Financial Toxicity-Related Factors in Patients With Nasopharyngeal Carcinoma: A Cross-Sectional Study.

doi:10.21203/rs.3.rs-4653463/v1

Download PDF

Research Article

Financial Toxicity-Related Factors in Patients With Nasopharyngeal Carcinoma: A Cross-Sectional Study.

https://doi.org/10.21203/rs.3.rs-4653463/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Purpose

This cross-sectional study aimed to investigate the incidence and related factors of financial toxicity among nasopharyngeal carcinoma(NPC) patients, and propose strategies for improvement.

Methods

Nasopharyngeal carcinoma patients were recruited from December 2022 to June 2023 in Changsha, Hunan Province, China, using convenience sampling. A questionnaire survey focusing on financial toxicity among nasopharyngeal carcinoma patients was conducted. The assessment tools used in this study include Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM), Medical Coping Modes Questionnaire (MCMQ) and Perceived Social Support Scale (PSSS).

Results

A total of 155 nasopharyngeal carcinoma patients were included in the study. The incidence of financial toxicity among participants was found to be 65.8%, with an average COST scores of 22.45 ± 7.91. A significant negative correlation was showed between MCMQ scores and financial toxicity in patients (r= -0.235, p = 0.003), while a significant positive correlation was showed between the PSSS scores and financial toxicity (r = 0274, p = 0.001). The results of multiple linear regression analysis showed that personal monthly income, MCMQ scores and PSSS scores were related to the financial toxicity in nasopharyngeal carcinoma patients.

Conclusion

This study revealed a high prevalence of financial toxicity in nasopharyngeal carcinoma patients. Medical staffs need to identify the financial toxicity early and adopt appropriate strategies to help nasopharyngeal carcinoma patients return to work and guide them to choose positive medical coping modes and access greater social support.

Financial Toxicity

Nasopharyngeal Carcinoma

Cancer

Cross-Sectional Study

China

Nasopharyngeal carcinoma(NPC) represents an epithelial cancer deriving from the nasopharyngeal mucosal lining. As reported by the International Agency for Research on Cancer, in 2020, the number of new cases of nasopharyngeal cancer reached 133,354, accounting for 0.7% of the total incidence of cancer, and 80,008 new death, 0.8% of the mortality rate¹. In China, the incidence of nasopharyngeal carcinoma was identified as 38.29% of the global incidence, and primarily distributed in western and southern². Worldwide, China bears the burden of the highest incidence of nasopharyngeal carcinoma.

Nasopharyngeal carcinoma is a disease with unique characteristics. Host genetics, Epstein-Barr virus (EBV) infection, and environmental factors are the three major risk factors associated with NPC². The clinical manifestations of NPC include blood-stained nasal discharge, nasal congestion, hearing loss, and headache³. Chemoradiotherapy is the primary treatment of NPC, and immunotherapy was considered as a promising treatment strategy for NPC patients with advanced or metastatic tumors currently⁴. The recommended basic principles of radiotherapy for NPC patients were 33–35 times, finished in 7 weeks (once a day, 5 times per week)⁵. However, long-term treatment period and adverse effects of chemoradiotherapy (eg, oral mucositis, dermatitis, nausea, vomiting and myelosuppression) aggravated the physical and mental stress of NPC patients^5,6. Although China has implemented national medical insurance, NPC patients and their families are under a serious financial burden due to the increasing costs of examinations, drugs and medical service during the period of diagnosis and treatment.

Financial toxicity (FT) refers to the negative impact of the high cost of cancer treatment on patients and survivors of cancer. It mainly consists of the objective financial burden and the subjective psychological stress of patients⁷. FT could result from the out-of-pocket medical expenses, transportation and accommodation costs, lost productivity, disrupted employment, and damage of the whole family's livelihood throughout the course of cancer treatment⁸. Studies have shown that FT could lead the patients to delay seeking treatment, abandon treatment opportunities, lower the quality of life, and even increase mortality^9,10. Ramsey¹¹ noted that oncology patients were 2.65 times more likely to declare personal bankruptcy than non-oncology patients. As a study of 231,596 cancer patients reported that those who suffered bankruptcy had nearly twice the risk of death opposed to those who did not¹². Fang¹³ pointed out that the better the financial status of NPC patients, the lower the severity of head and neck dysfunction. However, there are few studies related to FT in patients with nasopharyngeal carcinoma. Therefore, this study aimed to investigate the financial toxicity among nasopharyngeal carcinoma patients and identify the related factors, hoping to provide a guide for the establishment of effective FT early warning model and reasonable intervention strategies for NPC patients.

