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.
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.
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6.	易瓊, 田勇梅, 黃岑, 等. 綜合性醫院日間化療病房醫護一體化管理模式探索與實踐. 中國護理管理, 2014, 14(10): 1095-1098.
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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.
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10.	廖藏宜, 蔡文富, 李峰, 等. 門診按人頭打包付費的臺州經驗及改革成效. 衛生經濟研究, 2021, 38(12): 47-50.
11.	吳榮海, 向前. 基本醫療保險按病種分值付費比較研究. 經濟師, 2021(1): 240, 242.
12.	倪平, 陳京立, 劉娜. 護理研究中量性研究的樣本量估計. 中華護理雜志, 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.	于慧會, 畢雪, 劉運泳. 中文版癌癥患者報告結局的經濟毒性量表信度和效度研究. 中華流行病學雜志, 2017, 38(8): 1118-1120.
15.	袁瀟逸, 孫艷玲, 況藝, 等. 乳腺癌生存者經濟毒性現狀及其對生活質量的影響研究. 護士進修雜志, 2022, 37(23): 2113-2118.
16.	孫艷玲, 況藝, 袁瀟逸, 等. 癌癥生存者經濟毒性現狀及影響因素. 護理學雜志, 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, 黨思琪. 商業健康保險對居民健康的影響—來自 CGSS 數據的經驗證據. 中國衛生政策研究, 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.	何偉麗, 練會招, 翟賀寧, 等. 乳腺癌患者新輔助化療效果. 中國老年學雜志, 2022, 42(7): 1598-1601.
30.	景靜鳳. 非轉移性乳腺癌患者經濟毒性調查及影響因素分析. 太原: 山西醫科大學, 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. 易瓊, 田勇梅, 黃岑, 等. 綜合性醫院日間化療病房醫護一體化管理模式探索與實踐. 中國護理管理, 2014, 14(10): 1095-1098.
7. 張繼東, 聞大翔, 駱華杰, 等. 日間醫療的實踐探索與思考. 中華醫院管理雜志, 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. 國內日間化療工作開展現況調查研究. 中國醫院管理, 2022, 42(2): 47-49.
10. 廖藏宜, 蔡文富, 李峰, 等. 門診按人頭打包付費的臺州經驗及改革成效. 衛生經濟研究, 2021, 38(12): 47-50.
11. 吳榮海, 向前. 基本醫療保險按病種分值付費比較研究. 經濟師, 2021(1): 240, 242.
12. 倪平, 陳京立, 劉娜. 護理研究中量性研究的樣本量估計. 中華護理雜志, 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. 于慧會, 畢雪, 劉運泳. 中文版癌癥患者報告結局的經濟毒性量表信度和效度研究. 中華流行病學雜志, 2017, 38(8): 1118-1120.
15. 袁瀟逸, 孫艷玲, 況藝, 等. 乳腺癌生存者經濟毒性現狀及其對生活質量的影響研究. 護士進修雜志, 2022, 37(23): 2113-2118.
16. 孫艷玲, 況藝, 袁瀟逸, 等. 癌癥生存者經濟毒性現狀及影響因素. 護理學雜志, 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, 黨思琪. 商業健康保險對居民健康的影響—來自 CGSS 數據的經驗證據. 中國衛生政策研究, 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. 何偉麗, 練會招, 翟賀寧, 等. 乳腺癌患者新輔助化療效果. 中國老年學雜志, 2022, 42(7): 1598-1601.
30. 景靜鳳. 非轉移性乳腺癌患者經濟毒性調查及影響因素分析. 太原: 山西醫科大學, 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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