Jin Ruiqi, Paul Sudeshna, Belcher Sarah M, Bai Jinbing, Graetz Ilana, Hunter Anthony M, Burns Emily J, Yeager Katherine A
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Support Care Cancer. 2025 Jun 5;33(7):542. doi: 10.1007/s00520-025-09618-z.
Patients diagnosed with chronic myeloid leukemia (CML) are at risk of developing financial toxicity (FT) due to the high cost of tyrosine kinase inhibitor (TKI) treatment and other cancer-related costs. This theory-based study evaluated relationships between risk factors, patients' behaviors, FT experience, and health outcomes among survivors of CML.
We collected cross-sectional survey data from 129 adults with CML prescribed a TKI from 10/2019 to 01/2024. Instruments included measures of FT, patients' behaviors related to FT (financial sacrifices, non-adherence, and debt or bankruptcy), and health outcomes (psychoneurological symptom cluster severity, health-related quality of life, and distress). Risk factors were collected via a sociodemographic questionnaire and researcher-abstracted medical record data. Structural equation modeling was used to test the adapted theoretical model of FT.
Participants were relatively young (mean ± standard deviation 49.7 ± 15.5, median 51, 19-84 years) and balanced in sex (49% female) and race (43% non-White); median time since diagnosis was 57 months. A higher level of FT was directly associated with adverse health outcomes (standardized coefficient = 0.33, P < .01), with patients' behaviors as mediators (mediating total effects = 0.62, P < .001). Risk factors, including lower education, lower income, non-private insurance, and being a racial minority, were positively associated with higher levels of FT (standardized coefficient = 0.51, P < .001).
Our findings support hypothesized pathways and help validate the theoretical model that contributes to understanding patients' FT experience. Further investigation is needed to explicate the longitudinal nature of FT, patients' behaviors, and outcomes to guide better methods of risk assessment and inform intervention development.
由于酪氨酸激酶抑制剂（TKI）治疗费用高昂以及其他与癌症相关的费用，被诊断为慢性粒细胞白血病（CML）的患者面临发生经济毒性（FT）的风险。这项基于理论的研究评估了CML幸存者的风险因素、患者行为、FT经历和健康结果之间的关系。
我们收集了2019年10月至2024年1月期间129名接受TKI治疗的成年CML患者的横断面调查数据。所使用的工具包括FT测量、患者与FT相关的行为（经济牺牲、不依从以及债务或破产）和健康结果（精神神经症状群严重程度、健康相关生活质量和痛苦程度）。通过社会人口学问卷和研究人员提取的病历数据收集风险因素。采用结构方程模型来检验FT的适应性理论模型。
参与者相对年轻（平均±标准差为49.7±15.5岁，中位数为51岁，年龄范围19 - 84岁），性别（49%为女性）和种族（43%为非白人）分布均衡；自诊断以来的中位时间为57个月。较高水平的FT与不良健康结果直接相关（标准化系数 = 0.33，P < 0.01），患者行为起中介作用（中介总效应 = 0.62，P < 0.001）。风险因素，包括低教育水平、低收入、非私人保险以及属于少数种族，与较高水平的FT呈正相关（标准化系数 = 0.51，P < 0.001）。
我们的研究结果支持了假设的途径，并有助于验证有助于理解患者FT经历的理论模型。需要进一步研究以阐明FT、患者行为和结果的纵向性质，以指导更好的风险评估方法并为干预措施的制定提供信息。