Study design

A cross-sectional study was conducted to access the financial toxicity among nasopharyngeal carcinoma patients and identify the relationship between medical coping modes, perceived social support and financial toxicity among patients with NPC.

Sample

Nasopharyngeal carcinoma patients were recruited from December 2022 to June 2023. The inclusion criteria were as follows: (1) diagnosed with nasopharyngeal carcinoma (International Union Against Cancer/American Joint Committee on Cancer, UICC/AJCC, eighth edition²), (2) radiotherapy was conducted, (3) age ≥ 18 years, (4) agree to participate in this study.

Setting and sample size

The study adopted a convenience sampling method and was carried out at the nasopharyngeal carcinoma research center of a tertiary hospital in Changsha, Hunan Province, China. A rough estimate of the sample size was performed. The sample size was 5 ~ 10 times of the number of variables, and 20% of invalid data were considered. There were 18 variables in this study, so the required sample size was 106–213.

Variables and outcomes

General information questionnaire

Our team designed the general information questionnaire based on literature review and clinical practice experience. The general information questionnaire mainly consisted of basic information and disease-related information. Basic information included age, sex, marital status, education level, rurality, main caregiver, personal monthly income, household monthly income, annual household income, occupational status and health insurance. The disease-related information included complications, tumor stage, chemotherapy, completed radiotherapy sessions, immunity therapy and targeted therapy.

Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM): This is a tool developed by Souza¹⁴ in 2014 to assess the financial toxicity experienced by cancer patients. In 2017, Chinese scholar Yu¹⁵ translated the Chinese version of COST-PROM scale. This scale include 11 items and is scored based on a five-point Likert scale, with higher scores indicating greater financial toxicity. Patients were scored depending on their own conditions in the past 7 days. The degree of FT was identified as follows: no FT (COST ≥ 26), mild FT (COST 14–25), moderate FT(COST 0–13) and severe FT(COST = 0). Cronbach's α coefficient of Chinese version of the COST-PROM scale is 0.891.

Medical Coping Modes Questionnaire (MCMQ): The MCMQ is a standardized assessment tool developed by Feifel¹⁶ to evaluate coping strategies utilized by individuals facing medical illness. It has been translated into Chinese by Shen¹⁷. This instrument plays a crucial role in understanding patients' coping mechanisms, tailoring interventions, and providing appropriate support for effectively managing the psychological impact of their illness. This questionnaire is divided into 3 dimensions: confrontation, avoidance, and acceptance-resignation. The MCMQ consists of 20 items and is scored based on a four-point Likert scale. The higher the dimension score, the more inclined the patients were to adopt this coping approach. Cronbach's α coefficients of Chinese version of the three dimensions of the questionnaire were 0.703, 0.736 and 0.799, respectively.

Perceived Social Support Scale (PSSS)

The Perceived Social Support Scale (PSSS) is a well-established measurement tool developed by Zimet¹⁸. It is used to assess an individual's perception of the support they receive from their social network. The significance of PSSS lies in interventions could be tailored to enhance social support networks and promote the well-being of individuals facing various challenges, including medical conditions. It is included three dimensions of family support, friend support and significant other support, with Cronbach's α coefficient greater than 0.8 for each dimension. The PSSS comprises 12 items, using Likert 7-level scoring system, with 1 representing "strongly disagree", 7 representing "strongly agree". The total score is 12–84 points, the higher the score, the higher the social support.

Data collection and ethical considerations

The research team provided training to 3 nurses on data collection methods. Patients who met the inclusion criteria were explained about the purpose and content of the study, the required time, and the confidentiality measures by face-to-face. The informed consent was signed after obtaining the consent of the patients and paper questionnaires were distributed. The contents that the patient could not understand were explained in a unified language. Questionnaires were collected on the spot and its integrity was checked. Our study was approved by the institutional review board (IRB) of the study Hospital (No. 202212288).

