COST评分低于参加UEBMI的患者。心理困扰的多元分析模型显示，年龄超过70岁（P = 0.010）与苦恼温度计（DT）得分低显著相关，而结直肠癌患者（P = 0.009）、手术组（P < 0.001）和辅助治疗组（P < 0.001）与DT得分高显著相关。在化疗相关治疗组中，经济毒性与心理困扰之间的相关性较弱，但具有统计学意义。
结论
该研究突出了成年癌症患者经济和心理困扰的高发生率。应根据相关因素为癌症患者提供多维度的困扰筛查和心理社会干预。
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