Guidry J J, Aday L A, Zhang D, Winn R J
Department of Health and Kinesiology, Texas A&M University, College Station 77843, USA.
Cancer Pract. 1998 May-Jun;6(3):182-7. doi: 10.1046/j.1523-5394.1998.006003182.x.
An analytical cross-sectional survey was conducted to determine the prevalence of barriers to cancer treatment in Texas as perceived by diagnosed cancer patients. Results reported here address the role of insurance coverage, indirect costs (transportation, lodging, and work days lost), and direct costs of care as barriers to treatment for white, black, and Hispanic cancer patients. Specific objectives of the analyses undertaken here are to examine 1) racial/ethnic differences in insurance coverage; 2) barriers relating to insurance coverage experienced by cancer patients; and 3) role of treatment-related costs as barriers to cancer treatment.
A mail questionnaire was developed to assess the perceived barriers to cancer treatment in Texas for adult cancer patients, 17 years and older, who had been diagnosed with breast, colon, cervical, prostate, or lymphoma during the period of 1989 to 1993. The sampling frame for this study was obtained from a network of cancer treatment facilities throughout the state of Texas within the University of Texas M.D. Anderson Cancer Center Texas Community Oncology Network. A total of 593 cancer patients returned their surveys, yielding a 65.2% response rate. Weighting adjustments were then made to correct for differential sampling and response rates by racial groupings and type of cancer. All of the analyses used adjusted weights.
The findings document the financial considerations (insurance, direct and indirect costs) as they relate to barriers to cancer treatment. Specific insurance premium-related barriers with regard to maintaining and affording coverage were more prevalent for blacks. Hispanics were less likely to have insurance coverage; however, more blacks reported being denied insurance coverage when they changed jobs compared with whites and Hispanics. Minorities, particularly Hispanics, were more likely to have experienced cost-related barriers associated with medications, diagnostic tests, and hospitalizations. In addition, Hispanics experienced significant out-of-pocket costs in paying for cancer treatment.
This research shows the need for staff at cancer treatment facilities to be aware that there are nonclinical, financial factors that are important considerations in the treatment of cancer patients. Assessment of cancer patients during the diagnostic and treatment stages, possibly through case management, will provide information on potential barriers to treatment for individual patients. Hospital programs that reimburse out-of-pocket costs, transportation costs to obtain services, and lodging accommodations may be available. Additional services may be offered through cancer advocacy groups, such as the American Cancer Society and the National Coalition for Cancer Survivors, to assist patients with managing costs and overcoming barriers to care.
开展一项分析性横断面调查，以确定德克萨斯州确诊癌症患者所感知的癌症治疗障碍的患病率。此处报告的结果涉及保险覆盖范围、间接成本（交通、住宿和误工天数）以及护理直接成本对白人、黑人和西班牙裔癌症患者治疗的阻碍作用。此处进行分析的具体目标是检验：1）保险覆盖范围的种族/族裔差异；2）癌症患者所经历的与保险覆盖范围相关的障碍；3）治疗相关成本作为癌症治疗障碍的作用。
设计了一份邮寄调查问卷，以评估1989年至1993年期间被诊断患有乳腺癌、结肠癌、宫颈癌、前列腺癌或淋巴瘤的17岁及以上成年癌症患者对德克萨斯州癌症治疗障碍的感知。本研究的抽样框架来自德克萨斯大学MD安德森癌症中心德克萨斯社区肿瘤网络内遍布该州的癌症治疗设施网络。共有593名癌症患者回复了调查问卷，回复率为65.2%。然后进行加权调整，以校正按种族分组和癌症类型的差异抽样和回复率。所有分析均使用调整后的权重。
研究结果记录了与癌症治疗障碍相关的财务考量因素（保险、直接和间接成本）。与维持和负担保险覆盖范围相关的特定保险费相关障碍在黑人中更为普遍。西班牙裔拥有保险覆盖范围的可能性较小；然而，与白人和西班牙裔相比，更多黑人报告在换工作时被拒绝承保。少数族裔，尤其是西班牙裔，更有可能经历与药物、诊断测试和住院相关的成本相关障碍。此外，西班牙裔在支付癌症治疗费用方面承担了大量自付费用。
本研究表明，癌症治疗机构的工作人员需要意识到，存在非临床的财务因素是治疗癌症患者时的重要考量因素。在诊断和治疗阶段对癌症患者进行评估，可能通过病例管理进行，将为个体患者提供有关潜在治疗障碍的信息。可能有医院项目报销自付费用、获取服务的交通费用和住宿费用。癌症倡导组织，如美国癌症协会和全国癌症幸存者联盟，可能会提供额外服务，以帮助患者管理费用并克服护理障碍。