Statistical analysis

The collected data were entered and verified by two researchers, and analyzed by SPSS 26.0 software. Values for continuous variables were presented as mean, standard deviations (SD), and 95% confidence intervals (95% CI). Values for categorical variables were summarized with frequencies, percentages, and 95% CI. To assess the impact of demographic information of nasopharyngeal carcinoma patients on financial toxicity, independent t-tests and one-way ANOVA were conducted. Pearson's correlation coefficient was utilized to explore the relationship among medical coping modes, social support and FT of NPC patients. Multiple linear regression analysis was employed to examine the influencing factors. A two-tailed p < 0.05 was considered statistically significant.

Patient characteristics and financial toxicity

Totally 162 questionnaires were sent out between December 2022 to June 2023, 155 were effectively received with effective recovery of 95.68%. 155 participants were finally included, with 126 males (81.3%) and 29 females (18.7%). The mean age of the NPC patients was 48.77 ± 10.56 years, varied from 22 to 83 years. The characteristics of NPC patients and their association with financial toxicity are presented in Table 1.

Table 1

Patient Characteristics And COST Scores
Patient characteristics	N (%)	COST scores (Mean, 95% CI)	P
Basic information
Age (years) ≤ 55 >55	110 45	22.40 (20.87–23.93) 22.58 (20.32–24.93)	.899
Sex male female	126 29	23.04 (21.67–24.41) 19.90 (16.78–23.01)	.053
Marital status married single/divorced/widowed	143 12	22.14 (20.81–23.47) 26.17 (22.80-29.54)	.090
Education level college or above (> 12 year) college or below (0–12 year)	27 128	22.74 (20.86–24.62) 22.39 (20.91–23.87)	.768
Rurality urban rural	69 86	22.45 (20.31–24.59) 22.45 (20.94–23.97)	.997
Main caregivers oneself family member	42 113	23.48 (20.50-26.45) 22.07 (20.72–23.42)	.327
Personal monthly income(CNY) <3000 3000–5000 >5000	91 43 21	20.44 (18.74–22.14) 24.84 (22.78–26.90) 26.29 (23.38–29.19)	<.001
Household monthly income (CNY) < 6000 6000–12000 > 12000	94 48 13	21.02 (19.30-22.75) 24.35 (22.52–26.19) 25.77 (21.27–30.27)	.016
Annual household income (CNY) 0-100000 100001–200000 > 200000	132 21 2	21.73 (20.39–23.07) 26.90 (23.40-30.41) 23.50 (-8.27-55.27)	.019
Occupational status employed unemployed retired freelance	64 55 5 31	22.33 (20.34–24.32) 21.55 (19.26–23.83) 29.20 (20.45–37.95) 23.23 (20.81–25.64)	.198
Health insurance NCMS URBMI UEBMI commercial insurance	82 15 51 7	21.40 (19.68–23.13) 21.87 (16.53–27.20) 23.86 (21.75–25.97) 25.71 (19.63–31.80)	.228
Table 1 (Continued)
Patient characteristics	N (%)	COST scores (Mean, 95% CI)	P
Disease-related information
Complications yes no	24 131	24.13 (20.85–27.40) 22.15 (20.77–23.52)	.261
Tumor stage Ⅰ Ⅱ Ⅲ Ⅳ	22 11 48 74	26.91 (24.07–29.75) 20.09 (14.80-25.38) 22.02 (20.06–23.98) 21.76 (19.75–23.76)	.032
Chemotherapy yes no	138 17	22.23 (20.88–23.58) 24.24 (20.63–27.84)	.326
Completed radiotherapy sessions < 10 fractions 10–20 fractions > 20 fractions	40 51 64	22.48 (19.87–25.08) 23.75 (21.82–25.67) 21.41 (19.28–23.53)	.300
Immunity therapy yes no	37 118	20.24 (17.06–23.42) 23.14 (21.83–24.46)	.051
Targeted therapy yes no	35 120	23.20 (20.56–25.84) 22.23 (20.79–23.68)	.526
Note: UEBMI, The Urban Employees’ Basic Medical Insurance Scheme covering 70–90% of the medical expenses; URBMI, The Urban Residents’ Basic Medical Insurance Scheme covering 50–70% of the medical expenses; NCMS, The New Cooperative Medical Scheme covering 50–60% of the medical expenses; CNY, Chinese Yuan.

