Boulanger Mary, Mitchell Carley, Zhong Jeffrey, Hsu Melinda
Department of Medicine, Johns Hopkins University, Baltimore, MD, United States.
Department of Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, United States.
Front Oncol. 2022 Oct 21;12:1004102. doi: 10.3389/fonc.2022.1004102. eCollection 2022.
In the United States, lung cancer is the third most common cancer and the overall leading cause of cancer death. Due to advances in immunotherapy and targeted therapy, 5-year survival is increasing. The growing population of patients with lung cancer and cancer survivors highlights the importance of comprehensive cancer care, including recognizing and addressing financial toxicity. Financial toxicity is a term used to contextualize the negative effects of the costs of cancer treatment in terms of patient quality of life. The American Society of Clinical Oncology (ASCO) Value Framework places emphasis on high-value care as it evaluates cancer treatments "based on clinical benefit, side effects, and improvements in patient symptoms or quality of life in the context of cost". Prior studies have shown that risk factors for financial toxicity in patients with lung cancer include lower household income or savings, inability to afford basic necessities, higher than anticipated out of pocket expenses, and taking sick leave. Among lung cancer survivors, patients experience increased unemployment and lower wages compared to the general population underscoring the lasting effects of financial toxicity. Financial toxicity is associated with increased psychosocial distress and decreased quality of life, and bankruptcy is an independent predictor of mortality in patients with cancer. Despite the negative implications of financial toxicity on patients, standardized screening practices and evidence-based interventions are lacking. The "COmphrensive Score for financial Toxicity (COST)" tool has been validated for assessing financial toxicity with correlation with health-related quality of life. Further research is needed to understand the utility of incorporating routine screening for financial toxicity into clinical practice and the efficacy of interventions. Understanding the relationship between financial toxicity and quality of life and survival is critical to providing high-value cancer care and survivorship care.
在美国，肺癌是第三大常见癌症，也是癌症死亡的首要总体原因。由于免疫疗法和靶向疗法的进展，5年生存率正在提高。肺癌患者和癌症幸存者群体的不断壮大凸显了综合癌症护理的重要性，包括认识和应对经济毒性。经济毒性是一个用于将癌症治疗费用对患者生活质量的负面影响进行情境化描述的术语。美国临床肿瘤学会（ASCO）价值框架强调高价值护理，因为它在评估癌症治疗时“基于临床获益、副作用以及在成本背景下患者症状或生活质量的改善情况”。先前的研究表明，肺癌患者经济毒性的风险因素包括家庭收入或储蓄较低、无力负担基本生活必需品、自付费用高于预期以及请病假。在肺癌幸存者中，与普通人群相比，患者的失业率增加且工资降低，这突出了经济毒性的持久影响。经济毒性与心理社会困扰增加和生活质量下降相关联，并且破产是癌症患者死亡率的一个独立预测因素。尽管经济毒性对患者有负面影响，但缺乏标准化的筛查方法和循证干预措施。“经济毒性综合评分（COST）”工具已被验证可用于评估经济毒性，并与健康相关生活质量具有相关性。需要进一步研究以了解将经济毒性常规筛查纳入临床实践的效用以及干预措施的疗效。了解经济毒性与生活质量及生存之间的关系对于提供高价值癌症护理和生存护理至关重要。
