Introduction
Methods
Design and participants
Measurements
Ethical consideration
Data collection
Data analysis
Results
Patient characteristics
Variables | Frequency N (%) | Financial toxicity | ||
---|---|---|---|---|
Score of COST1 M (SD) | F/t | p | ||
Age | ||||
<45y | 33 (21.85) | 16.85 (7.07) | 7.236 |
0.001**
|
≥45, <60y | 55 (36.43) | 15.6 (8.12) | ||
≥60y | 63 (41.72) | 20.65 (7.02) | ||
Gender | ||||
Male | 92 (60.93) | 18.80 (7.56) | 2.691 | 0.103 |
Female | 59 (39.07) | 16.69 (7.95) | ||
Employment status | ||||
Yes | 30 (19.87) | 15.73 (6.80) | -1.753 | 0.082 |
No | 121 (80.13) | 18.50 (7.92) | ||
Marital status | ||||
Married | 132 (87.42) | 18.51 (7.65) | 2.344 |
0.020
*
|
Single (unmarried, divorced or widowed) | 19 (12.58) | 14.11 (7.69) | ||
Educational level | ||||
Primary school or illiteracy | 21 (13.91) | 18.86 (6.46) | 0.979 | 0.405 |
Middle | 49 (32.45) | 16.65 (7.80) | ||
High school | 53 (35.10) | 18.00 (8.10) | ||
College or above | 28 (18.54) | 19.61 (7.88) | ||
Residence | ||||
Urban | 111 (73.51) | 19.10 (7.67) | 4.996 |
0.008
**
|
Suburban | 17 (11.26) | 16.12 (6.51) | ||
Rural | 23 (15.23) | 14.00 (7.66) | ||
Insurance type | ||||
Medical insurance for staff | 65 (43.04) | 18.63 (8.61) | 2.344 | 0.075 |
Medical insurance for town residents | 33 (21.86) | 20.03 (5.44) | ||
New rural cooperative medical insurance | 49 (32.45) | 16.02 (7.73) | ||
Self-paying | 4 (2.65) | 14.00 (4.55) | ||
Diagnosis | ||||
Gastrointestinal cancer | 134 (88.74) | 18.25 (7.82) | 1.487 | 0.225 |
Other cancers | 17 (11.26) | 15.82 (7.06) | ||
Time diagnosed with cancer | ||||
≤ 6 months | 73 (48.34) | 19.15 (7.40) | 1.834 | 0.163 |
>6 months, ≤ 12 months | 55 (36.43) | 17.30 (7.75) | ||
>12 months | 23 (15.23) | 16.00 (8.72) | ||
Tumor stage | ||||
Stage II | 19 (12.58) | 16.35 (8.59) | 3.949 |
0.022
*
|
Stage III | 65 (43.05) | 19.91 (6.88) | ||
Stage IV | 67 (44.37) | 16.07 (8.29) | ||
ECOG score 2 | ||||
0 | 21 (13.91) | 18.80 (8.22) | 2.677 | 0.072 |
1 | 123 (81.46) | 18.33 (7.59) | ||
2 | 7 (4.63) | 11.57 (7.11) | ||
Recurrence | ||||
Yes | 26 (17.22) | 15.04 (8.46) | -2.152 |
0.033
*
|
No | 125 (82.78) | 18.59 (7.49) | ||
Drugs of oral chemotherapy | ||||
Capecitabine | 107 (70.86) | 18.47 (7.52) | 1.256 | 0.288 |
Tegafur | 40 (26.49) | 17.18 (8.23) | ||
Others | 4 (2.65) | 13.00 (8.83) | ||
Times of taking oral chemotherapy drugs at home | ||||
The first time | 33 (21.85) | 16.42 (7.74) | -1.321 | 0.188 |
The second time or above | 118 (79.15) | 18.44 (7.76) |
Financial toxicity and the influencing factors
Variables | Dependent variable: Financial toxicity | ||||
---|---|---|---|---|---|
Estimate |
SE
|
Wald
|
p-value
|
95% CI
| |
Model (χ2 = 12.078, p = 0.017, R2 = 0.091) | |||||
Age (Estimate≥ 60y =0) | |||||
<45y | 0.454 | 0.433 | 1.096 | 0.295 | -0.396, 1.303 |
≥45, <60y | 0.763 | 0.375 | 4.133 |
0.042
*
| 0.027, 1.499 |
Residence (Estimate Rural =0) | |||||
