Narayan Aditya, Lapen Kaitlyn, Dee Edward Christopher, Thom Bridgette, Aviki Emeline M, Chino Fumiko
School of Medicine, Stanford University, Palo Alto, CA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
JCO Oncol Pract. 2025 Jul 11:OP2500218. doi: 10.1200/OP-25-00218.
Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.
From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.
Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; < .001), advanced disease (stage III [β, 1.33; < .001]; IV [β, 1.56; < .001]), recent treatment (β, 3.23; < .001), and anal (β, 1.97; = .003), esophageal (β, 1.66; = .005), or hepatobiliary cancer (β, 1.05; = .031). Older age (≥65 years [β, -5.17; < .001]), higher income ($100,000-$200,000 [β, -1.81; < .001]; >$200,000 [β, -3.80; < .001]), and private insurance (β, -1.70; < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; < .001), advanced disease (stage III [OR, 1.31; = .001]; IV [OR, 1.24; = .010]), recent treatment (OR, 1.20; = .001), and gastric cancer (OR, 1.25; = .027). Lower HRSR was associated with older age (OR, 0.59; < .001), higher income ($100,000-$200,000 [OR, 0.66; < .001]; >$200,000 [OR, 0.48; < .001]), and private insurance (OR, 0.64; < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; < .001) and reduced medication adherence (β, 0.11; < .001).
High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.
胃肠道癌症患者常面临严重的经济毒性（FT）和与健康相关的社会风险（HRSR），但筛查的最佳实践仍不明确。本研究旨在评估FT和HRSR的患病率，并确定相关因素。
2022年6月至2023年8月，使用经济毒性综合评分（COST）、患者报告的HRSR（如住房、粮食不安全）和生活质量（QOL）对患者进行筛查。采用多变量回归评估FT和HRSR的预测因素，并对多个变量进行调整。
在8335例胃肠道癌症患者中，45%的COST评分<26，表明存在经济毒性。在调整后的线性回归中，经济毒性与种族/族裔少数群体身份（β，4.20；P<0.001）、晚期疾病（III期[β，1.33；P<0.001]；IV期[β，1.56；P<0.001]）、近期治疗（β，3.23；P<0.001）以及肛管癌（β，1.97；P = 0.003）、食管癌（β，1.66；P = 0.005）或肝胆癌（β，1.05；P = 0.031）相关。年龄较大（≥65岁[β，-5.17；P<0.001]）、收入较高（100,000 - 200,000美元[β，-1.81；P<0.001]；>200,000美元[β，-3.80；P<0.001]）和拥有私人保险（β，-1.70；P<0.001）具有保护作用。28%的患者报告至少存在一项HRSR。HRSR与少数群体身份（比值比[OR]，2.14；P<0.001）、晚期疾病（III期[OR，1.31；P = 0.001]；IV期[OR，1.24；P = 0.010]）、近期治疗（OR，1.20；P = 0.001）和胃癌（OR，1.25；P = 0.027）相关。较低的HRSR与年龄较大（OR，0.59；P<0.001）、收入较高（1,00,000 - 200,000美元[OR，0.66；P<0.001]；>200,000美元[OR = 0.48；P<0.001]）和拥有私人保险（OR，0.64；P<0.001）相关。性别不是预测因素。最严重的经济毒性与生活质量下降（β，-0.98；P<0.001）和药物依从性降低（β，0.11；P<0.001）相关。
在胃肠道癌症患者中观察到高水平的经济毒性和HRSR。针对经济和社会负担的早期干预可能改善疾病和生存结局。
