Yanez Betina, Perry Laura M, Peipert John Devin, Kuharic Maja, Taub Chloe, Garcia Sofia F, Diaz Alma, Buitrago Diana, Mai Quan, Gharzai Laila A, Cella David, Kircher Sheetal M
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
JCO Oncol Pract. 2024 Dec;20(12):1776-1783. doi: 10.1200/OP.24.00025. Epub 2024 Aug 15.
Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer.
This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy.
The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms ( = 0.310) and anxiety ( = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, = .070; 6-month β = .072, = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, = .023; 9-month β = .071, = .068).
FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.
经济困难（FH）是癌症护理中的一个复杂问题，会影响物质条件、幸福感和应对行为。本研究旨在纵向研究经济困难、焦虑、抑郁症状及其关联，同时将健康的社会决定因素和医疗保健成本协变量纳入被诊断为癌症的患者样本中。
这项前瞻性纵向队列研究分析了来自西北大学改善癌症治疗期间及之后症状管理试验的2305名参与者的数据。在基线以及基线后3、6、9和12个月评估的结果包括抑郁症状、焦虑和经济困难。分析采用随机截距交叉滞后面板模型来探索个体间和个体内效应，纳入年龄、性别、保险状况、邻里地区贫困程度、医疗保健费用、自付费用和健康素养等因素。
该队列的平均年龄为60.7岁（标准差[SD]=12.7），大多数为女性（64.9%）且为白人（86.2%）。发现经济困难与抑郁症状（=0.310）和焦虑（=0.289）之间存在相关性。观察到经济困难与抑郁症状之间存在预测关系，基线和6个月时的抑郁症状水平可预测后期的经济困难（基线β=.079，=0.070；6个月β=.072，=0.081），9个月时的经济困难显著预测12个月时的抑郁症状（β=.083，=0.025），即使在考虑了医疗保健费用和自付费用之后也是如此。基线和9个月时的焦虑与随后的经济困难存在预测关系（基线β=.09
