Xu Binbin, So Winnie K W, Choi Kai Chow, Huang Yu, Liu Mei, Qiu Lanxiang, Tan Jianghong, Tao Hua, Yan Keli, Yang Fei
Author Affiliations: School of Nursing, Hunan University of Chinese Medicine, Changsha, Hunan (Dr Xu); Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong (Drs Xu, So, and Choi); Nursing Department of the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou (Ms Huang); Infection Control Department of Xuzhou Cancer Hospital, Xuzhou (Ms Liu); and Nursing Department of the Third Affiliated Hospital of Xuzhou Medical University (Ms Qiu), Xuzhou, Jiangsu; Nursing Department of Zhuzhou Central Hospital, Zhuzhou, Hunan (Ms Tan); and Oncology Department of the First Affiliated Hospital of Nanjing Medical University (Ms Tao); Internal Medicine Nursing Office, the First Affiliated Hospital of Nanjing Medical University (Ms Yan); and Nursing Department of Nanjing Pukou People's Hospital (Ms Yang), Nanjing, Jiangsu, China.
Cancer Nurs. 2024 Dec 10. doi: 10.1097/NCC.0000000000001432.
Factors influencing health-related quality of life (HRQoL) and financial toxicity (FT) have been found to overlap, and the robust correlation between HRQoL and FT raises the possibility that FT mediates the relationships between the shared risk factors and HRQoL. However, empirical evidence supporting this hypothesis is limited.
This study aimed to explore whether FT mediates the relationships between HRQoL and its risk factors.
A cross-sectional study was conducted, with 1208 participants from 12 hospitals (6 tertiary, 6 secondary) in 6 cities across 3 income-level-diverse provinces in China from February to October 2022. FT and HRQoL were measured using the COmprehensive Score for financial Toxicity and the Functional Assessment of Cancer Therapy-General. Twenty-two risk factors for both HRQoL and FT were included for analysis. Mediation analyses were conducted using Mplus 8.3.
FT predominantly mediated the relationships between HRQoL and both annual household income and hospital level. Meanwhile, it partially mediated the relationships of HRQoL with the number of treatment modalities, social support, perceived stress, healthcare provider-patient discussion regarding cancer care costs, and social medical insurance, and the mediating effect accounted for 19.7%, 7.8%, 10.7%, 22.3%, and 46.8% of the total effect, respectively.
FT plays a significant mediating role in the associations between HRQoL and some of its risk factors among patients with cancer.
Developing a more comprehensive and patient-centered approach to cancer care that addresses the unique challenges posed by cancer-related FT is urgently needed to improve the HRQoL among this population.
已发现影响健康相关生活质量（HRQoL）和经济毒性（FT）的因素存在重叠，且HRQoL与FT之间的强相关性增加了FT介导共同风险因素与HRQoL之间关系的可能性。然而，支持这一假设的实证证据有限。
本研究旨在探讨FT是否介导HRQoL与其风险因素之间的关系。
于2022年2月至10月在中国3个收入水平不同省份的6个城市的12家医院（6家三级医院，6家二级医院）进行了一项横断面研究，纳入1208名参与者。使用经济毒性综合评分和癌症治疗功能评估通用版量表分别测量FT和HRQoL。纳入22个HRQoL和FT的风险因素进行分析。使用Mplus 8.3进行中介分析。
FT主要介导了HRQoL与家庭年收入和医院级别之间的关系。同时，它部分介导了HRQoL与治疗方式数量、社会支持、感知压力、医护人员与患者关于癌症治疗费用的讨论以及社会医疗保险之间的关系，中介效应分别占总效应的19.7%、7.8%、10.7%、22.3%和46.8%。
FT在癌症患者HRQoL与其某些风险因素之间的关联中起显著中介作用。
迫切需要制定一种更全面且以患者为中心的癌症护理方法，以应对癌症相关经济毒性带来的独特挑战，从而改善这一人群的HRQoL。
