财务毒性及其与前列腺癌和结肠癌筛查的关联。

Financial Toxicity and Its Association With Prostate and Colon Cancer Screening.

机构信息

Pediatrics Department, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio.

The Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel.

出版信息

J Natl Compr Canc Netw. 2022 Sep;20(9):981-988. doi: 10.6004/jnccn.2022.7036.

DOI:10.6004/jnccn.2022.7036

PMID:36075394

Abstract

BACKGROUND

The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening.

METHODS

This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively.

RESULTS

Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039).

CONCLUSIONS

Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.

摘要

背景

“财务毒性”或“经济困难”是一个患者报告的结果，源于癌症治疗的物质成本、这些成本的心理影响以及患者用来应对包括延迟或放弃治疗在内的压力的应对策略。然而，人们对财务毒性对癌症筛查的影响知之甚少。我们研究了财务毒性对前列腺癌和结肠癌筛查使用的影响。我们假设，更大的经济困难会与癌症筛查的患病率下降相关。

方法

这是一项基于横断面调查的美国研究，纳入了 2018 年 1 月至 12 月期间国家健康访谈调查数据库中年龄≥50 岁的男性和女性。通过总结 10 个财务毒性二分问题（是或否）的回答，制定了一个 0 到 10 分的财务困难评分（FHS），分数越高表示经济困难越大。主要结局是自我报告的前列腺特异性抗原（PSA）血液检测和结肠镜检查用于前列腺癌和结肠癌筛查。

结果

总体上，共收集了 13439 个个体的回复。共有 9277 人（69.03%）接受了结肠镜检查，3455 人（70.94%）男性接受了 PSA 检测。白人、已婚、有工作的男性更有可能接受 PSA 检测和结肠镜检查。未接受 PSA 检测或结肠镜检查的个体的平均 FHS 高于接受这些检查的个体（分别为 0.70 和 0.79 与 0.47 和 0.61；均 P≤.001）。多变量逻辑回归模型表明，FHS 较高与 PSA 检测（比值比，0.916；95%置信区间，0.867-0.967；P=.002）和结肠镜检查（比值比，0.969；95%置信区间，0.941-0.998；P=.039）的可能性降低相关。