Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Mối lo ngại về tài chính và căng thẳng tâm lý ở những người sống sót sau ung thư tại Hoa Kỳ, 2013—2018
Tóm tắt
Một tỷ lệ ngày càng tăng của những người sống sót sau ung thư phải trải qua tình trạng độc hại tài chính. Tuy nhiên, gánh nặng tâm lý từ chi phí liên quan đến ung thư và các kết quả sức khỏe tâm thần đi kèm cần được khảo sát thêm. Chúng tôi đã đánh giá sự phổ biến và các yếu tố dự đoán của mối lo ngại tài chính tự báo cáo và các kết quả sức khỏe tâm thần trong số những người sống sót sau ung thư. Dữ liệu từ cuộc Khảo sát Phỏng vấn Y tế Quốc gia (NHIS) năm 2013–2018 cho những người trưởng thành báo cáo chẩn đoán ung thư đã được sử dụng. Phân tích hồi quy logistic bội biến đã xác định tỷ lệ odds đã điều chỉnh (AOR) của việc báo cáo mối lo ngại tài chính theo các biến sociodemographic liên quan, và tỷ lệ phổ biến đã điều chỉnh theo trọng số mẫu của mối lo ngại tài chính được ước tính. Sự liên quan giữa mối lo ngại tài chính và căng thẳng tâm lý, được định nghĩa bởi Thang đo Căng thẳng Tâm lý Kessler sáu mục, cũng đã được đánh giá. Trong số 13.361 người tham gia khảo sát (tuổi trung vị 67; 60,0% nữ giới), có 9.567 người (71,6%) tự báo cáo mối lo ngại tài chính, bao gồm những lo ngại về chi phí cho việc thanh toán học phí đại học cho con cái (62,7%), duy trì mức sống của chính mình (59,7%), và chi phí y tế do bệnh tật hoặc tai nạn (58,3%). Giới tính nữ, độ tuổi trẻ hơn và chủng tộc người Mỹ gốc Á đều có liên quan đến việc gia tăng khả năng lo ngại tài chính (P < 0,05 cho tất cả). Trong số 13.218 người tham gia có câu trả lời đầy đủ cho các câu hỏi K6, 701 người (5,3%) đạt ngưỡng cho căng thẳng tâm lý nghiêm trọng. Các người tham gia xác nhận lo ngại tài chính có khả năng cao hơn vào việc gặp căng thẳng tâm lý (6,6% so với 1,2%, AOR 2,89, 95% CI 2,03–4,13, P< 0,001) với mỗi lo ngại bổ sung tăng khả năng gặp căng thẳng tâm lý lên 23,9%. Một phần lớn bệnh nhân sống sót sau ung thư báo cáo lo ngại tài chính, điều này có liên quan đến việc gia tăng khả năng báo cáo căng thẳng tâm lý. Cần có các chính sách và hướng dẫn để xác định và giảm thiểu mối lo ngại tài chính và căng thẳng tâm lý trong số bệnh nhân bị ung thư, với mục tiêu cải thiện phúc lợi tâm lý và chăm sóc bệnh nhân sống sót sau ung thư tổng thể.
