癌症相关经济毒性对治疗后生存者生殖关注和家庭生育决策的影响。
The Impact of Cancer-Related Financial Toxicity on Reproductive Concerns and Family-Building Decision-Making in Post-Treatment Survivorship.
机构信息
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA.
Stanford Cancer Institute, Stanford, California, USA.
出版信息
J Adolesc Young Adult Oncol. 2023 Jun;12(3):408-415. doi: 10.1089/jayao.2022.0088. Epub 2022 Sep 27.
Adolescent and young adult (AYA) survivors are at-risk for cancer-related financial difficulties (i.e., financial toxicity [FT]). Family building after cancer often requires reproductive medicine or adoption with high costs; AYAs experience financial barriers to family building. This study evaluated the relationships among cancer FT, reproductive concerns, and decision-making processes about family building after cancer. AYA female (AYA-F) cancer survivors completed a cross-sectional survey including measures of FT, reproductive concerns, decisional conflict about family building, and decision-making self-efficacy. Differences across FT subgroups (i.e., no/mild, moderate, and severe FT) were tested. Linear regression evaluated the relationships between FT and reproductive concerns and decision-making processes. Participants ( = 111) averaged 31.0 years (standard deviation [SD] = 5.49), 90% were nulliparous, and 84% were employed full/part-time. The overall FT levels were in the "moderate" range ( = 20.44, SD = 9.83); 48% worried or about financial problems because of cancer. AYA-Fs reporting severe FT (24% of sample) experienced higher levels of reproductive concerns compared with those reporting no/mild and moderate FT. Those reporting moderate FT (46% of sample) reported greater decisional conflict about family-building options, compared with the no/mild FT subgroup. Both moderate and severe FT subgroups reported lower decision-making self-efficacy compared with the no/mild FT subgroup. In separate models controlling for covariates, greater FT related to higher levels of reproductive concerns ( = -0.39, < 0.001), greater decisional conflict about family building ( = -0.56, = 0.02), and lower decision-making self-efficacy ( = 0.60, = 0.01). Given the high costs of reproductive medicine and adoption, fertility counseling pre- and post-treatment must address survivors' financial concerns and barriers.
青少年和年轻成人（AYA）幸存者面临癌症相关经济困难（即财务毒性[FT]）的风险。癌症后家庭建设通常需要高成本的生殖医学或收养；AYA 面临家庭建设的经济障碍。本研究评估了癌症 FT、生殖关注以及癌症后家庭建设决策过程之间的关系。AYA 女性（AYA-F）癌症幸存者完成了一项横断面调查，包括 FT、生殖关注、家庭建设决策冲突以及决策自我效能的测量。测试了 FT 亚组（即无/轻度、中度和重度 FT）之间的差异。线性回归评估了 FT 与生殖关注和决策过程之间的关系。参与者（n=111）平均年龄为 31.0 岁（标准差[SD]=5.49），90%为未婚，84%全职/兼职工作。整体 FT 水平处于“中度”范围（=20.44，SD=9.83）；48%因癌症而担心或担心财务问题。报告严重 FT（样本的 24%）的 AYA-F 经历了更高水平的生殖关注，与报告无/轻度和中度 FT 的患者相比。报告中度 FT（样本的 46%）的患者对家庭建设选择的决策冲突更大，与无/轻度 FT 亚组相比。中度和重度 FT 亚组报告的决策自我效能均低于无/轻度 FT 亚组。在控制协变量的单独模型中，较高的 FT 与较高水平的生殖关注（= -0.39， < 0.001）、对家庭建设的更大决策冲突（= -0.56， = 0.02）和较低的决策自我效能（= 0.60， = 0.01）相关。鉴于生殖医学和收养的高成本，治疗前后必须进行生育咨询，以解决幸存者的财务问题和障碍。
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