Urban | -1.114 | 0.463 | 5.781 |
0.016
*
| -2.021, -0.206 |
Suburban | -0.514 | 0.631 | 0.663 | 0.415 | -1.751, 0.723 |
Symptoms and unplanned healthcare utilization at home
Relationship between financial toxicity and symptoms
Outcome variables Mean (SD) | Overall (n = 151) | Financial Toxicity3 | |||||
---|---|---|---|---|---|---|---|
No/mild (n = 18) | Moderate (n = 86) | Severe (n = 47) | F | p-value | |||
Symptoms severity at home | 1.37 (1.31) | 0.95 (0.93) | 1.18 (1.32) | 1.86 (1.31) | 5.376 |
0.006**
| |
Pain | 1.17 (1.99) | 0.17 (0.38) | 1.08 (1.79) | 1.70 (2.51) | 4.206 |
0.017
*
| |
Fatigue | 1.86 (2.31) | 1.56 (2.50) | 1.51 (2.06) | 2.62 (2.53) | 3.796 |
0.025
*
| |
Nausea | 1.54 (2.02) | 1.33 (2.09) | 1.41 (1.93) | 1.85 (2.17) | 0.834 | 0.436 | |
Disturbed sleep | 1.76 (2.31) | 1.39 (1.91) | 1.34 (2.03) | 2.68 (2.69) | 5.726 |
0.004
**
| |
Distress (emotional) | 1.25 (2.00) | 0.61 (1.09) | 1.06 (1.93) | 1.83 (2.26) | 3.406 |
0.036
*
| |
Shortness of breath | 0.71 (1.46) | 0.28 (0.83) | 0.60 (1.37) | 1.06 (1.72) | 2.443 | 0.090 | |
Difficulty remembering | 1.28 (1.77) | 0.78 (1.31) | 1.15 (1.80) | 1.70 (1.86) | 2.317 | 0.102 | |
Lack of appetite | 1.95 (2.18) | 1.83 (2.33) | 1.48 (1.90) | 2.85 (2.37) | 6.486 |
0.002
**
| |
Drowsiness | 1.23 (1.85) | 0.39 (0.85) | 0.99 (1.75) | 2.00 (2.06) | 7.194 |
0.001
**
| |
Dry mouth | 1.25 (1.63) | 1.11 (1.45) | 1.03 (1.54) | 1.70 (1.79) | 2.682 | 0.072 | |
Sadness | 0.75 (1.51) | 0.17 (0.38) | 0.78 (1.59) | 0.94 (1.61) | 1.722 | 0.182 | |
Vomiting | 0.97 (1.73) | 0.89 (2.03) | 0.79 (1.36) | 1.32 (2.16) | 1.448 | 0.238 | |
Numbness/Tingling | 2.05 (2.09) | 1.83 (1.86) | 2.16 (2.16) | 1.94 (2.08) | 0.289 | 0.750 | |
Symptom interference at home | 0.91 (1.53) | 0.21(0.39) | 0.76 (1.33) | 1.45 (1.94) | 5.405 |
0.005
**
| |
General activity | 1.16 (2.08) | 0.24 (0.66) | 1.12 (2.03) | 1.57 (2.40) | 2.694 | 0.071 | |
Mood | 0.97 (1.84) | 0.29 (0.69) | 0.81 (1.72) | 1.49 (2.22) | 3.420 |
0.035
*
| |
Working | 1.02 (1.88) | 0.29 (0.59) | 0.87 (1.75) | 1.55 (2.27) | 3.524 |
0.032
*
| |
Relations with others | 0.66 (1.61) | 0.06 (0.24) | 0.51 (1.45) | 1.15 (2.02) | 3.845 |
0.024
*
| |
Walking | 0.81 (1.90) | 0.12 (0.33) | 0.59 (1.60) | 1.47 (2.50) | 4.726 |
0.010
*
| |
Enjoyment of life | 0.87 (1.80) | 0.24 (0.44) | 0.66 (1.51) | 1.47 (2.39) | 4.390 |
0.014
*
|
Variables |
Estimate
|
SE
|
Wald
|
p-value
|
95% CI
|
---|---|---|---|---|---|
Dependent variable: Fatigue | |||||
Financial Toxicity (Estimate Severe=0) | |||||
No/mild | -0.506 | 0.550 | 0.845 | 0.358 | -1.584, 0.573 |
Moderate | -0.746 | 0.353 | 4.461 |
0.035
*
| -1.437, -0.054 |
Dependent variable: Disturbed sleep | |||||
Financial Toxicity (Estimate Severe=0) | |||||
No/mild | -1.073 |
0.536
|
4.003
|
0.045
*
| -2.124, -0.022 |
Moderate | -1.073 |
0.346
|
9.597
|
0.002
**
| -1.752, -0.394 |
Dependent variable: Distress (emotional) | |||||
Financial Toxicity (Estimate Severe=0) | |||||