Financial toxicity

Of the 155 NPC patients, the incidence of FT was 65.8% and the average COST scores was 22.45 ± 7.91. Specifically, 85 participants (54.8%) reported mild FT, 14 participants (9.0%) encountered moderate FT, and 3 patients (1.9%) expressed severe FT .

Correlation analysis associated with financial toxicity

The results of the Pearson correlation analysis revealed a significant correlation between the medical coping modes, social support, and financial toxicity among NPC patients. Detailed information regarding the correlation analysis of each dimension are showed in Table 2.

Table 2

Correlation Analysis Of Financial Toxicity Among NPC Patients.
	COST scores	MCMQ scores	confrontation	avoidance	acceptance- resignation	PSSS scores	family support	friend support	other support
COST scores	1
MCMQ scores	− .235*	1
confrontation	.067	.354 **	1
avoidance	− .259*	.521 **	− .423 **	1
acceptance-resignation	− .192*	.711 **	− .094	.279 **	1
PSSS scores	.274*	− .203*	.300 **	− .528 **	− .114	1
family support	.259*	− .118	.291 **	− .506 **	.015	.882 **	1
friend support	.227*	− .241*	.258*	− .468 **	− .196*	.916 **	.664 **	1
other support	.269*	− .196*	.277 **	− .479 **	− .128	.952 **	.771 **	.846 **	1
Note:*p < .01, p < .05.

Predictors associated with financial toxicity

The dependent variable in this study was the total scores of COST. The independent variables consisted of the following: personal monthly income, household monthly income, annual household income, tumor stage, MCMQ scores and PSSS scores. Consequently, Four independent variables were associated with the level of FT among NPC patients (Table 3). Variance analysis of the regression equation revealed a statistically significant result, with an F value of 6.768 (p < .001), indicating that the multiple linear regression equation fitted well. Furthermore, the complex correlation coefficient R = 0.494 and the determination coefficient R² = 0.244 demonstrated that these three variables accounted for 24.4% of the variation (Table 3).

Table 3

Multiple linear regression analysis of financial toxicity among NPC patients.
Variable	B-value	SE	95% CI of β	t	p
constant	30.863	5.870	19.263–42.463	5.258	.000
Personal monthly income	3.092	1.064	0.990–5.194	2.907	.004
MCMQ scores	− .193	.086	-0.362–0.024	-2.253	.026
PSSS scores	.125	.038	0.050–0.200	3.277	.001

This study was effectively conducted on 155 patients with the aim of assessing the financial toxicity among nasopharyngeal carcinoma patients in a tertiary hospital in China. By using the General Information Questionnaire, COST-PROM, MCMQ, and PSSS, we identified factors influencing FT. Understanding these factors could help clinical staff develop appropriate strategies to relief the financial burden in NPC patients.

Prevelence of financial toxicity

In this study, the incidence of FT among NPC patients in our study was 65.8% and the median COST score in was 22.45, the results provide further evidence that the risk of FT remains high in NPC patients, emphasizing the need for increased attention to this issue. Our findings showed a higher prevalence of financial toxicity compared to Fabian’s study (31%)¹⁹. It is worth noting that Fabian’s study recruited cancer patients undergoing radiotherapy, with the majority being breast cancer (24%) and prostate cancer (18%) patients. However, we included NPC patients only. Previous study showed that head and neck cancer patients have greater medical expenses and out-of-pocket costs compared to other oncological patients²⁰. NPC patients could suffer functional deficits due to long-term chemoradiotherapy, including dysphagia, oral mucositis, ototoxicity, fibrosis, neck and shoulder dysfunction, and xerostomia. These symptoms could lead to difficulties in eating, poor nutrition, and a bleak prognosis, further exacerbating the financial burden. Moreover, NPC patients are mostly middle-aged men, typically between the ages of 40–50, who often serve as the primary breadwinners for their families. The lengthy treatment duration could results in decreased working hours, while the accompanying side effects of treatment can hinder work efficiency, potentially leading to unemployment and even financial bankruptcy^20,21.

