Xu Binbin, So Winnie K W, Choi Kai Chow, Huang Yu, Liu Mei, Qiu Lanxiang, Tan Jianghong, Tao Hua, Yan Keli, Yang Fei
School of Nursing, Hunan University of Chinese Medicine, Changsha, China.
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
Asia Pac J Oncol Nurs. 2024 Dec 9;12:100636. doi: 10.1016/j.apjon.2024.100636. eCollection 2025 Dec.
China's diverse economic landscape across its regions may contribute to disparities in cancer-related financial toxicity (FT), but empirical evidence is lacking. This study examined regional disparities in cancer-related FT across economically diverse provinces in China.
A cross-sectional study was conducted among adult patients with cancer from six tertiary and six secondary hospitals across three Chinese provinces with varying economic statuses (high-, middle-, and low-income). FT was assessed using the COmprehensive Score for financial Toxicity (COST). Hierarchical regression analysis was employed to compare FT among participants from different economic regions, controlling for 13 patient-level sociodemographic and clinical risk factors.
From February to October 2022, 1208 participants completed the survey (response rate = 97.3%). Mean COST scores were 21.99 ± 6.37 (high-income), 20.38 ± 8.01 (middle-income), and 19.20 ± 5.14 (low-income), showing significant differences ( < 0.001), with lower scores indicating more severe FT. After adjusting for covariates, regional economic level was significantly associated with FT, with more severe FT in middle- (B: -1.515; 95% CI: -2.250, -0.780) and low-income regions (B: -2.159; 95% CI: -2.899, -1.418) than in high-income regions.
This study reveals significant disparities in cancer-related FT across economically diverse provinces in China. The findings underscore the need for targeted policies and interventions to improve health equity in cancer care, with a focus on not neglecting middle-income regions. Oncology nurses are expected to enhance awareness of FT management, voice the needs of patients, and advocate for policy reforms to address these disparities.
中国各地区多样的经济格局可能导致癌症相关经济毒性（FT）的差异，但缺乏实证证据。本研究调查了中国经济状况各异的省份之间癌症相关FT的地区差异。
对来自中国三个经济状况不同（高收入、中等收入和低收入）省份的六家三级医院和六家二级医院的成年癌症患者进行了一项横断面研究。使用财务毒性综合评分（COST）评估FT。采用分层回归分析比较不同经济地区参与者的FT情况，并控制13个患者层面的社会人口学和临床风险因素。
2022年2月至10月，1208名参与者完成了调查（回复率=97.3%）。平均COST得分分别为21.99±6.37（高收入）、20.38±8.01（中等收入）和19.20±5.14（低收入），差异有统计学意义（<0.001），得分越低表明FT越严重。调整协变量后，地区经济水平与FT显著相关，中等收入地区（B：-1.515；95%CI：-2.250，-0.780）和低收入地区（B：-2.159；95%CI：-2.899，-1.418）的FT比高收入地区更严重。
本研究揭示了中国经济状况各异的省份之间癌症相关FT存在显著差异。研究结果强调需要制定有针对性的政策和干预措施，以改善癌症护理中的健康公平性，尤其要关注中等收入地区。预计肿瘤护士将提高对FT管理的认识，表达患者的需求，并倡导政策改革以解决这些差异。
