Diao Kevin, Lei Xiudong, Smith Grace L, Jagsi Reshma, Peterson Susan E, Sumer Baran D, Smith Benjamin D, Sher David J
Departments of Radiation Oncology.
Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Int J Radiat Oncol Biol Phys. 2023 May 1;116(1):142-153. doi: 10.1016/j.ijrobp.2022.08.065. Epub 2022 Oct 25.
Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood.
We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1,668 eligible patients, 1,600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes.
Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24).
Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
口咽鳞状细胞癌（OPSCC）患者面临较高的经济毒性（FT）风险，但对于接受原发放射治疗（RT）或手术后所经历的FT的性质、程度及预测因素，人们了解甚少。
我们使用了德克萨斯癌症登记处基于人群的样本，这些患者在2006年至2016年间被诊断为I至III期OPSCC，并接受了原发RT或手术治疗。在1668名符合条件的患者中，抽取了1600名，400名做出回应，396名确诊为OPSCC。测量指标包括MD安德森症状问卷头颈版、颈部清扫损伤指数，以及一项根据个体化癌症护理（iCanCare）研究改编的经济毒性工具。多变量逻辑回归评估暴露因素与结局之间的关联。
在396名可分析的受访者中，269名（68%）接受了原发RT，127名（32%）接受了手术。从诊断到调查的中位时间为7年。由于OPSCC，54%的患者经历了物质牺牲（包括28%减少食品支出和6%失去住房），45%的患者担心经济问题，29%的患者经历了长期FT。与更多长期FT相关的独立因素包括女性（比值比[OR]，1.72；95%置信区间[CI]，1.23 - 2.40）、非西班牙裔黑人种族（OR，2.98；95% CI，1.26 - 7.09）、未婚状态（OR，1.50；95% CI，1.11 - 2.03）、使用饲管（OR，3.98；95% CI，2.29 - 6.90），以及MD安德森症状问卷头颈版和颈部清扫损伤指数中最差四分位数与最佳四分位数相比（OR，1.89；95% CI，1.23 - 2.90和OR，5.62；95% CI，3.79 - 8.34）。与较少长期FT相关的因素包括年龄>57岁（OR，0.54；95% CI，0.41 - 0.71；P <.001）和家庭收入≥80,000美元（OR，0.60；95% CI，0.44 - 0.82；P =.001）。原发RT与手术相比，与长期FT无关（OR，0.92；95% CI，0.68 - 1.24）。
口咽癌幸存者经历物质牺牲和长期FT的比例较高，我们确定了重要的风险因素。慢性症状负担与长期财务状况明显更差相关，支持了毒性缓解策略可能减少长期FT的假设。
