乳腺癌治疗收据与不同乳腺癌幸存者的财务压力、健康素养和计算能力的关系。
Breast cancer treatment receipt and the role of financial stress, health literacy, and numeracy among diverse breast cancer survivors.
机构信息
Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Survey and Qualitative Methods Core, Dana-Farber Cancer Institute, Boston, MA, USA.
出版信息
Breast Cancer Res Treat. 2023 Jul;200(1):127-137. doi: 10.1007/s10549-023-06960-w. Epub 2023 May 13.
PURPOSE
Disparities in breast cancer treatment for low-income and minority women are well documented. We examined economic hardship, health literacy, and numeracy and whether these factors were associated with differences in receipt of recommended treatment among breast cancer survivors.
METHODS
During 2018-2020, we surveyed adult women diagnosed with stage I-III breast cancer between 2013 and 2017 and received care at three centers in Boston and New York. We inquired about treatment receipt and treatment decision-making. We used Chi-squared and Fisher's exact tests to examine associations between financial strain, health literacy, numeracy (using validated measures), and treatment receipt by race and ethnicity.
RESULTS
The 296 participants studied were 60.1% Non-Hispanic (NH) White, 25.0% NH Black, and 14.9% Hispanic; NH Black and Hispanic women had lower health literacy and numeracy and reported more financial concerns. Overall, 21 (7.1%) women declined at least one component of recommended therapy, without differences by race and ethnicity. Those not initiating recommended treatment(s) reported more worry about paying large medical bills (52.4% vs. 27.1%), worse household finances since diagnosis (42.9% vs. 22.2%), and more uninsurance before diagnosis (9.5% vs. 1.5%); all P < .05. No differences in treatment receipt by health literacy or numeracy were observed.
CONCLUSION
In this diverse population of breast cancer survivors, rates of treatment initiation were high. Worry about paying medical bills and financial strain were frequent, especially among non-White participants. Although we observed associations of financial strain with treatment initiation, because few women declined treatments, understanding the scope of impact is limited. Our results highlight the importance of assessments of resource needs and allocation of support for breast cancer survivors. Novelty of this work includes the granular measures of financial strain and inclusion of health literacy and numeracy.
目的
低收入和少数族裔妇女在乳腺癌治疗方面的差异是有据可查的。我们研究了经济困难、健康素养和计算能力，以及这些因素是否与乳腺癌幸存者接受推荐治疗的差异有关。
方法
在 2018-2020 年期间，我们调查了在 2013 年至 2017 年期间被诊断患有 I-III 期乳腺癌并在波士顿和纽约的三个中心接受治疗的成年女性。我们询问了治疗的接受情况和治疗决策。我们使用卡方检验和 Fisher 精确检验来检查经济压力、健康素养、计算能力（使用经过验证的措施）与种族和族裔之间治疗接受情况的关系。
结果
在 296 名研究参与者中，60.1%是非西班牙裔（NH）白人，25.0%是 NH 黑人，14.9%是西班牙裔；NH 黑人和西班牙裔女性的健康素养和计算能力较低，并且报告了更多的经济问题。总体而言，有 21 名（7.1%）女性至少拒绝了推荐治疗方案的一个组成部分，种族和族裔之间没有差异。那些没有开始接受推荐治疗的人报告说，他们更担心支付大额医疗费用（52.4%比 27.1%）、诊断后家庭财务状况更差（42.9%比 22.2%）和诊断前没有保险的情况更多（9.5%比 1.5%）；所有 P 值均小于 0.05。健康素养和计算能力与治疗接受情况没有差异。
结论
在这个多样化的乳腺癌幸存者群体中，开始治疗的比例很高。尤其是在非白人参与者中，对支付医疗费用和经济压力的担忧很常见。尽管我们观察到经济压力与治疗开始之间存在关联，但由于很少有女性拒绝治疗，因此对影响范围的理解是有限的。我们的研究结果强调了评估资源需求和为乳腺癌幸存者提供支持的重要性。这项工作的新颖之处在于对经济压力的详细衡量以及对健康素养和计算能力的纳入。
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