Kadambi Sindhuja, Wang Ying, Job Anna, Khankan Leen, Yu Tristan, Patel Arpan, Nipp Ryan, Loh Kah Poh
Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY.
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY.
JCO Oncol Pract. 2025 Jan;21(1):92-99. doi: 10.1200/OP.24.00105. Epub 2025 Jan 10.
With advances in cancer treatment, long-term survival rates have improved in recent decades, resulting in extended life expectancies for many patients. This progress brings substantial challenges, however, particularly in terms of the costs associated with cancer care. The financial burden, often considerable, poses difficulties for older adults with cancer and their caregivers. Financial toxicity refers to the unintended financial consequences and distress that patients and families incur from cancer and its treatment. The prevalence of financial toxicity varies (some estimates with over half experiencing this challenge), and certain subgroups (eg, race other than White and those with lack of social support) are at greater risk. Although studies focusing on older adults are limited, existing research has shown that financial toxicity is associated with adverse outcomes, including delayed care, poorer physical, social, and psychological well-being, and lower overall quality of life. Moreover, financial toxicity may result in negative caregiver health outcomes, which can in turn affect patient outcomes. These negative caregiver effects may persist into the bereavement phase. Various methods are available to assess financial toxicity, and they consist of three domains: material, psychological, and behavioral. Available interventions focus on identifying those at risk and providing financial counseling, navigation, and literacy, as well as tangible assistance. Although the impact of financial toxicity is increasingly recognized, studies in older adults and their caregivers are lacking. A better understanding of their needs is important to develop interventions aimed at mitigating financial toxicity in older adults with cancer and their caregivers.
随着癌症治疗的进展，近几十年来长期生存率有所提高，许多患者的预期寿命得以延长。然而，这一进展带来了巨大挑战，尤其是在癌症护理相关费用方面。经济负担往往相当沉重，给老年癌症患者及其护理人员带来了困难。经济毒性是指患者及其家庭因癌症及其治疗而产生的意外经济后果和困扰。经济毒性的发生率各不相同（一些估计表明超过一半的人面临这一挑战），某些亚组（例如非白人种族以及缺乏社会支持的人群）面临的风险更大。尽管针对老年人的研究有限，但现有研究表明，经济毒性与不良后果相关，包括延迟治疗、身体、社会和心理健康状况较差以及总体生活质量较低。此外，经济毒性可能导致护理人员出现负面健康结果，进而影响患者的治疗结果。这些负面的护理人员影响可能会持续到丧亲阶段。有多种方法可用于评估经济毒性，它们包括三个领域：物质、心理和行为。现有的干预措施侧重于识别有风险的人群，并提供财务咨询、指导和知识普及，以及实际援助。尽管经济毒性的影响越来越受到认可，但针对老年人及其护理人员的研究却很缺乏。更好地了解他们的需求对于制定旨在减轻老年癌症患者及其护理人员经济毒性的干预措施至关重要。
