Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System
Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System
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DOI：
10.1016/j.cllc.2018.12.010
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发表时间：
2019-07-01
影响因子：
3.6
通讯作者：
Leighl, Natasha B.
中科院分区：
文献类型：
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作者：
Ezeife, Doreen A.;Morrstein, Brandon Josh;Leighl, Natasha B.
随着癌症治疗费用的增加，本研究探讨了公共卫生保健系统中与经济负担（FB）相关的因素。200名肺癌患者完成了调查问卷，检查癌症治疗的FB。结果显示，年龄小于65岁，自付费用高，没有私人保险的患者报告的FB显著较高。社会支持和财政援助计划应针对这些弱势patient population.Introduction：财务困境已被确立为一个临床相关的患者报告的结果与更糟糕的死亡率和生活质量。我们的目标是确定公共卫生保健系统中与财政负担（FB）相关的因素。材料与方法：从Princess Margaret Cancer Centre（多伦多，加拿大）的门诊招募晚期肺癌患者。FB是用经过验证的财务毒性综合评分（COST）工具测量的，这是一项12项调查，得分从0到44，得分越低，反映财务状况越差。收集了患者和治疗特征、总自付费用（OOP）和私人保险覆盖范围的数据。多变量logistic回归模型拟合COST评分和每个变量，以确定与较大FB（COST <21）相关的因素。结果：在251例患者中，200例（80%）参与。队列的中位年龄为65岁; 56%为女性。总OOP中位数介于1000加元和5000加元之间。中位COST评分为21（范围，0 - 44）。FB与年龄相关，<65岁的患者报告的FB高于老年患者（COST，18.0 vs. 24.0; P <.0001）。在多变量逻辑回归分析中，当调整收入、就业状况、OOP和私人保险范围时，年龄越小，FB越大（优势比，3.6; 95%置信区间，1.5 - 9.1; P <.0001）。结论：在加拿大（安大略）公共卫生保健系统中，年龄与FB显著相关，年轻肺癌患者报告的经济困难更大。本研究强调了应定期评估FB并提供适当支持资源的优先患者人群。
With increasing costs of cancer treatment, this study examined factors associated with financial burden (FB) in a public health care system. Two hundred patients with lung cancer completed questionnaires examining the FB of cancer treatment. Results showed that patients younger than 65 years, with high out-of-pocket costs, and with no private insurance reported significantly higher FB. Social support and financial assistance programs should target these vulnerable patient populations.Introduction: Financial distress has been established as a clinically relevant patient-reported outcome associated with worse mortality and quality of life. Our goal was to define factors associated with financial burden (FB) in a public health care system. Materials and Methods: Patients with advanced lung cancer were recruited from outpatient clinics at the Princess Margaret Cancer Centre (Toronto, Canada). FB was measured with the validated Comprehensive Score for Financial Toxicity (COST) instrument, a 12-item survey scored from 0 to 44, with lower scores reflecting worse financial well-being. Data on patient and treatment characteristics, total out-of-pocket costs (OOP), and private insurance coverage were collected. Multivariable logistic regression models were fit for COST score and each variable, to determine factors associated with greater FB (COST < 21). Results: Of 251 patients approached, 200 (80%) participated. The median age of the cohort was 65 years; 56% were female. The median total OOP ranged between $1000 and $5000 CAD. The median COST score was 21 (range, 0-44). FB was associated with age, with patients < 65 years reporting greater FB than older patients (COST, 18.0 vs. 24.0; P < .0001). In multivariable logistic regression analysis, younger age was associated with greater FB, when adjusting for income, employment status, OOP, and private insurance coverage (odds ratio, 3.6; 95% confidence interval, 1.5-9.1; P < .0001). Conclusion: Age is significantly associated with FB in the Canadian (Ontario) public health care system, with younger patients with lung cancer reporting greater financial distress. This study highlights priority patient populations where FB should be routinely assessed and appropriate resources for support offered.