Conti Rena M, McCue Shaylene, Dockter Travis, Gunn Heather J, Dusetzina Stacie B, Bennett Antonia V, Rapkin Bruce, Gracia Gabriela, Jazowski Shelley, Johnson Michelle, Behrens Robert, Richardson Paul, Subbiah Niveditha, Chow Selina, Chang George J, Neuman Heather B, Weiss Elisa S
Boston University, Questrom School of Business, Boston, MA.
Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN.
medRxiv. 2024 Sep 18:2024.09.13.24311098. doi: 10.1101/2024.09.13.24311098.
To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukemia (CLL).
23 U.S. community and minority oncology practice sites affiliated with the National Cancer Institute Community Oncology Research Program (NCORP).
521 patients (≥18 years) with MM or CLL were consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%).
Observational, prospective, protocol-based survey administered in 2019-2020.
Financial difficulty was assessed using a single-item standard measure, the EORTC QLQC30: "Has your physical condition or medical treatment caused you financial difficulties in the past year?" and using an 'any-or-none' composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association between financial difficulty, diagnosis, and socioeconomic and treatment characteristics.
16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM versus CLL (adjusted odds ratio [aOR], 0.34; 95% CI, 0.13-0.84; =.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37-4.66; =.003), being non-White (aOR, 2.21; 95% CI, 1.04-4.72; =.04), and having a high school education or below (aOR, 0.36; 95% CI, 0.21-0.64; =.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41-0.94; =.03).
U.S. patients with blood cancer report financial difficulty, especially those with low socio-economic status. Evidence-based and targeted interventions are needed.
评估多发性骨髓瘤（MM）或慢性淋巴细胞白血病（CLL）患者自我报告的经济困难比例及其相关因素。
23个隶属于美国国立癌症研究所社区肿瘤研究项目（NCORP）的美国社区及少数族裔肿瘤诊疗机构。
521例年龄≥18岁的MM或CLL患者签署了知情同意书，416例患者回复了调查问卷（完成率=79.8%）。回复者中，MM诊断患者占74.0%，拥有副学士学位或更高学历者占53.4%，白人占89.2%，均有保险（100%），且接受临床医生开具药物治疗者占68.0%。
2019 - 2020年进行的基于方案的观察性前瞻性调查。
使用单一项目标准测量方法（欧洲癌症研究与治疗组织生活质量核心问卷30：“在过去一年中，您的身体状况或医疗治疗是否给您带来了经济困难？”）以及使用一个由22个项目组成的“有或无”综合测量方法来评估经济困难，该综合测量方法评估经济困难、担忧以及成本应对策略的使用情况。多变量逻辑回归模型评估经济困难、诊断以及社会经济和治疗特征之间的关联。
使用单一项目测量方法时，16.8%的患者报告经历过经济困难；使用综合测量方法时，这一比例为60.3%。综合测量方法中最常被认可的项目是对支付与癌症相关的大额医疗账单的经济担忧以及支付医疗账单困难。使用单一项目测量方法时，经济困难与患有MM而非CLL相关（调整优势比[aOR]，0.34；95%置信区间[CI]，0.13 - 0.84；P =.02），与拥有医疗保险以外的其他保险相关（aOR，2.53；95% CI，1.37 - 4.66；P =.003），与非白人相关（aOR，2.21；95% CI，1.04 - 4.72；P =.04），以及与高中及以下学历相关（aOR，0.36；95% CI，0.21 - 0.64；P =.001）。使用综合测量方法时，经济困难与高中及以下学历相关（aOR，0.62；95% CI，0.41 - 0.94；P =.03）。
美国血癌患者报告存在经济困难，尤其是社会经济地位较低的患者。需要有循证且有针对性的干预措施。
