因癌症接受肺部和食道切除术的成年人发生经济毒性的风险。

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-11-06 DOI:10.1016/j.athoracsur.2024.10.023

Ayesha P Ng, Yas Sanaiha, Joseph E Hadaya, Arjun Verma, Jane Yanagawa, Peyman Benharash

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引用次数: 0

摘要

背景：经济毒性是指接受癌症治疗的患者所承受的有害的经济负担，尽管经济毒性越来越受到关注，但缺乏胸部肿瘤学方面的数据。我们旨在研究接受胸部恶性肿瘤手术切除的患者的经济毒性风险：在 2012-2021 年全国住院病人样本 (NIS) 中确定了因癌症接受肺叶切除术、肺切除术或食管切除术的成年人。经济毒性风险的定义是医疗支出（未参保者的住院总费用和参保者的最高自付费用）超过自给自足后收入的 40%。多变量逻辑回归用于确定与经济毒性风险相关的因素：在 384 340 名患者中，69.5% 拥有政府资助的保险，27.2% 拥有私人保险，1.0% 没有保险。与有保险的患者相比，无保险的患者多为黑人和西班牙裔，且较少选择入院。无论保险状况如何，死亡率、并发症、住院时间和费用都相当。大约 68.9% 的未参保患者和 17.3% 的参保患者面临财务毒性风险，且财务毒性发生率随时间推移保持稳定。经过风险调整后，在未投保的患者中，并发症导致的经济毒性风险增加了 2 倍多（AOR 2.21，95% CI 1.38-3.55）。在投保人中，黑人、西班牙裔和公费投保患者的财务毒性风险更高，而微创手术和大都市医院的财务毒性风险较低：与之前对腹部肿瘤手术经济毒性的研究结果一致，胸外科也表现出了类似的经济毒性负担。对于有经济毒性风险的胸部恶性肿瘤切除术患者，可考虑转诊政策和护理补贴。

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Risk of Financial Toxicity Among Adults Undergoing Lung and Esophageal Resections for Cancer.

Background: Although financial toxicity, defined as the harmful financial burden experienced by patients undergoing cancer treatment, has been of growing interest, data in thoracic oncology are lacking. We aimed to examine the risk of financial toxicity among patients undergoing surgical resection of thoracic malignancies.

Methods: Adults undergoing lobectomy, pneumonectomy, or esophagectomy for cancer were identified in the 2012-2021 National Inpatient Sample (NIS). Risk of financial toxicity was defined as health expenditure (total hospitalization costs for the uninsured and maximum out-of-pocket costs for the insured) exceeding 40% of post-subsistence income. Multivariable logistic regressions were used to identify factors associated with financial toxicity risk.

Results: Of 384,340 patients, 69.5% had government-funded insurance, 27.2% private insurance, and 1.0% were uninsured. Compared to those with insurance, uninsured patients were more commonly Black and Hispanic and less commonly electively admitted. Mortality, complications, LOS, and costs were comparable regardless of insurance status. Approximately 68.9% of uninsured and 17.3% of insured patients were at risk of financial toxicity, and incidence of financial toxicity remained stable over time. After risk adjustment, complications were associated with over 2-fold increased risk of financial toxicity among uninsured (AOR 2.21, 95% CI 1.38-3.55). Among the insured, Black, Hispanic, and publicly insured patients demonstrated greater risk of financial toxicity, while minimally invasive operations and metropolitan hospitals exhibited lower risk of financial toxicity.

Conclusions: Concordant with prior work examining financial toxicity in abdominal oncologic surgery, thoracic surgery demonstrates a comparable burden of financial toxicity. Referral policies and care subsidization may be considered in patients undergoing thoracic malignancy resections at risk for financial toxicity.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.