Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Radiother Oncol. 2023 Jun;183:109604. doi: 10.1016/j.radonc.2023.109604. Epub 2023 Mar 7.
To establish and confirm prevalence as well as risk factors of financial toxicity in a large national cohort of cancer patients undergoing radiotherapy in a universal health care system.
We conducted a prospective cross-sectional study offering a patient-reported questionnaire to all eligible cancer patients treated with radiotherapy in 11 centers in Germany during 60 consecutive days. The four-point subjective financial distress question of the EORTC QLQ-C30 was used as a surrogate for financial toxicity. Confirmatory hypothesis testing evaluated the primary study outcomes: overall prevalence of financial toxicity and its association with predefined risk factors. P-values < 0.05 were considered statistically significant.
Of 2341 eligible patients, 1075 (46%) participated. The prevalence of subjective financial distress (=any grade higher than not present) was 41% (438/1075) exceeding the hypothesized range of 26.04-36.31%. Subjective financial distress was felt "A little" by 26% (280/1075), "Quite a bit" by 11% (113/1075) and "Very much" by 4% (45/1075) of the patients. Lower household income, lower global health status/ quality of life, higher direct costs and higher loss of income significantly predicted higher subjective financial distress per ordinal regression and confirmed these risk factors. Higher psychosocial distress and lower patient satisfaction were significantly associated with higher subjective financial distress in an exploratory ordinal regression model.
The overall prevalence of financial toxicity was higher than anticipated, although reported at low or moderate degrees by most affected patients. As we confirmed risk factors associated with financial toxicity, patients at risk should be addressed early for potential support.
在一个全民医疗保健系统中，对接受放疗的大型国家癌症患者队列进行研究，以确定经济毒性的流行率和相关风险因素。
我们进行了一项前瞻性的横断面研究，在德国 11 个中心的 60 天内，为所有接受放疗的符合条件的癌症患者提供一份患者报告的调查问卷。使用 EORTC QLQ-C30 的四点主观财务困境问题作为财务毒性的替代指标。验证性假设检验评估了主要的研究结果：财务毒性的总体流行率及其与预定义风险因素的关联。P 值<0.05 被认为具有统计学意义。
在 2341 名符合条件的患者中，有 1075 名（46%）参与了研究。主观财务困境（=任何高于不存在的等级）的患病率为 41%（438/1075），超过了假设的 26.04-36.31%范围。26%（280/1075）的患者感到“有点”，11%（113/1075）的患者感到“相当多”，4%（45/1075）的患者感到“非常多”。按顺序回归分析，较低的家庭收入、较低的总体健康状况/生活质量、较高的直接费用和较高的收入损失显著预测了较高的主观财务困境，验证了这些风险因素。在探索性的顺序回归模型中，较高的心理社会困扰和较低的患者满意度与较高的主观财务困境显著相关。
尽管大多数受影响的患者报告的程度较低或为中度，但经济毒性的总体患病率高于预期。由于我们确认了与经济毒性相关的风险因素，因此应及早为有风险的患者提供潜在的支持。
