Cwalina Thomas B, Zheng David X
Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA.
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
J Gastrointest Cancer. 2025 Apr 3;56(1):92. doi: 10.1007/s12029-025-01217-9.
Patients with hepatopancreatobiliary (HPB) cancers may experience financial toxicity as a result of diagnosis and treatment. We characterized the prevalence and predictors of financial toxicity among United States (U.S.) HPB cancer patients using the National Health Interview Survey. Outcomes were delaying medical care due to cost or being unable to afford necessary medical care within the past 12 months. Prevalence was estimated in univariable analyses and sociodemographic predictors were identified in multivariable analyses. Among 5,630,270 U.S. adults with self-reported HPB cancer, 567,531 (10.1%) delayed medical care due to cost and 474,632 (8.4%) were unable to afford necessary medical care within the past 12 months. Uninsured patients were more likely to delay care due to cost (aOR 14.38, 95% CI 4.81-43.01) or to be unable to afford necessary medical care (aOR 19.93, 95% CI 6.45-61.55). Non-White race (aOR 2.01, 95% CI 1.06-3.81) was a risk factor for delaying care due to cost, whereas household income < 200% of the federal poverty level (aOR 2.69, 95% CI 1.20-6.04) was associated with inability to afford necessary medical care. Patients who had received surgery within the past 12 months were not at higher odds of either financial toxicity outcome. Targeted interventions to mitigate financial toxicity among at-risk patients are warranted to alleviate the financial burden of HPB cancer care.
肝胰胆（HPB）癌患者可能因诊断和治疗而经历经济毒性。我们使用美国国家健康访谈调查对美国HPB癌患者中经济毒性的患病率和预测因素进行了特征描述。结果是在过去12个月内由于费用问题推迟医疗护理或无力支付必要的医疗护理费用。在单变量分析中估计患病率，并在多变量分析中确定社会人口统计学预测因素。在5630270名自我报告患有HPB癌的美国成年人中，567531人（10.1%）由于费用问题推迟医疗护理，474632人（8.4%）在过去12个月内无力支付必要的医疗护理费用。未参保患者因费用问题更有可能推迟护理（调整后比值比[aOR]为14.38，95%置信区间[CI]为4.81 - 43.01）或无力支付必要的医疗护理费用（aOR为19.93，95% CI为6.45 - 61.55）。非白人种族（aOR为2.01，95% CI为1.06 - 3.81）是因费用问题推迟护理的一个风险因素，而家庭收入低于联邦贫困水平的200%（aOR为2.69，95% CI为1.20 - 6.04）与无力支付必要的医疗护理费用有关。在过去12个月内接受过手术的患者出现任何一种经济毒性结果的几率并不更高。有必要对高危患者采取针对性干预措施以减轻经济毒性，从而减轻HPB癌护理的经济负担。
