经济毒性:肿瘤分子靶向及免疫治疗时代不可忽视的问题
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摘要
随着分子靶向治疗及免疫治疗的蓬勃发展,经济毒性已经成为肿瘤治疗过程中不可忽视的副作用。已知导致经济毒性的相关危险因素包括了疾病本身的特性、患者的身体状况、年龄、种族、收入、医疗保险的类型等。经济毒性直接影响患者的预后,经济问题导致患者生活质量下降、护理质量下降、治疗依从性差、工作能力受损,从而进一步导致疾病恶化、收入来源不稳定,形成恶性循环并最终导致了不良预后甚至高死亡率。减少经济毒性的干预措施应该在多层面、多角度进行。今后亟待开展更多的相关研究来指导制定更有效的干预措施,从而降低肿瘤治疗过程中的经济毒性。
Much substantial evidence suggests that financial toxicity has become an issue in the era of molecular and immune therapy of cancer treatment. Some independent factors related to financial toxicity including illness status,patients' general health,age,race,income,health insurance. Financial problem can lead to lower quality of life,poor medical care,treatment nonadherence,impaired working ability and thus increase the mortality. Therefore,the interventions should be done in multiple levels and requires all parts of populaion involved. At the same time,we need more evidence-based research and statistics for guidance.
Much substantial evidence suggests that financial toxicity has become an issue in the era of molecular and immune therapy of cancer treatment. Some independent factors related to financial toxicity including illness status,patients' general health,age,race,income,health insurance. Financial problem can lead to lower quality of life,poor medical care,treatment nonadherence,impaired working ability and thus increase the mortality. Therefore,the interventions should be done in multiple levels and requires all parts of populaion involved. At the same time,we need more evidence-based research and statistics for guidance.
引文
[1] Zafar SY,Peppercorn JM,Schrag D,et al. The financial toxicity of cancer treatment:a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience[J]. Oncologist,2013,18(4):381-390.
[2] Zafar SY. Financial toxicity of cancer care:It's time to intervene[J/OL]. J Natl Cancer Inst,2016[2018-05-10]. https://academic.oup.com/jnci/article/108/5/djv370/2412415.
[3] Bradley CJ,Yabroff KR,Warren JL,et al. Trends in the treatment of metastatic colon and rectal cancer in elderly patients[J].Med Care,2016,54(5):490-497.
[4] Tran G,Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies[J]. Ann Transl Med,2018,6(9):166.
[5]田梦媛,崔丹,张欲晓,等. 3种抗肿瘤靶向药物的可负担性评价——以湖北省为例[J].中国药房,2017,28(20):2746
[6] de Souza JA,Yap BJ,Hlubocky FJ,et al. The development of a financial toxicity patient-reported outcome in cancer:The COST measure[J]. Cancer,2014,120(20):3245-3253.
[7] de Souza JA,Yap BJ,Wroblewski K,et al. Measuring financial toxicity as a clinically relevant patient-reported outcome:The validation of the comprehensive score for financial toxicity(COST)[J]. Cancer,2017,123(3):476-484.
[8]于慧会,毕雪,刘运泳.中文版癌症患者报告结局的经济毒性量表信度和效度研究[J].中华流行病学杂志,2017,38(8):1118-1120.
[9] PDQ Adult Treatment Editorial Board. Financial Toxicity and Cancer Treatment(PDQ):Health Professional Version[EB/OL].[2018-06-10]. https://www. ncbi. nlm. nih. gov/pubmed/27583328.
[10] Yabroff KR,Dowling EC,Guy GP Jr,et al. Financial hardship associated with cancer in the United States:Findings from a population-based sample of adult cancer survivors[J]. J Clin Oncol,2016,34(3):259-267.
[11] Pisu M,Kenzik KM,Oster RA,et al. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis:another long-term effect of cancer?[J]. Cancer,2015,121(8):1257-1264.
[12] Banegas MP,Guy GP Jr,de Moor JS,et al. For Working-age cancer survivors,medical debt and bankruptcy create financial hardships[J]. Health Aff(Millwood),2016,35(1):54-61.
[13]胡广宇,毛阿燕,董沛,等.北京地区六种癌症患者的诊疗情况和疾病经济负担分析[J].肿瘤防治研究,2015,42(2):171-176.
