Bachtiary Barbara, Grawehr Leonie, Grillo Ruggieri Filippo, Held Ulrike, Weber Damien C
Centre for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland.
Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland.
Cancers (Basel). 2023 Nov 21;15(23):5498. doi: 10.3390/cancers15235498.
Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress-an effect known as "financial toxicity." This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy.
Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment.
The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children's caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4, ≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate -3.7, 95% CI -5.7 to -1.9, ≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: -9.1, 95% CI -14.8 to -3.4, ≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate -9.5, 95% CI -12.4 to -6.6, ≤ 0.001), spending savings (estimate -3.9, 95% CI -6.3 to -1.4, = 0.002), borrowing money (estimate -6.3, 95% CI -10.4 to -2.2, = 0.003), and increasing workload (estimate -5.5, 95% CI -10.5 to -0.4, = 0.035).
A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy.
质子治疗适用于难以用传统放射疗法治疗的癌症。在瑞士，强制医疗保险涵盖了这种治疗的费用，但这并不意味着质子治疗对每个癌症患者来说都是成本中性的。由于与质子治疗相关的费用，可能会产生大量的自付费用，患者可能会经历与治疗相关的经济困境——这种效应被称为“经济毒性”。本研究调查了在一个实行强制医疗保险政策的高收入国家接受质子治疗的患者的经济毒性。
2019年9月至2021年11月期间，146名接受质子治疗的瑞士癌症患者参与了本研究，其中90名（62%）为成年人，56名（38%）为儿童癌症患者的照顾者。使用FACIT经济毒性综合评分（COST）评估经济毒性。在质子治疗期间每周记录自付费用，并在治疗结束时记录经济应对策略。
所有患者的经济毒性中位数COST评分为29.9（四分位间距21.0；36.0），成人为30.0（四分位间距21.3；37.9），儿童照顾者为28.0（四分位间距20.5；34.0）。较高的收入（估计值8.1，95%置信区间3.7至12.4，P≤0.001）与较高的COST评分显著相关，表明经济毒性较小。每增加100公里从家到治疗中心的距离（估计值-3.7，95%置信区间-5.7至-1.9，P≤0.001）与较低的COST评分显著相关，表明经济毒性增加。已婚成年患者的COST评分显著低于单身患者（估计值：-9.1，95%置信区间-14.8至-3.4，P≤0.001）。自付费用中位数为2050瑞士法郎，主要用于旅行、住宿和外出就餐。63名（43%）患者动用了储蓄；54名（37%）减少了休闲活动支出；21名（14.4%）削减了生活费用；14名（9.6%）借了钱；9名（6.2%）增加了工作量；4名（2.7%）出售了房产。COST评分高的患者使用诸如减少休闲活动支出（估计值-9.5，95%置信区间-12.4至-6.6，P≤0.001）、动用储蓄（估计值-3.9，95%置信区间-6.3至-1.4，P=0.002）、借钱（估计值-6.3，95%置信区间-10.4至-2.2，P=0.003）和增加工作量（估计值-5.5，95%置信区间-10.5至-0.4，P=0.035）等应对策略的情况明显较少。
在瑞士，大量接受质子治疗的癌症患者经历了经济毒性。到质子治疗中心的长途距离和低收入对这些患者在质子治疗期间的经济状况产生了负面影响。
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