No/mild | -1.283 | 0.602 | 4.537 |
0.033
*
| -2.463, -0.102 |
Moderate | -0.867 | 0.354 | 6.012 |
0.014
*
| -1.561, -0.174 |
Dependent variable: Lack of appetite | |||||
ECOG score (Estimate score 2 =0) | |||||
0 | -2.174 | 0.908 | 5.734 |
0.017
*
| -3.953, -0.395 |
1 | -1.642 | 0.805 | 4.155 |
0.042
*
| -3.220, -0.063 |
Financial Toxicity (EstimateSevere=0) | |||||
No/mild | -0.590 | 0.539 | 1.196 | 0.274 | -1.647, 0.467 |
Moderate | -1.135 | 0.359 | 9.984 |
0.002
**
| -1.840, -0.431 |
Dependent variable: mood interference | |||||
Age ( Estimate≥ 60y =0 ) | |||||
<45y | 0.686 | 0.523 | 1.718 | 0.190 | -0.340, 1.711 |
≥45, <60y | 1.003 | 0.462 | 4.708 |
0.030
*
| 0.097, 1.909 |
Financial Toxicity (Estimate Severe=0) | |||||
No/mild | -1.659 | 0.827 | 4.027 |
0.045
*
| -3.280, -0.039 |
Moderate | -0.644 | 0.390 | 2.734 | 0.098 | -1.408, 0.120 |
Dependent variable: interference of relations with others | |||||
Financial Toxicity (Estimate Severe=0) | |||||
No/mild | -2.200 | 1.080 | 4.150 |
0.042
*
| -4.318, -0.083 |
Moderate | -0.955 | 0.411 | 5.392 |
0.020
*
| -1.761, -0.149 |
Relationship between Financial Toxicity and Unplanned Healthcare utilization
Variables | Dependent variable: Unplanned Healthcare Utilization | |||||
---|---|---|---|---|---|---|
B
|
SE
|
Wald
|
p-value
|
Exp (B)
|
95% CI
| |
Univariate binary regression | ||||||
Financial toxicity (B severe = 0) | ||||||
No/mild | -1.039 | 0.638 | 2.650 | 0.104 | 0.354 | 0.101, 1.236 |
Moderate | -0.794 | 0.381 | 4.336 |
0.037
*
| 0.452 | 0.214, 0.954 |
Marital status (B single= 0) | ||||||
Married | -1.038 | 0.499 | 4.329 |
0.037
*
| 0.354 | 0.133, 0.942 |
Recurrence (B no = 0) | ||||||
Yes | 1.537 | 0.452 | 11.550 |
0.001
**
| 4.650 | 1.917, 11.282 |
Pain (B Moderate/severe = 0) | ||||||
No | -1.774 | 0.545 | 10.590 |
0.001
**
| 0.170 | 0.058, 0.494 |
Mild | -0.663 | 0.583 | 1.293 | 0.255 | 0.515 | 0.164, 1.616 |
Disturbed sleep (B Moderate/severe = 0) | ||||||
No | -1.322 | 0.461 | 8.221 |
0.004
**
| 0.267 | 0.108, 0.658 |
Mild | -0.341 | 0.471 | 0.524 | 0.469 | 0.711 | 0.283, 1.790 |
Distress (emotional) (B Moderate/severe = 0) | ||||||
No | -1.084 | 0.490 | 4.896 |
0.027
*
| 0.338 | 0.129, 0.884 |
Mild | -0.539 | 0.543 | 0.985 | 0.321 | 0.583 | 0.201, 1.691 |
Shortness of breath (B Moderate/severe = 0) | ||||||
No | -1.172 | 0.596 | 3.869 |
0.049
*
| 0.310 | 0.096, 0.996 |
Mild | -0.395 | 0.687 | 0.331 | 0.565 | 0.673 | 0.175, 2.588 |
Lack of appetite (B Moderate/severe = 0) | ||||||
No | -1.225 | 0.469 | 6.831 |
0.009
**
| 0.294 | 0.117, 0.736 |
Mild | -0.658 | 0.447 | 2.172 | 0.140 | 0.518 | 0.216, 1.243 |
Dry mouth (B Moderate/severe = 0) | ||||||
No | -1.127 | 0.558 | 4.069 |
0.044
*
| 0.324 | 0.108, 0.969 |
Mild | -0.302 | 0.555 | 0.296 | 0.586 | 0.739 | 0.249, 2.194 |
Multiple binary regression | ||||||
Recurrence (B no = 0) | ||||||
Yes | 1.601 | 0.538 | 8.860 |
0.003
**
| 4.959 | 1.728, 14.234 |