Từ khóa
#sống sót sau ung thư #lo ngại tài chính #căng thẳng tâm lý #sức khỏe tâm thần #khảo sát y tế quốc gia #phân tích hồi quy logisticTài liệu tham khảo
de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, Nicholas LH, O'Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D (2017) Measuring financial toxicity as a clinically relevant patient-reported outcome: The validation of the COmprehensive Score for financial Toxicity (COST). Cancer. 123(3):476–484. https://doi.org/10.1002/cncr.30369
Valero-Elizondo J, Khera R, Saxena A, Grandhi GR, Virani SS, Butler J, Samad Z, Desai NR, Krumholz HM, Nasir K (2019) Financial Hardship From Medical Bills Among Nonelderly U.S. Adults With Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol 73(6):727–732. https://doi.org/10.1016/j.jacc.2018.12.004
Nipp RD, Shui AM, Perez GK, Kirchhoff AC, Peppercorn JM, Moy B, Kuhlthau K, Park ER (2018) Patterns in health care access and affordability among cancer survivors during implementation of the affordable care act. JAMA Oncol 4(6):791–797. https://doi.org/10.1001/jamaoncol.2018.0097
Nipp RD, Kirchhoff AC, Fair D, Rabin J, Hyland KA, Kuhlthau K, Perez GK, Robison LL, Armstrong GT, Nathan PC, Oeffinger KC, Leisenring WM, Park ER (2017) Financial burden in survivors of childhood cancer: A report from the childhood cancer survivor study. J Clin Oncol 35(30):3474–3481. https://doi.org/10.1200/JCO.2016.71.7066
Dusetzina SB (2016) Drug pricing trends for orally administered anticancer medications reimbursed by commercial health plans, 2000-2014. JAMA Oncol 2(7):960–961. https://doi.org/10.1001/jamaoncol.2016.0648
Meropol NJ, Schrag D, Smith TJ, Mulvey TM, Langdon RM Jr, Blum D, Ubel PA, Schnipper LE, American Society of Clinical Oncology (2009) American Society of Clinical Oncology guidance statement: The cost of cancer care. J Clin Oncol 27(23):3868–3874. https://doi.org/10.1200/JCO.2009.23.1183
Himmelstein DU, Warren E, Thorne D, Woolhandler S (2005) Illness and injury as contributors to bankruptcy. Health Aff (Millwood) Suppl Web
Knight TG, Deal AM, Dusetzina SB, Muss HB, Choi SK, Bensen JT, Williams GR (2018) Financial toxicity in adults with cancer: adverse outcomes and noncompliance. J Oncol Pract 14(11):e665–e673. https://doi.org/10.1200/jop.18.00120
Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist. 18(4):381–390. https://doi.org/10.1634/theoncologist.2012-0279
Kale HP, Carroll NV (2016) Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer. 122(8):1283–1289. https://doi.org/10.1002/cncr.29808
Piette JD, Heisler M, Wagner TH (2004) Cost-related medication underuse among chronically ill adults: The treatments people forgo, how often, and who is at risk. Am J Public Health 94(10):1782–1787. https://doi.org/10.2105/AJPH.94.10.1782
Aizer AA, Falit B, Mendu ML, Chen MH, Choueiri TK, Hoffman KE, Hu JC, Martin NE, Trinh QD, Alexander BM, Nguyen PL (2014) Cancer-specific outcomes among young adults without health insurance. J Clin Oncol 32(19):2025–2030. https://doi.org/10.1200/JCO.2013.54.2555
Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: A population-based exploratory analysis. J Clin Oncol 30(14):1608–1614. https://doi.org/10.1200/JCO.2011.37.9511
ASCO. National Survey Reveals Surprising Number of Americans Believe Alternative Therapies Can Cure Cancer. Published 2018. Accessed August 3, 2019. https://www.asco.org/about-asco/press-center/news-releases/national-survey-reveals-surprising-number-americans-believe
Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: A systematic literature review. Psychooncology. Published online 2020. https://doi.org/10.1002/pon.5516
Centers for Disease Control and Prevention. National Health Interview Survey: Methods. Accessed July 24, 2019. http://www.cdc.gov/nchs/nhis/methods.htm
StataCorp (2013) Stata Multilevel Mixed-Effects Reference Manual: Release 13
IPUMS. IPUMS Health Surveys: Sample Person Weight. IPUMS Health Surveys. Accessed December 19, 2020. https://nhis.ipums.org/nhis-action/variables/SAMPWEIGHT#description_section
Ruggles S, Flood S, Goeken R, et al (2019) IPUMS USA: Version 9.0 [Dataset]. https://doi.org/10.18128/D010.V9.0
