Construction of financial toxicity early warning model for breast cancer patients undergoing daytime chemotherapy under diagnosis intervention packet_West China Medical Journal

Authors：

 SUN Bei ¹ , WANG Yang ² , SUN Yingming ² , LI Mengqi ² , SUN Hui ³

1. Outpatient Department, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P. R. China;
2. Day-care Ward, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P. R. China;
3. National Health Commission Hospital Management Institute, Beijing 100044, P. R. China;

Corresponding author：

SUN Bei, Email: sunpei003@sina.com

Keywords：

Breast cancer; financial toxicity; diagnosis intervention packet; daytime chemotherapy; early warning model construction

DOI：

10.7507/1002-0179.202209105

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Objective To explore the current situation of financial toxicity (FT) of breast cancer patients undergoing daytime chemotherapy under the background of diagnosis intervention packet (DIP) and its influencing factors, and to build a risk early warning model.Methods Convenient sampling method was used to select breast cancer patients undergoing chemotherapy in the daytime ward of Tianjin Medical University Cancer Institute & Hospital between April and May 2022. The general data questionnaire and FT comprehensive score scale were used to investigate them, and the influencing factors of patients’ FT were discussed through single factor analysis and logistic regression analysis, and the risk early warning model was established. Hosmer-Lemeshow fitting effect test was used to evaluate the prediction effect of the model.Results A total of 278 patients were included. The median (lower quartile, upper quartile) of FT score was 14.00 (8.75, 23.00), of which 195 patients (70.14%) had FT score≤22; 83 patients (29.86%) had FT scores>22. Logistic regression analysis showed that age, per capita monthly income of families, commercial health insurance, chemotherapy cycle, tumor stage, neoadjuvant chemotherapy were the influencing factors for high-risk FT of breast cancer patients undergoing daytime chemotherapy. The results of Hosmer-Lemeshow goodness of fit test showed that the model-predicted FT of breast cancer patients undergoing daytime chemotherapy was in good agreement with the actual observation value (χ²=10.685, P=0.220). The area under the curve of the model was 0.931 [95% confidence interval (0.900, 0.962)], the sensitivity was 0.807, and the specificity was 0.913.Conclusions The FT of breast cancer patients undergoing daytime chemotherapy is at a high level. Older age, purchase of commercial health insurance, and high per capita monthly income of families are protective factors for high-risk FT. The wind with chemotherapy cycle≤4 weeks, tumor stage Ⅱ, neoadjuvant chemotherapy are high-risk FT risk factors. The final warning model has been tested to have a good prediction effect, which can provide a reference for clinical medical staff to identify high-risk FT patients early and make preventive strategies as soon as possible.

Citation： SUN Bei, WANG Yang, SUN Yingming, LI Mengqi, SUN Hui. Construction of financial toxicity early warning model for breast cancer patients undergoing daytime chemotherapy under diagnosis intervention packet. West China Medical Journal, 2023, 38(2): 226-232. doi: 10.7507/1002-0179.202209105 Copy

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2.	Xu TT, Wu J. Financial toxicity of cancer in China. J Cancer Policy, 2018, 15(7): 96-99.
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13.	de Souza JA, Yap BJ, Hlubocky FJ, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer, 2014, 120(20): 3245-3253.
14.	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. 中华流行病学杂志, 2017, 38(8): 1118-1120.
15.	袁潇逸, 孙艳玲, 况艺, 等. 乳腺癌生存者经济毒性现状及其对生活质量的影响研究. 护士进修杂志, 2022, 37(23): 2113-2118.
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17.	Chan RJ, Gordon LG, Tan CJ, et al. Relationships between financial toxicity and symptom burden in cancer survivors: a systematic review. J Pain Symptom Manage, 2019, 57(3): 646-660.e1.
18.	Jing J, Feng R, Zhang X, et al. Financial toxicity and its associated patient and cancer factors among women with breast cancer: a single-center analysis of low-middle income region in China. Breast Cancer Res Treat, 2020, 181(2): 435-443.
19.	Moore AM, Gamblin TC, Geller DA, et al. A prospective study of posttraumatic growth as assessed by self-report and family caregiver in the context of advanced cancer. Psychooncology, 2011, 20(5): 479-487.
20.	Honda K, Gyawali B, Ando M, et al. Prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol, 2019, 5: 1-8.
21.	Blinder V, Eberle C, Patil S, et al. Women with breast cancer who work for accommodating employers more likely to retain jobs after treatment. Health Aff (Millwood), 2017, 36(2): 274-281.
22.	Zhu Z, Xing W, Zhang X, et al. Cancer survivors' experiences with financial toxicity: a systematic review and meta-synthesis of qualitative studies. Psychooncology, 2020, 29(6): 945-959.
23.	Pauge S, Surmann B, Mehlis K, et al. Patient-reported financial distress in cancer: a systematic review of risk factors in universal healthcare systems. Cancers (Basel), 2021, 13(19): 5015.
24.	周德水, 党思琪. 商业健康保险对居民健康的影响—来自 CGSS 数据的经验证据. 中国卫生政策研究, 2021, 14(8): 8-15.
25.	Thom B, Benedict C, Friedman DN, et al. The intersection of financial toxicity and family building in young adult cancer survivors. Cancer, 2018, 124(16): 3284-3289.
26.	Gordon LG, Merollini KMD, Lowe A, et al. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient, 2017, 10(3): 295-309.
27.	Su TT, Azzani M, Tan FL, et al. Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia. Support Care Cancer, 2018, 26(5): 1617-1624.
28.	Huang HY, Shi JF, Guo LW, et al. Expenditure and financial burden for common cancers in China: a hospital-based multicentre cross-sectional study. LANCET, 2016, 388(Suppl 1): S10.
29.	何伟丽, 练会招, 翟贺宁, 等. 乳腺癌患者新辅助化疗效果. 中国老年学杂志, 2022, 42(7): 1598-1601.
30.	景静凤. 非转移性乳腺癌患者经济毒性调查及影响因素分析. 太原: 山西医科大学, 2020.