[14] Guy GP Jr,Ekwueme DU,Yabroff KR,et al. Economic burden of cancer survivorship among adults in the United States[J]. J Clin Oncol,2013,31(30):3749-3757.
[15]马桂峰,蔡伟芹,王培承,等.我国不同社会医疗保险参保群体卫生服务利用不平等研究[J].中国卫生经济,2017,36(12):28-31.
[16] Jagsi R,Pottow JA,Griffith KA,et al. Long-term financial burden of breast cancer:experiences of a diverse cohort of survivors identified through population-based registries[J]. J Clin Oncol,2014,32(12):1269-1276.
[17] Finkelstein EA,Tangka FK,Trogdon JG,et al. The personal financial burden of cancer for the working-aged population[J]. Am J Manag Care,2009,15(11):801-806.
[18]周海平,陈万青,周海英,等.癌症损失对家庭与区域经济的影响[J].中国卫生经济,2013,32(11):65-66.
[19] Shankaran V,Jolly S,Blough D,et al. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer:a population-based exploratory analysis[J]. J Clin Oncol,2012,30(14):1608-1614.
[20] Ramsey S,Blough D,Kirchhoff A,et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis[J]. Health Aff(Millwood),2013,32(6):1143-1152.
[21] Meeker CR,Geynisman DM,Egleston BL,et al. Relationships among financial distress,emotional distress,and overall distress in insured patients with cancer[J]. J Oncol Pract,2016,12(7):755-764.
[22] Sharp L,Carsin A,Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer[J]. Psychooncology,22(4):745-755.
[23] Kale HP,Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors[J]. Cancer,2016,122(8):283-289.
[24] Fenn KM,Evans SB,Mc Corkle R,et al. Impact of financial burden of cancer on survivors'quality of life[J]. J Oncol Pract,2014,10(5):332-338.
[25] Dusetzina SB,Winn AN,Abel GA,et al. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia[J]. J Clin Oncol,2014,32(4):306-311.
[26] Neugut AI,Subar M,Wilde ET,et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer[J]. J Clin Oncol,2011,29(18):2534-2542.
[27] Bestvina CM,Zullig LL,Rushing C,et al. Patient-oncologist cost communication,financial distress,and medication adherence[J].J Oncol Pract,2014,10(3):162-167.
[28] Streeter SB,Schwartzberg L,Husain N,et al. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions[J]. J Oncol Pract,2011,7(3 Suppl):46-51.
[29] Wong YN,Egleston BL,Sachedva K,et al. Cancer patients'trade-offs among efficacy,toxicity,and out-of-pocket cost in the curative and noncurative setting[J]. Med Care,2013,51(9):838-845.
[30]周蕾.大病医保与家庭灾难性医疗支出[J].经济师,2015,12(1):52-53.
[31] Meropol NJ,Schrag D,Smith TJ,et al. American Society of Clinical Oncology guidance statement:the cost of cancer care[J].J Clin Oncol,2009,27(23):3868-3874.
[2] Zafar SY. Financial toxicity of cancer care:It's time to intervene[J/OL]. J Natl Cancer Inst,2016[2018-05-10]. https://academic.oup.com/jnci/article/108/5/djv370/2412415.
[3] Bradley CJ,Yabroff KR,Warren JL,et al. Trends in the treatment of metastatic colon and rectal cancer in elderly patients[J].Med Care,2016,54(5):490-497.
[4] Tran G,Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies[J]. Ann Transl Med,2018,6(9):166.
[5]田梦媛,崔丹,张欲晓,等. 3种抗肿瘤靶向药物的可负担性评价——以湖北省为例[J].中国药房,2017,28(20):2746
[6] de Souza JA,Yap BJ,Hlubocky FJ,et al. The development of a financial toxicity patient-reported outcome in cancer:The COST measure[J]. Cancer,2014,120(20):3245-3253.
[7] de Souza JA,Yap BJ,Wroblewski K,et al. Measuring financial toxicity as a clinically relevant patient-reported outcome:The validation of the comprehensive score for financial toxicity(COST)[J]. Cancer,2017,123(3):476-484.
