Sibert N T, Breidenbach C, Benz S R, Post S, Seufferlein T, Ackermann C, Blossey R D, Böhm G, Brennfleck F, Bunse J, Dahlke M-H, Egetemeyer J, Elhabash S, Emmanouilidis N, Flemming S, Freitag B, Goetzky K, von Haeften E, Henschel M, Hollerbach S, Höppner J, Kim M, Klein C, Klinik C, Klump B, Köninger J, Lee L D-G, Mirow L, Ockenga J, Petzoldt S, Neumann P A, Piso P, Reißfelder C, Rickenberger A, Riechmann M, Rolinger J, Rosenberg R, Schilawa D, Schmidt J, Schnell M W, Steinemann D, Varga-Szabó D, Wahba R, Weyhe D, Willeke F, Wirth U, Wittel U, Zielinski C B, Kolb V, Kowalski C
Department of Health Services Research, German Cancer Society, Berlin, Germany; Oncological Health Services Research with a Focus on Digital Medicine, Department of Gynaecology and Obstetrics, CIO Aachen, Düsseldorf, Germany; University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Department of Health Services Research, German Cancer Society, Berlin, Germany.
ESMO Open. 2025 May;10(5):105078. doi: 10.1016/j.esmoop.2025.105078. Epub 2025 May 2.
The purpose of this study is to investigate self-reported financial difficulties (FDs) in patients with colorectal cancer (CRC) and to develop easy-to-implement models to predict FDs 1 year after initiation of CRC treatment.
In the prospective EDIUM cohort, CRC patients are asked to complete the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and QLQ-CR29 before (T0) and 1 year after initiation of treatment (T1). These patient-reported outcomes are combined with sociodemographic and clinical data. The QLQ-C30 'FD' item is firstly analysed descriptively, together with covariates. Logistic lasso regression was carried out to develop a predictive model (full model) of FDs at T1, and its predictive capacity was assessed. This predictive model was then simplified using easy-to-collect predictors which showed importance in the full model.
Of 9124 CRC patients enrolled between October 2018 and May 2023, 6061 completed follow-up questionnaires (T1). Of those initially without FDs (n = 4989), 25% (1248 patients) reported new FDs at T1. These patients were younger [median age 66 versus 72 years; odds ratio (OR) 2.81 (95% confidence interval [CI] 2.46-3.22)] and had a higher proportion of lower educational attainment [74% versus 69%; OR 1.32 (95% CI 1.14-1.54)]. Clinically, FDs were more frequently reported by patients with higher International Union Against Cancer (UICC) stages [48% in stages III/IV versus 32.5% in stages I/II; OR 1.98 (95% CI 1.74-2.26)] and rectal cancer [37% versus 28%; OR 1.52 (95% CI 1.32-1.73)]. The full model [based on a test and training dataset of n = 5910 patients, including 14 predictors, area under the curve (AUC) 0.75] was reduced to two simplified models with only the predictors age, sex (model 1, AUC 0.72)/localisation of tumour (model 2), and FDs at T0 (AUC = 0.74). On this basis, two risk assessment tables were developed.
A significant proportion of CRC patients report FDs 1 year after treatment initiation, particularly among socioeconomically disadvantaged groups. Together with the predictive models and two ready-to-use risk assessment tables, these findings can be utilised by clinicians and psychosocial counselling services to provide tailored support options.
本研究旨在调查结直肠癌（CRC）患者自我报告的经济困难（FDs）情况，并开发易于实施的模型来预测CRC治疗开始1年后的FDs。
在前瞻性EDIUM队列中，CRC患者被要求在治疗开始前（T0）和治疗开始1年后（T1）完成欧洲癌症研究与治疗组织（EORTC）生活质量问卷核心30（QLQ-C30）和QLQ-CR29。这些患者报告的结果与社会人口统计学和临床数据相结合。首先对QLQ-C30的“FD”项目进行描述性分析，并结合协变量。进行逻辑套索回归以建立T1期FDs的预测模型（完整模型），并评估其预测能力。然后使用在完整模型中显示出重要性的易于收集的预测因子对该预测模型进行简化。
在2018年10月至2023年5月期间纳入的9124例CRC患者中，6061例完成了随访问卷（T1）。在最初没有FDs的患者（n = 4989）中，25%（1248例患者）在T1期报告了新的FDs。这些患者更年轻[中位年龄66岁对72岁；优势比（OR）2.81（95%置信区间[CI] 2.46 - 3.22）]，且教育程度较低的比例更高[74%对69%；OR 1.32（95% CI 1.14 - 1.54）]。临床上，国际抗癌联盟（UICC）分期较高的患者[III/IV期为48%，I/II期为32.5%；OR 1.98（95% CI 1.74 - 2.26）]和直肠癌患者[37%对28%；OR 1.52（95% CI 1.32 - 1.73）]更常报告FDs。完整模型[基于n = 5910例患者的测试和训练数据集，包括14个预测因子，曲线下面积（AUC）0.75]简化为两个简化模型，仅包含预测因子年龄、性别（模型1，AUC 0.72）/肿瘤部位（模型2）以及T0期的FDs（AUC = 0.74）。在此基础上，制定了两个风险评估表。
相当一部分CRC患者在治疗开始1年后报告有FDs，尤其是在社会经济弱势群体中。连同预测模型和两个现成的风险评估表，临床医生和心理社会咨询服务机构可利用这些发现提供量身定制的支持方案。
