Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), Rome, Italy.
University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
JCO Oncol Pract. 2024 Mar;20(3):438-447. doi: 10.1200/OP.23.00434. Epub 2024 Jan 11.
We investigated the association of financial toxicity (FT) with the health-related quality of life (HRQoL) profile of patients with hematologic malignancies treated in a universal health care system.
We did a secondary analysis of six multicenter studies enrolling patients with hematologic malignancies. FT was evaluated using the financial difficulties item of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Multivariable linear regression models were used to assess the mean differences in HRQoL scores between patients with or without FT, while adjusting for key potential confounding factors. We also examined the prevalence of clinically important problems and symptoms by the experience of FT, using established thresholds for the EORTC QLQ-C30. Multivariable binary logistic regression analysis was performed to explore the risk factors associated with FT.
Overall, 1,847 patients were analyzed, of whom 441 (23.9%) reported FT. We observed statistically and clinically relevant worse scores for patients with FT compared with those without FT for all the EORTC QLQ-C30 scales. The three largest clinically relevant mean differences between patients with and without FT were observed in pain (∆ = 19.6 [95% CI, 15.7 to 23.5]; < .001), social functioning (∆ = -18.9 [95% CI, -22.5 to -15.2]; < .001), and role functioning (Δ = -17.7 [95% CI, -22.1 to -13.3]; < .001). Patients with FT tended to report a higher prevalence of clinically important problems and symptoms across all EORTC QLQ-C30 scales. In the univariable and multivariable analyses, the presence of FT was associated with the presence of comorbidities, an Eastern Cooperative Oncology Group performance status ≥1, and not receiving a salary.
Patients with hematologic malignancies treated in the setting of a universal health care system who experience FT have a worse HRQoL profile compared with those without FT.
我们调查了在全民医疗保健体系中接受治疗的血液恶性肿瘤患者的财务毒性（FT）与健康相关生活质量（HRQoL）状况之间的关联。
我们对纳入血液恶性肿瘤患者的六项多中心研究进行了二次分析。使用欧洲癌症研究与治疗组织生存质量问卷核心 30 （EORTC QLQ-C30）的财务困难条目评估 FT。使用多变量线性回归模型评估 FT 患者与无 FT 患者之间 HRQoL 评分的平均差异，同时调整了关键潜在混杂因素。我们还通过 FT 经验检查了 EORTC QLQ-C30 既定阈值下的临床重要问题和症状的患病率。使用多变量二项逻辑回归分析来探讨与 FT 相关的危险因素。
共有 1847 名患者接受了分析，其中 441 名（23.9％）报告了 FT。与无 FT 的患者相比，我们观察到 FT 患者的所有 EORTC QLQ-C30 量表的评分均存在统计学和临床相关的差异。FT 患者与无 FT 患者之间存在三个最大的临床相关平均差异，分别是疼痛（∆=19.6 [95％CI，15.7 至 23.5]；<0.001）、社会功能（∆=-18.9 [95％CI，-22.5 至-15.2]；<0.001）和角色功能（Δ=-17.7 [95％CI，-22.1 至-13.3]；<0.001）。FT 患者在所有 EORTC QLQ-C30 量表上均倾向于报告更高的临床重要问题和症状的患病率。在单变量和多变量分析中，FT 的存在与合并症的存在、东部肿瘤合作组表现状态≥1 和不领薪有关。
在全民医疗保健体系中接受治疗的血液恶性肿瘤患者中，经历 FT 的患者的 HRQoL 状况比无 FT 的患者差。