[8]于慧会,毕雪,刘运泳.中文版癌症患者报告结局的经济毒性量表信度和效度研究[J].中华流行病学杂志,2017,38(8):1118-1120.
[9] PDQ Adult Treatment Editorial Board. Financial Toxicity and Cancer Treatment(PDQ):Health Professional Version[EB/OL].[2018-06-10]. https://www. ncbi. nlm. nih. gov/pubmed/27583328.
[10] Yabroff KR,Dowling EC,Guy GP Jr,et al. Financial hardship associated with cancer in the United States:Findings from a population-based sample of adult cancer survivors[J]. J Clin Oncol,2016,34(3):259-267.
[11] Pisu M,Kenzik KM,Oster RA,et al. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis:another long-term effect of cancer?[J]. Cancer,2015,121(8):1257-1264.
[12] Banegas MP,Guy GP Jr,de Moor JS,et al. For Working-age cancer survivors,medical debt and bankruptcy create financial hardships[J]. Health Aff(Millwood),2016,35(1):54-61.
[13]胡广宇,毛阿燕,董沛,等.北京地区六种癌症患者的诊疗情况和疾病经济负担分析[J].肿瘤防治研究,2015,42(2):171-176.
[14] Guy GP Jr,Ekwueme DU,Yabroff KR,et al. Economic burden of cancer survivorship among adults in the United States[J]. J Clin Oncol,2013,31(30):3749-3757.
[15]马桂峰,蔡伟芹,王培承,等.我国不同社会医疗保险参保群体卫生服务利用不平等研究[J].中国卫生经济,2017,36(12):28-31.
[16] Jagsi R,Pottow JA,Griffith KA,et al. Long-term financial burden of breast cancer:experiences of a diverse cohort of survivors identified through population-based registries[J]. J Clin Oncol,2014,32(12):1269-1276.
[17] Finkelstein EA,Tangka FK,Trogdon JG,et al. The personal financial burden of cancer for the working-aged population[J]. Am J Manag Care,2009,15(11):801-806.
[18]周海平,陈万青,周海英,等.癌症损失对家庭与区域经济的影响[J].中国卫生经济,2013,32(11):65-66.
[19] Shankaran V,Jolly S,Blough D,et al. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer:a population-based exploratory analysis[J]. J Clin Oncol,2012,30(14):1608-1614.
[20] Ramsey S,Blough D,Kirchhoff A,et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis[J]. Health Aff(Millwood),2013,32(6):1143-1152.
[21] Meeker CR,Geynisman DM,Egleston BL,et al. Relationships among financial distress,emotional distress,and overall distress in insured patients with cancer[J]. J Oncol Pract,2016,12(7):755-764.
[22] Sharp L,Carsin A,Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer[J]. Psychooncology,22(4):745-755.
[23] Kale HP,Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors[J]. Cancer,2016,122(8):283-289.
[24] Fenn KM,Evans SB,Mc Corkle R,et al. Impact of financial burden of cancer on survivors'quality of life[J]. J Oncol Pract,2014,10(5):332-338.
[25] Dusetzina SB,Winn AN,Abel GA,et al. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia[J]. J Clin Oncol,2014,32(4):306-311.
[26] Neugut AI,Subar M,Wilde ET,et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer[J]. J Clin Oncol,2011,29(18):2534-2542.
[27] Bestvina CM,Zullig LL,Rushing C,et al. Patient-oncologist cost communication,financial distress,and medication adherence[J].J Oncol Pract,2014,10(3):162-167.
[28] Streeter SB,Schwartzberg L,Husain N,et al. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions[J]. J Oncol Pract,2011,7(3 Suppl):46-51.
[29] Wong YN,Egleston BL,Sachedva K,et al. Cancer patients'trade-offs among efficacy,toxicity,and out-of-pocket cost in the curative and noncurative setting[J]. Med Care,2013,51(9):838-845.
[30]周蕾.大病医保与家庭灾难性医疗支出[J].经济师,2015,12(1):52-53.
[31] Meropol NJ,Schrag D,Smith TJ,et al. American Society of Clinical Oncology guidance statement:the cost of cancer care[J].J Clin Oncol,2009,27(23):3868-3874.