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医疗账单之外:越南癌症患者中财务毒性的高发生率及多样的管理策略

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer.

作者信息

Tran Binh Thang, Nguyen Thanh Gia, Le Dinh Duong, Nguyen Minh Tu, Nguyen Nhan P T, Nguyen Minh Hanh, Ong The Due

机构信息

Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.

Undergraduate Training Office, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam.

出版信息

J Prev Med Public Health. 2024 Jul;57(4):407-419. doi: 10.3961/jpmph.24.090. Epub 2024 Jun 24.

Abstract

OBJECTIVES

This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.

METHODS

This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.

RESULTS

The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.

CONCLUSIONS

FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

摘要

目的

本研究旨在使用财务毒性综合评分(COST)来衡量越南癌症患者的财务毒性(FT),并描述这些患者所采用的成本管理策略。

方法

这项综合性横断面研究纳入了越南两家专业肿瘤医院的634名患者。使用COST cutoff分数,FT被分类为无/轻度(≥26)、中度(14 - 25)或重度(≤13)。成本管理策略或应对机制被分为4组:生活方式改变、财务资源策略、治疗调整和寻求支持。

结果

FT的患病率为91.8%,其中51.7%的参与者表现为重度FT,40.1%表现为中度FT。重度FT与女性、低教育水平、不稳定就业、低家庭经济状况和晚期癌症阶段显著相关。最常见的应对策略如下:在生活方式改变方面,减少基本物品和休闲活动的开支(78.7%)以及削减必要的家庭开支(66.4%);在财务资源策略方面,向亲戚或朋友借钱(49.1%)以及从退休或储蓄账户提取资金(34.1%);在治疗调整方面,因成本担忧而更换治疗机构或医生(9.3%);在寻求支持方面,从福利或社区组织获得帮助(18.8%)。所有策略在重度FT患者中使用的可能性显著更高。

结论

FT在癌症患者中高度普遍。大多数患者依赖生活方式调整和应对策略,这凸显了改善财务支持系统以减轻与癌症护理相关的经济负担的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17cd/11309834/c47fc45c6887/jpmph-24-090f1.jpg

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