经济毒性对癌症患者处方药使用和心理健康的影响。
Effects of financial toxicity on prescription drug use and mental well-being in cancer patients.
作者信息
Chan Kelly, Sepassi Aryana, Saunders Ila M, Goodman Aaron, Watanabe Jonathan H
机构信息
University of California San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA 92037, United States of America.
Assistant Professor of Clinical Pharmacy, Department of Clinical Pharmacy Practice, University of California, Irvine, School of Pharmacy & Pharmaceutical Science, Berk Hall Room 120 D, Irvine, CA, 92617, United States of America.
出版信息
Explor Res Clin Soc Pharm. 2022 Apr 14;6:100136. doi: 10.1016/j.rcsop.2022.100136. eCollection 2022 Jun.
BACKGROUND
In the US, medical costs for cancer patients have grown from $27 billion in 1990 to $174 billion in 2020. The increased financial strain that cancer patients and survivors endure is referred to as financial toxicity.
OBJECTIVE
To quantify the relationship between indicators of financial toxicity and health utilization and quality of life in patients ever diagnosed with cancer.
METHODS
Adult cancer patients and survivors in 2017 were identified using the Medical Expenditure Panel Survey. Multiple logistic regression models were used to quantify the relationship between three financial toxicity exposures (concern for keeping an income, paying large medical bills, and going into debt or borrowing money) and two discrete outcomes of being able to purchase prescriptions and often worrying that cancer would worsen or come back.
RESULTS
This study assessed 609 respondents. After survey weighting was applied, that represented 16,215,673 individuals. Patients who reported concern for keeping an income were at 2.91 (95% Confidence Interval [CI], 1.16 to 7.31) and 2.97 (95% CI, 2.01 to 2.67) times increased odds to report avoiding purchase of prescriptions and worry of cancer status, respectively, versus those who did not. Patients who reported worry about paying large medical bills were at 4.46 (95% CI, 2.15 to 9.24) and 2.80 (95% CI, 1.98 to 3.96) times increased odds to report avoiding purchase of prescriptions and worry of cancer status, respectively, versus those who did not. Patients who reported borrowing money or going into debt were at 3.04 (95% CI, 1.19 to 7.76) and 2.42 (95% CI, 1.54 to 3.18) times increased odds to report avoiding purchase of prescriptions and worry of cancer status, respectively, versus those who did not.
CONCLUSIONS
Financial toxicity is associated with decreased prescription utilization and quality of life in the form of excessive worry among cancer patients including cancer survivors.
背景
在美国，癌症患者的医疗费用已从1990年的270亿美元增长到2020年的1740亿美元。癌症患者及其幸存者所承受的日益增加的经济压力被称为经济毒性。
目的
量化经济毒性指标与曾被诊断患有癌症的患者的医疗利用和生活质量之间的关系。
方法
使用医疗支出面板调查确定2017年的成年癌症患者及其幸存者。采用多元逻辑回归模型量化三种经济毒性暴露（担心维持收入、支付大额医疗账单以及负债或借钱）与能够购买处方药和经常担心癌症会恶化或复发这两个离散结果之间的关系。
结果
本研究评估了609名受访者。应用调查权重后，这代表了16215673人。报告担心维持收入的患者报告避免购买处方药和担心癌症状况的几率分别是未报告者的2.91倍（95%置信区间[CI]，1.16至7.31）和2.97倍（95%CI，2.01至2.67）。报告担心支付大额医疗账单的患者报告避免购买处方药和担心癌症状况的几率分别是未报告者的4.46倍（95%CI，2.15至9.24）和2.80倍（95%CI，1.98至3.96）。报告借钱或负债的患者报告避免购买处方药和担心癌症状况的几率分别是未报告者的3.04倍（95%CI，1.19至7.76）和2.42倍（95%CI，1.54至3.18）。
结论
经济毒性与癌症患者（包括癌症幸存者）处方利用率降低以及过度担忧形式的生活质量下降有关。
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