Department of Pediatrics, University of California at Irvine, Irvine, California; Division of Hematology, Oncology at Children's Hospital of Orange County, Orange, California.
Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
Transplant Cell Ther. 2023 Nov;29(11):705.e1-705.e9. doi: 10.1016/j.jtct.2023.07.024. Epub 2023 Aug 2.
Long-term survivors of childhood cancer are at risk for financial hardship. However, it is not known if HCT leads to an incremental change in financial hardship for survivors who received it versus those who did not. We examined financial outcomes among adult survivors of childhood cancer who had undergone HCT. Using a cross-sectional survey in the Childhood Cancer Survivor Study population between 2017 and 2019, self-reported financial hardship was compared between survivors who received HCT, survivors treated without HCT ("non-HCT"), and siblings and categorized into 3 domains: material hardship/financial sacrifices, behavioral, and psychological hardship. The standardized score of each domain of financial hardship was calculated by adding the item responses and dividing by the standard deviation among siblings. Multivariable linear and logistic regression were used to evaluate associations between sociodemographic characteristics, cancer diagnosis, post-treatment complications, and financial hardship among survivors. The mean adjusted score for each hardship domain was not significantly different between HCT survivors (n = 133) and non-HCT survivors (n = 2711); mean differences were .18 (95% confidence interval [CI], -.05 to .41) for material hardship/financial sacrifices, .07 (95% CI, -.18 to .32) for behavioral hardship, and .19 (95% CI, -.04 to .42) for psychological hardship. Within specific items, a higher proportion of survivors treated with HCT reported greater financial hardship compared to non-HCT survivors. HCT survivors also had significantly higher mean domain scores compared to sibling controls (n = 1027) in all domains. Household income and chronic health conditions, but not HCT, were associated with financial hardship among all survivors. Adult survivors of childhood cancer treated with HCT do not report greater overall financial hardship compared to non-HCT survivors but do report greater overall financial hardship compared to sibling controls. Surveillance and intervention may be necessary for all survivors regardless of HCT status.
儿童癌症幸存者长期存在经济困难的风险。然而，尚不清楚 HCT 是否会导致接受 HCT 的幸存者与未接受 HCT 的幸存者之间经济困难程度的增量变化。我们研究了接受过 HCT 的儿童癌症幸存者的财务结果。在 2017 年至 2019 年期间，在儿童癌症幸存者研究人群中进行了一项横断面调查，使用自我报告比较了接受 HCT 的幸存者、未接受 HCT 治疗的幸存者（“非 HCT”）和兄弟姐妹之间的经济困难，并分为 3 个领域：物质困难/经济牺牲、行为和心理困难。每个经济困难领域的标准化得分是通过添加项目反应并除以兄弟姐妹之间的标准差来计算的。多变量线性和逻辑回归用于评估社会人口统计学特征、癌症诊断、治疗后并发症与幸存者经济困难之间的关联。HCT 幸存者（n=133）和非 HCT 幸存者（n=2711）之间每个困难领域的平均调整得分差异无统计学意义；物质困难/经济牺牲的平均差异为.18（95%置信区间 [CI]，-.05 至.41），行为困难为.07（95% CI，-.18 至.32），心理困难为.19（95% CI，-.04 至.42）。在特定项目中，与非 HCT 幸存者相比，接受 HCT 治疗的幸存者报告了更多的经济困难。与兄弟姐妹对照组（n=1027）相比，HCT 幸存者在所有领域的平均领域得分也明显更高。家庭收入和慢性健康状况，但不是 HCT，与所有幸存者的经济困难有关。与非 HCT 幸存者相比，接受 HCT 治疗的儿童癌症成年幸存者总体经济困难程度没有报告更高，但与兄弟姐妹对照组相比，总体经济困难程度报告更高。无论 HCT 状态如何，可能都需要对所有幸存者进行监测和干预。
