Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study
Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study
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DOI：
10.1016/s2352-3026(15)00151-9
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发表时间：
2015-10-01
影响因子：
24.7
通讯作者：
Stadtmauer, Edward A.
中科院分区：
文献类型：
--
作者：
Huntington, Scott F.;Weiss, Brendan M.;Stadtmauer, Edward A.
背景在美国，人们越来越认识到财务毒性会对癌症患者的生活质量和用药依从性产生不利影响。多发性骨髓瘤患者可能由于新疗法的大量使用和治疗时间的延长而特别脆弱。方法2014年8月18日至2015年1月7日，我们在美国一家三级学术医学中心对接受至少3个月持续治疗的多发性骨髓瘤患者进行了横断面调查。这项调查是根据以前报道的研究得出的，包括11项成本衡量标准(金融毒性评分范围为0-44)。一份纸质调查提供给符合条件的患者到达后进行常规随访，参与者被要求在他们去诊所之前或之后完成调查。保险和治疗数据是从患者的电子健康记录中获得的。在111名参与研究的患者中，有100人完成了调查。在100名患者中，59名(59%)报告治疗费用高于预期，99名患者中有70名(71%)至少有轻微的经济负担，100名患者中有36名(36%)报告申请经济援助。使用储蓄来支付骨髓瘤治疗是很常见的(94名患者中有43名[46%])，98名患者中有21名(21%)借钱支付药物费用。费用得分与患者报告的应对骨髓瘤治疗费用的策略的使用高度相关。在多变量分析中，年龄较小(相关系数为0.36，95%可信区间为0.15至0.56，p=0.00092)、未婚(5.6、1.5至9.6，p=0.0074)、确诊时间较长(-4.8、-9.3至-0.2，p=0.042)和较低的家庭收入(美元40 000-79 999：7.8、2.7至12.9，p=0.0031；&>=8万美元：11.8、7.1至16.4，p=0.
Background Financial toxicity is increasingly recognised as adversely affecting the quality of life and medication adherence in patients with cancer in the USA. Patients with multiple myeloma might be particularly vulnerable because of high use of novel treatments and extended treatment duration.Methods Between Aug 18, 2014, and Jan 7, 2015, we did a cross-sectional survey of individuals receiving at least 3 months of ongoing treatment for multiple myeloma at a tertiary academic medical centre in the USA. The survey was derived from previous reported studies and included the 11-item COST measure (financial toxicity score range 0-44). A paper survey was offered to eligible patients on arrival for routine follow-up visits, and participants were asked to complete the survey before or after their visit to the clinic. Insurance and treatment data were obtained from patients' electronic health records.Findings Of 111 patients approached for the study, 100 individuals completed the survey. 59 (59%) of 100 patients reported that treatment costs were higher than expected, 70 (71%) of 99 had at least minor financial burden, and 36 (36%) of 100 reported applying for financial assistance. Use of savings to pay for myeloma treatment was common (43 [46%] of 94 patients) and 21 (21%) of 98 individuals borrowed money to pay for medications. COST scores were highly correlated with patient-reported use of strategies to cope with myeloma treatment expenses. On multivariable analysis, younger age (correlation coefficient beta 0.36, 95% CI 0.15 to 0.56, p=0.00092), non-married status (5.6, 1.5 to 9.6, p=0.0074), longer duration since diagnosis (-4.8, -9.3 to -0.2, p=0.042), and lower household income (US$40 000-79 999: 7.8, 2.7 to 12.9, p=0.0031; >=$80 000: 11.8, 7.1 to 16.4, p