Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary.
Value Health. 2023 Feb;26(2):300-316. doi: 10.1016/j.jval.2022.07.017. Epub 2022 Sep 5.
Financial toxicity is recognized as an important adverse effect of cancer treatment that may decrease patients' health-related quality of life (HRQOL). We aim to perform a systematic review and meta-analysis on studies investigating the association of HRQOL and financial toxicity measured with the Comprehensive Score for Financial Toxicity in patients with cancer and survivors.
A systematic literature search was completed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (last update April 2022). Methodological quality of included studies was assessed using the Appraisal Tool for Cross-Sectional Studies and the Critical Appraisal Skills Program Cohort Study Checklist. Where possible, study outcomes were pooled by random-effects meta-analysis.
Thirty-one studies were included with a combined sample of 13 481 patients and survivors with more than 25 cancer types from 9 countries. Nineteen different validated HRQOL instruments were used in these studies, with the Functional Assessment of Cancer Therapy - General (n = 9), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (n = 5), and EQ-5D (n = 5) being the most common. All but one included studies reported that higher financial toxicity was significantly associated with worse HRQOL. Ten HRQOL domains were correlated with financial toxicity, including physical health (r = 0.34-0.66), social health (r = 0.16-0.55), mental health (r = 0.21-0.54), and daily functioning (r = 0.23-0.52). The meta-analysis indicated a moderate correlation between financial toxicity and overall HRQOL as measured by the Functional Assessment of Cancer Therapy instruments (r = 0.49, 95% confidence interval 0.44-0.54).
This is the first systematic review and meta-analysis to summarize the literature on the association of financial toxicity and HRQOL in patients with cancer and survivors. Our findings substantiate financial toxicity as a relevant outcome of cancer care that is associated with a decline of HRQOL.
财务毒性被认为是癌症治疗的一个重要不良后果，可能会降低患者的健康相关生活质量（HRQOL）。我们旨在对研究癌症患者和幸存者的财务毒性与 HRQOL 之间关联的文献进行系统评价和荟萃分析，这些研究使用综合性财务毒性评分进行测量。
在 PubMed、Web of Science、Cumulative Index to Nursing and Allied Health Literature 和 PsycInfo（最后更新于 2022 年 4 月）上完成了系统文献检索。使用横断面研究评估工具和批判性评估技能计划队列研究清单评估纳入研究的方法学质量。在可能的情况下，通过随机效应荟萃分析汇总研究结果。
共纳入 31 项研究，共计 13481 名患者和幸存者，来自 9 个国家，涵盖 25 种以上癌症类型。这些研究使用了 19 种不同的经过验证的 HRQOL 工具，其中癌症治疗功能评估-一般量表（n=9）、欧洲癌症研究与治疗组织生活质量问卷核心 30 量表（n=5）和 EQ-5D（n=5）最为常见。除一项研究外，所有研究均报告称，财务毒性较高与 HRQOL 较差显著相关。有 10 个 HRQOL 领域与财务毒性相关，包括身体健康（r=0.34-0.66）、社会健康（r=0.16-0.55）、心理健康（r=0.21-0.54）和日常功能（r=0.23-0.52）。荟萃分析表明，财务毒性与癌症治疗功能评估工具测量的整体 HRQOL 之间存在中度相关性（r=0.49，95%置信区间 0.44-0.54）。
这是第一项系统评价和荟萃分析，总结了癌症患者和幸存者财务毒性与 HRQOL 关联的文献。我们的研究结果证实了财务毒性是癌症护理的一个相关结果，与 HRQOL 的下降有关。
