Aditya Narayan, Kaitlyn Lapen, Edward Christopher Dee, Bridgette Thom, Emeline M Aviki, Fumiko Chino
{"title":"筛查胃肠道癌患者的财务毒性和健康相关社会风险：来自一个大型癌症中心的结果","authors":"Aditya Narayan, Kaitlyn Lapen, Edward Christopher Dee, Bridgette Thom, Emeline M Aviki, Fumiko Chino","doi":"10.1200/OP-25-00218","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.</p><p><strong>Methods: </strong>From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.</p><p><strong>Results: </strong>Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; <i>P</i> < .001), advanced disease (stage III [β, 1.33; <i>P</i> < .001]; IV [β, 1.56; <i>P</i> < .001]), recent treatment (β, 3.23; <i>P</i> < .001), and anal (β, 1.97; <i>P</i> = .003), esophageal (β, 1.66; <i>P</i> = .005), or hepatobiliary cancer (β, 1.05; <i>P</i> = .031). Older age (≥65 years [β, -5.17; <i>P</i> < .001]), higher income ($100,000-$200,000 [β, -1.81; <i>P</i> < .001]; >$200,000 [β, -3.80; <i>P</i> < .001]), and private insurance (β, -1.70; <i>P</i> < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; <i>P</i> < .001), advanced disease (stage III [OR, 1.31; <i>P</i> = .001]; IV [OR, 1.24; <i>P</i> = .010]), recent treatment (OR, 1.20; <i>P</i> = .001), and gastric cancer (OR, 1.25; <i>P</i> = .027). Lower HRSR was associated with older age (OR, 0.59; <i>P</i> < .001), higher income ($100,000-$200,000 [OR, 0.66; <i>P</i> < .001]; >$200,000 [OR, 0.48; <i>P</i> < .001]), and private insurance (OR, 0.64; <i>P</i> < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; <i>P</i> < .001) and reduced medication adherence (β, 0.11; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"OP2500218"},"PeriodicalIF":4.6000,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258957/pdf/","citationCount":"0","resultStr":"{\"title\":\"Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large Cancer Center.\",\"authors\":\"Aditya Narayan, Kaitlyn Lapen, Edward Christopher Dee, Bridgette Thom, Emeline M Aviki, Fumiko Chino\",\"doi\":\"10.1200/OP-25-00218\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.</p><p><strong>Methods: </strong>From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.</p><p><strong>Results: </strong>Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; <i>P</i> < .001), advanced disease (stage III [β, 1.33; <i>P</i> < .001]; IV [β, 1.56; <i>P</i> < .001]), recent treatment (β, 3.23; <i>P</i> < .001), and anal (β, 1.97; <i>P</i> = .003), esophageal (β, 1.66; <i>P</i> = .005), or hepatobiliary cancer (β, 1.05; <i>P</i> = .031). Older age (≥65 years [β, -5.17; <i>P</i> < .001]), higher income ($100,000-$200,000 [β, -1.81; <i>P</i> < .001]; >$200,000 [β, -3.80; <i>P</i> < .001]), and private insurance (β, -1.70; <i>P</i> < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; <i>P</i> < .001), advanced disease (stage III [OR, 1.31; <i>P</i> = .001]; IV [OR, 1.24; <i>P</i> = .010]), recent treatment (OR, 1.20; <i>P</i> = .001), and gastric cancer (OR, 1.25; <i>P</i> = .027). Lower HRSR was associated with older age (OR, 0.59; <i>P</i> < .001), higher income ($100,000-$200,000 [OR, 0.66; <i>P</i> < .001]; >$200,000 [OR, 0.48; <i>P</i> < .001]), and private insurance (OR, 0.64; <i>P</i> < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; <i>P</i> < .001) and reduced medication adherence (β, 0.11; <i>P</i> < .001).</p><p><strong>Conclusion: </strong>High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.</p>\",\"PeriodicalId\":14612,\"journal\":{\"name\":\"JCO oncology practice\",\"volume\":\" \",\"pages\":\"OP2500218\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12258957/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCO oncology practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1200/OP-25-00218\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO oncology practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1200/OP-25-00218","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Screening for Financial Toxicity and Health-Related Social Risks in Patients With GI Cancer: Results From a Large Cancer Center.
Purpose: Patients with GI cancers often face significant financial toxicity (FT) and health-related social risks (HRSRs), yet best practices for screening remain unclear. This study aimed to evaluate the prevalence of FT and HRSR and identify associated factors.
Methods: From June 2022 to August 2023, patients were screened using the Comprehensive Score for Financial Toxicity (COST), patient-reported HRSR (eg, housing, food insecurity), and quality of life (QOL). Multivariate regressions were used to assess predictors of FT and HRSR, adjusting for several variables.
Results: Among 8,335 patients with GI cancer, 45% had a COST score of <26, indicating FT. In adjusted linear regression, FT was associated with racial/ethnic minority status (β, 4.20; P < .001), advanced disease (stage III [β, 1.33; P < .001]; IV [β, 1.56; P < .001]), recent treatment (β, 3.23; P < .001), and anal (β, 1.97; P = .003), esophageal (β, 1.66; P = .005), or hepatobiliary cancer (β, 1.05; P = .031). Older age (≥65 years [β, -5.17; P < .001]), higher income ($100,000-$200,000 [β, -1.81; P < .001]; >$200,000 [β, -3.80; P < .001]), and private insurance (β, -1.70; P < .001) were protective. Twenty-eight percent reported at least one HRSR. HRSRs were associated with minority status (odds ratio [OR], 2.14; P < .001), advanced disease (stage III [OR, 1.31; P = .001]; IV [OR, 1.24; P = .010]), recent treatment (OR, 1.20; P = .001), and gastric cancer (OR, 1.25; P = .027). Lower HRSR was associated with older age (OR, 0.59; P < .001), higher income ($100,000-$200,000 [OR, 0.66; P < .001]; >$200,000 [OR, 0.48; P < .001]), and private insurance (OR, 0.64; P < .001). Sex was not a predictor. Worst FT was associated with decreased QOL (β, -0.98; P < .001) and reduced medication adherence (β, 0.11; P < .001).
Conclusion: High levels of FT and HRSR were observed in patients with GI cancer. Early intervention to address financial and social burdens may improve both disease and survivorship outcomes.
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