Ciou Yi-Yun Claire, Chien Li-Nien
Institute of Health and Welfare Policy, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan.
Oncologist. 2025 Jun 4;30(6). doi: 10.1093/oncolo/oyaf140.
Extreme income or asset loss as severe form of financial hardship (FH) has been linked to worse survival outcomes in cancer patients. This study aimed to assess the incidence, risk factors, and impact of severe financial hardship (SFH) on survival among working-age cancer patients in Taiwan's universal healthcare system, using an objective measure for SFH.
This study analyzed linked national longitudinal data for patients aged 20-63 years diagnosed with cancer between 2007 and 2018. Severe financial hardship was defined as household net income falling below the poverty threshold post-diagnosis. Propensity score matching (1:4) was used to balance baseline characteristics between SFH and non-SFH groups. Cox proportional hazard models were used to estimate the hazard ratio (HR) of outcomes.
Among 400 229 working-age cancer patients, the incidence of SFH was 4.7 per 1000 person-years (95% confidence interval [CI], 4.6-4.9) over a mean follow-up of 5.7 ± 4.3 years. Severe financial hardship was associated with younger age, male sex, advanced stage, and intensive treatments. Patients with SFH within 1 year of diagnosis had significantly lower survival, with an adjusted HR of 1.64 (95% CI, 1.56-1.72) for all-cause mortality compared to those without SFH. Notably, early stage patients with SFH faced a higher relative mortality risk than advanced-stage patients.
Severe financial hardship substantially increases mortality among cancer patients in Taiwan, highlighting gaps in financial protection. Addressing SFH through implementing targeted policies and enhancing support mechanisms is essential to improve survival outcomes and reduce disparities in cancer care.
极端收入或资产损失作为严重形式的经济困难（FH），已与癌症患者较差的生存结果相关联。本研究旨在使用一种针对严重经济困难（SFH）的客观衡量方法，评估台湾全民医保体系中劳动年龄癌症患者的严重经济困难的发生率、风险因素及其对生存的影响。
本研究分析了2007年至2018年间确诊为癌症的20至63岁患者的全国纵向关联数据。严重经济困难定义为诊断后家庭净收入低于贫困线。采用倾向得分匹配（1:4）来平衡SFH组和非SFH组之间的基线特征。使用Cox比例风险模型估计结局的风险比（HR）。
在400229名劳动年龄癌症患者中，平均随访5.7±4.3年期间，SFH的发生率为每1000人年4.7例（95%置信区间[CI]，4.6 - 4.9）。严重经济困难与年龄较小、男性、晚期和强化治疗相关。诊断后1年内出现SFH的患者生存率显著较低，与无SFH的患者相比，全因死亡率调整后的HR为1.64（95%CI，1.56 - 1.72）。值得注意的是，早期患有SFH的患者面临的相对死亡风险高于晚期患者。
严重经济困难显著增加了台湾癌症患者的死亡率，凸显了经济保护方面的差距。通过实施针对性政策和加强支持机制来解决SFH对于改善生存结局和减少癌症护理方面的差距至关重要。
