Social Determinants of Health and Symptom Burden During Cancer Treatment.
Social Determinants of Health and Symptom Burden During Cancer Treatment.
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癌症治疗期间健康和症状负担的社会决定因素。
DOI：
10.1097/nnr.0000000000000636
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发表时间：
2023
期刊：
影响因子：
2.5
通讯作者：
Sikorskii,Alla
中科院分区：
文献类型：
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作者：
Badger,TerryA;Segrin,Chris;Crane,TracyE;Chalasani,Pavani;Arslan,Waqas;Hadeed,Mary;Sikorskii,Alla
背景癌症幸存者（定义为从诊断到生命结束的个体）在治疗中经历多种身体和心理症状（例如疲劳、疼痛、抑郁、焦虑、睡眠障碍），这些症状影响他们的健康和治疗结果。代表性不足的癌症幸存者可能会不成比例地经历更大的症状负担本研究的目的是探讨健康的社会决定因素，包括年龄，种族，教育，收入和收入是否满足幸存者的需要，邻里关系，（农村与城市），获得保健的机会（例如，保险），和社会隔离，方法二次分析包括400例接受化疗或靶向治疗的实体瘤癌症幸存者的基线数据，参与了一项更大规模的症状管理干预随机试验。症状负担通过流行病学中心抑郁量表（抑郁）和患者报告结局测量信息系统（焦虑和社会隔离）评分、一般症状困扰量表（General Symptom Distress Scale）中16种症状的严重程度指数总和以及症状总数进行测量。使用Bayliss工具测量自我报告的共病状况。一般线性模型用于将症状测量（一次一个）与年龄、共病情况的数量、教育水平、婚姻状况、满足需求的收入和大都市社区的大小相关联。额外的协变量包括癌症的部位，其治疗，以及癌症是否是metabolic.ResultsNon-Hispanic白色幸存者（n= 191）年龄较大，并有更多的共病条件，转移性癌症的比例较高，和较高的教育和收入水平相比，西班牙裔幸存者（n= 168）和其他种族的非西班牙裔幸存者（n= 41）。与其他两组相比，西班牙裔幸存者的医疗保险可获得率最低，其他种族的非西班牙裔幸存者的社会隔离程度最低。年龄、合并症的数量和社会隔离与症状数量、症状严重程度和抑郁症显著相关。年龄和社会孤立与焦虑有关。此外，非西班牙裔白色幸存者的症状严重程度低于西班牙裔的幸存者和其他race.DiscussionThese研究结果强调癌症幸存者中经历的症状负担的健康差异时，考虑他们的健康的社会决定因素。评估这些可能有助于临床医生解决癌症护理中的健康差异。
BackgroundCancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (eg, fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety).ObjectivesThe aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (eg, insurance), and social isolation, with symptom burden in cancer survivors.MethodsThis secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies–Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic.ResultsNon-Hispanic White survivors (n= 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors (n= 168) and non-Hispanic survivors of other races (n= 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races.DiscussionThese findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.