Sanford NN, Lam MB, Butler SS, et al Self-reported Reasons and Patterns of Noninsurance among Cancer Survivors before and after Implementation of the Affordable Care Act, 2000-2017. JAMA Oncol. Published online 2019. https://doi.org/10.1001/jamaoncol.2019.1973
Prochaska JJ, Sung HY, Max W, Shi Y, Ong M (2012) Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization. Int J Methods Psychiatr Res 21(2):88–97. https://doi.org/10.1002/mpr.1349
Kessler RC, Barker PR, Colpe LJ, Epstein JF, Gfroerer JC, Hiripi E, Howes MJ, Normand SLT, Manderscheid RW, Walters EE, Zaslavsky AM (2003) Screening for serious mental illness in the general population. Arch Gen Psychiatry 60(2):184–189. https://doi.org/10.1001/archpsyc.60.2.184
Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC (2010) Improving the K6 short scale to predict serious emotional disturbance in adolescents in the USA. Int J Methods Psychiatr Res 19(SUPPL. 1):23–35. https://doi.org/10.1002/mpr.314
Kaiser NC, Hartoonian N, Owen JE (2010) Toward a cancer-specific model of psychological distress: Population data from the 2003-2005 National Health Interview Surveys. J Cancer Surviv 4(4):291–302. https://doi.org/10.1007/s11764-010-0120-3
Mitchell CM, Beals J (2011) The Utility of the Kessler Screening Scale for Psychological Distress (K6) in Two American Indian Communities. Psychol Assess 23(3):752–761. https://doi.org/10.1037/a0023288
Pirraglia PA, Hampton JM, Rosen AB, Witt WP (2011) Psychological distress and trends in healthcare expenditures and outpatient healthcare. Am J Manag Care 17(5):319–328
Chan CMH, Wong JE, Yeap LLL, Wee LH, Jamil NA, Swarna Nantha Y (2019) Workplace bullying and psychological distress of employees across socioeconomic strata: A cross-sectional study. BMC Public Health 19:608. https://doi.org/10.1186/s12889-019-6859-1
Hoffman KE, McCarthy EP, Recklitis CJ, Ng AK (2009) Psychological distress in long-term survivors of adult-onset cancer: Results from a national survey. Arch Intern Med 169(14):1274–1281. https://doi.org/10.1001/archinternmed.2009.179
Dean LT, Moss SL, Ransome Y, et al “It still affects our economic situation”: long-term economic burden of breast cancer and lymphedema. Support Care Cancer. Published online 2019. https://doi.org/10.1007/s00520-018-4418-4
Lim JW, Ashing-Giwa KT (2011) Examining the effect of minority status and neighborhood characteristics on cervical cancer survival outcomes. Gynecol Oncol 121(1):87–93. https://doi.org/10.1016/j.ygyno.2010.11.041
Jagsi R, Ward KC, Abrahamse PH, Wallner LP, Kurian AW, Hamilton AS, Katz SJ, Hawley ST (2018) Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer. 124(18):3668–3676. https://doi.org/10.1002/cncr.31532
Yabroff KR, Dowling EC, Guy GP et al (2016) Financial hardship associated with cancer in the United States: Findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267. https://doi.org/10.1200/JCO.2015.62.0468
Zheng Z, Jemal A, Han X, Guy GP Jr, Li C, Davidoff AJ, Banegas MP, Ekwueme DU, Yabroff KR (2019) Medical financial hardship among cancer survivors in the United States. Cancer. 125(10):1737–1747. https://doi.org/10.1002/cncr.31913
Jagsi R, Pottow JAE, Griffith KA, Bradley C, Hamilton AS, Graff J, Katz SJ, Hawley ST (2014) Long-term financial burden of breast cancer: Experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 32(12):1269–1276. https://doi.org/10.1200/JCO.2013.53.0956
Guy GP, Ekwueme DU, Yabroff KR et al (2013) Economic burden of cancer survivorship among adults in the United States. J Clin Oncol 31(30):3749–3757. https://doi.org/10.1200/JCO.2013.49.1241
Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, Newcomb P, Hollingworth W, Overstreet K (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff 32(6):1143–1152. https://doi.org/10.1377/hlthaff.2012.1263
Lauzier S, Maunsell E, Drolet M, Coyle D, Hebert-Croteau N, Brisson J, Masse B, Abdous B, Robidoux A, Robert J (2008) Wage losses in the year after breast cancer: Extent and determinants among Canadian women. J Natl Cancer Inst 100(5):321–332. https://doi.org/10.1093/jnci/djn028
Kinney ED, Kinney ED (2013) Health Insurance Coverage in the United States. In: Protecting American Health Care Consumers. pp 23–40. https://doi.org/10.1215/9780822383536-003
Morrow PK, Broxson AC, Munsell MF et al (2014) Effect of age and race on quality of life in young breast cancer survivors. Clin Breast Cancer 14(2). https://doi.org/10.1016/j.clbc.2013.10.003