1. World Health Organization. The online globocan 2020 database. (2021-02-28)[2021-05-12].https://www.iarc.who.int/faq/latest-global-cancer-data-2020-qa/.
2. Xu TT, Wu J. Financial toxicity of cancer in China. J Cancer Policy, 2018, 15(7): 96-99.
3. Krieger N, Bassett MT, Gomez SL. Breast and cervical cancer in 187 countries between 1980 and 2010. Lancet, 2012, 379(9824): 1391-1392.
4. Xia J, Tang Z, Deng Q, et al. Predictors of the quality of life in Chinese breast cancer survivors. Breast Cancer Res Treat, 2018, 167(2): 537-545.
5. Zafar SY, Abernethy AP. Financial toxicity, Part Ⅱ: how can we help with the burden of treatment-related costs?. Oncology (Williston Park), 2013, 27(4): 253-254, 256.
6. 易琼, 田勇梅, 黄岑, 等. 综合性医院日间化疗病房医护一体化管理模式探索与实践. 中国护理管理, 2014, 14(10): 1095-1098.
7. 张继东, 闻大翔, 骆华杰, 等. 日间医疗的实践探索与思考. 中华医院管理杂志, 2017, 33(5): 345-348.
8. Dimitrova M, Gilchrist M, Seaton RA. Outpatient Parenteral Antimicrobial Therapy (OPAT) versus inpatient care in the UK: a health economic assessment for six key diagnoses. BMJ Open, 2021, 11(9): e49733.
9. 李晨雄, 王丹, 莫陶欣, 等. 国内日间化疗工作开展现况调查研究. 中国医院管理, 2022, 42(2): 47-49.
10. 廖藏宜, 蔡文富, 李峰, 等. 门诊按人头打包付费的台州经验及改革成效. 卫生经济研究, 2021, 38(12): 47-50.
11. 吴荣海, 向前. 基本医疗保险按病种分值付费比较研究. 经济师, 2021(1): 240, 242.
12. 倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计. 中华护理杂志, 2010, 45(4): 378-380.
13. de Souza JA, Yap BJ, Hlubocky FJ, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer, 2014, 120(20): 3245-3253.
14. 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. 中华流行病学杂志, 2017, 38(8): 1118-1120.
15. 袁潇逸, 孙艳玲, 况艺, 等. 乳腺癌生存者经济毒性现状及其对生活质量的影响研究. 护士进修杂志, 2022, 37(23): 2113-2118.
16. 孙艳玲, 况艺, 袁潇逸, 等. 癌症生存者经济毒性现状及影响因素. 护理学杂志, 2022, 37(15): 24-27, 31.
17. Chan RJ, Gordon LG, Tan CJ, et al. Relationships between financial toxicity and symptom burden in cancer survivors: a systematic review. J Pain Symptom Manage, 2019, 57(3): 646-660.e1.
18. Jing J, Feng R, Zhang X, et al. Financial toxicity and its associated patient and cancer factors among women with breast cancer: a single-center analysis of low-middle income region in China. Breast Cancer Res Treat, 2020, 181(2): 435-443.
19. Moore AM, Gamblin TC, Geller DA, et al. A prospective study of posttraumatic growth as assessed by self-report and family caregiver in the context of advanced cancer. Psychooncology, 2011, 20(5): 479-487.
20. Honda K, Gyawali B, Ando M, et al. Prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol, 2019, 5: 1-8.
21. Blinder V, Eberle C, Patil S, et al. Women with breast cancer who work for accommodating employers more likely to retain jobs after treatment. Health Aff (Millwood), 2017, 36(2): 274-281.
22. Zhu Z, Xing W, Zhang X, et al. Cancer survivors' experiences with financial toxicity: a systematic review and meta-synthesis of qualitative studies. Psychooncology, 2020, 29(6): 945-959.
23. Pauge S, Surmann B, Mehlis K, et al. Patient-reported financial distress in cancer: a systematic review of risk factors in universal healthcare systems. Cancers (Basel), 2021, 13(19): 5015.
24. 周德水, 党思琪. 商业健康保险对居民健康的影响—来自 CGSS 数据的经验证据. 中国卫生政策研究, 2021, 14(8): 8-15.
25. Thom B, Benedict C, Friedman DN, et al. The intersection of financial toxicity and family building in young adult cancer survivors. Cancer, 2018, 124(16): 3284-3289.
26. Gordon LG, Merollini KMD, Lowe A, et al. A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient, 2017, 10(3): 295-309.
27. Su TT, Azzani M, Tan FL, et al. Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia. Support Care Cancer, 2018, 26(5): 1617-1624.
28. Huang HY, Shi JF, Guo LW, et al. Expenditure and financial burden for common cancers in China: a hospital-based multicentre cross-sectional study. LANCET, 2016, 388(Suppl 1): S10.
29. 何伟丽, 练会招, 翟贺宁, 等. 乳腺癌患者新辅助化疗效果. 中国老年学杂志, 2022, 42(7): 1598-1601.
30. 景静凤. 非转移性乳腺癌患者经济毒性调查及影响因素分析. 太原: 山西医科大学, 2020.

West China Medical Journal

Construction of financial toxicity early warning model for breast cancer patients undergoing daytime chemotherapy under diagnosis intervention packet

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