Ramirez AG, Chalela P, Gallion KJ et al (2015) Attitudes Toward Breast Cancer Genetic Testing in Five Special Population Groups. J Health Dispar Res Pract 8(4):124–135 http://www.ncbi.nlm.nih.gov/pubmed/26855846/; http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4739821
Ho SMY, Ho JWC, Chan CLW, Kwan K, Tsui YKY. Decisional consideration of hereditary colon cancer genetic test results among Hong Kong Chinese adults. Cancer Epidemiol Biomarkers Prev. Published online 2003
Glanz K, Grove J, Lerman C, Gotay C, Le Marchand L. Correlates of intentions to obtain genetic counseling and colorectal cancer gene testing among at-risk relatives from three ethnic groups. Cancer Epidemiol Biomarkers Prev. Published online 1999
Oh KM, Taylor KL, Jacobsen KH (2017) Breast Cancer Screening Among Korean Americans: A Systematic Review. J Community Health 42(2):324–332. https://doi.org/10.1007/s10900-016-0258-7
Ashing KT, Padilla G, Tejero J, Kagawa-Singer M Understanding the breast cancer experience of Asian American women. Psychooncology. Published online 2003. https://doi.org/10.1002/pon.632
Wen KY, Fang CY, Ma GX. Breast cancer experience and survivorship among Asian Americans: A systematic review. J Cancer Surviv. Published online 2014. https://doi.org/10.1007/s11764-013-0320-8
Thompson CA, Gomez SL, Hastings KG, Kapphahn K, Yu P, Shariff-Marco S, Bhatt AS, Wakelee HA, Patel MI, Cullen MR, Palaniappan LP (2016) The burden of cancer in Asian Americans: A report of national mortality trends by asian ethnicity. Cancer Epidemiol Biomark Prev 25(10):1371–1382. https://doi.org/10.1158/1055-9965.EPI-16-0167
Trinh QD, Nguyen PL, Leow JJ et al (2015) Cancer-specific mortality of asian americans diagnosed with cancer: A nationwide population-based assessment. J Natl Cancer Inst 107(6). https://doi.org/10.1093/jnci/djv054
Secretan B, Straif K, Baan R, Grosse Y, el Ghissassi F, Bouvard V, Benbrahim-Tallaa L, Guha N, Freeman C, Galichet L, Cogliano V, WHO International Agency for Research on Cancer Monograph Working Group (2009) A review of human carcinogens—Part E: tobacco, areca nut, alcohol, coal smoke, and salted fish. Lancet Oncol 10(11):1033–1034. https://doi.org/10.1016/s1470-2045(09)70326-2
Yi JC, Syrjala KL (2017) Anxiety and Depression in Cancer Survivors. Med Clin North Am 101(6):1099–1113. https://doi.org/10.1016/j.mcna.2017.06.005
Bullock AJ, Hofstatter EW, Yushak ML, Buss MK (2012) Understanding Patients’ Attitudes Toward Communication About the Cost of Cancer Care. J Oncol Pract 8(4):e50–e58. https://doi.org/10.1200/jop.2011.000418
Shih YCT, Chien CR (2017) A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment. Cancer. 123(6):928–939. https://doi.org/10.1002/cncr.30423
Altomare I, Irwin B, Zafar SY, Houck K, Maloney B, Greenup R, Peppercorn J, Altomare I, Irwin B, Zafar SY, Houck K, Maloney B, Greenup R, Peppercorn J (2016) ReCAP: Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care. J Oncol Pract 12(3):247–248. https://doi.org/10.1200/jop.2015.007401
Schrag D, Hanger M (2007) Medical oncologists’ views on communicating with patients about chemotherapy costs: A pilot survey. J Clin Oncol 25(2):233–237. https://doi.org/10.1200/JCO.2006.09.2437
Kelly RJ, Forde PM, Elnahal SM, Forastiere AA, Rosner GL, Smith TJ (2015) Patients and Physicians Can Discuss Costs of Cancer Treatment in the Clinic. J Oncol Pract 11(4):308–312. https://doi.org/10.1200/jop.2015.003780
Shankaran V, Leahy T, Steelquist J, Watabayashi K, Linden H, Ramsey S, Schwartz N, Kreizenbeck K, Nelson J, Balch A, Singleton E, Gallagher K, Overstreet K Pilot feasibility study of an oncology financial navigation program. J Oncol Pract. Published online 2018. https://doi.org/10.1200/JOP.2017.024927
Kessler RC, Green JG, Gruber MJ, Sampson NA, Bromet E, Cuitan M, Furukawa TA, Gureje O, Hinkov H, Hu CY, Lara C, Lee S, Mneimneh Z, Myer L, Oakley-Browne M, Posada-Villa J, Sagar R, Viana MC, Zaslavsky AM (2010) Screening for serious mental illness in the general population with the K6 screening scale: Results from the WHO World Mental Health (WMH) survey initiative. Int J Methods Psychiatr Res 19(SUPPL. 1):4–22. https://doi.org/10.1002/mpr.310