Therefore, healthcare professionals could implemented regular assessments to identify nasopharyngeal cancer patients who may experience a high level of financial toxicity. Since high level of FT could diminish the quality of treatment among cancer patients²². Strategies, such as organizing patient-oriented communication gatherings, creating educational videos, and developing health education booklet could be carried out to enhance patients' and their families' knowledge level of financial toxicity and alleviate its impact.

Patient characteristics and financial toxicity

The findings from this study revealed that the variables including personal monthly income, household monthly income, annual household income and tumor stage were significant related to the FT of NPC patient. In our study, the lower the monthly income of an individual or family, the higher level of the financial toxity, and these results were consistent with Fabian's¹⁹. Prior research has indicated that individuals with lower incomes allocate a larger portion of their overall earnings towards medical treatment compared to those with higher incomes²³. As a result, they may experience increased financial burdens, potentially leading to reduced basic living expenses or even discontinuation of treatment. These findings indicated that it is crucial for hospitals to cultivate a positive and innovative work environment, encouraging medical staff to explore more efficient treatment techniques and nursing approaches to assist NPC patients and their families in returning to the workforce and deriving their income. This approach not only ensures their active involvement in the entire treatment process but also enhances their overall quality of life.

This study demonstrates that tumor stage significantly affects the FT of NPC patients. Patients in stage Ⅰ exhibited the lowest level of FT, which is consistent with Jing’s²⁴ research. However, irregular distribution of FT is observed in stages Ⅱ, Ⅲ and Ⅳ. Possible reasons for this phenomenon could be as follows. For one thing, Cancer patients typically undergo stages of denial, anger, bargaining, depression, and acceptance²⁵. NPC patients in stages III and IV mostly enter the stage of acceptance as their disease progresses. However, NPC patients in stage II tend to enter the stages of denial or anger. Different psychological stages of cancer patients could elicit varying perceptions of financial burden. For another, effective peer support has made a significant impact on individuals facing greater disadvantages²⁶. In our center, NPC patients in stage IV account for the highest percentage at 47.74%, followed by stage III at 30.97%, both higher than the 7.1% of patients in stage II. This implies that NPC patients in stage III and IV, who have more opportunities to interact with individuals who have similar experiences, may benefit from better peer support. Consequently, the financial toxicity tends to be slightly lower than that of stage II patients. In conclusion, the findings reminded that clinical staff should implement appropriate measures to mitigate FT based on the different psychological stages of NPC patients. Additionally, it is important to actively leverage the positive motivating role of patients with lower level of FT, empowering other patients to relief FT.

Medical coping modes and financial toxicity

Based on the results of this study, the researchers found a significant negative correlation between MCMQ scores and FT in NPC patients (p = 0.003). It was observed that the confrontation dimension did not show a significant relationship with FT, whereas the avoidance dimension and acceptance-resignation dimension were found to be significant negatively correlated with FT (all p < 0.05). This implies that patients who tend to adopt avoidance and acceptance-resignation coping styles tend to have more severe FT. The possible reasons for the results include the long treatment duration of nasopharyngeal cancer, the potential risk of tumor metastasis, and the adverse reactions associated with radiotherapy and chemotherapy. These reasons could further compounding the financial burden on patients and diminishing their treatment confidence. Consequently, patients may lean towards employing avoidance or acceptance-resignation strategies, such as reducing living expenses, modifying treatment plans, or even discontinuing treatment⁸. Therefore, it is crucial for healthcare professionals to actively enhance the quality of medical care, prevent potential complications, empower patients to foster confidence in overcoming the disease, and assist them in adopting appropriate medical coping strategies. This involves providing guidance to NPC patients on protecting the skin of the head and neck to prevent radiation dermatitis, promoting oral hygiene to prevent radiation stomatitis, and ensuring adequate nutrition to prevent weight loss^27,28. Additionally, it is imperative to inform patients in detail about the potential treatment costs, anticipated efficacy, and overall expenses. This enables patients and their families to be fully prepared to fight with disease.

Social support and financial toxicity

The findings of this study showed a significant positive correlation between the PSSS scores and FT among NPC patients (p = 0.001). Specifically, family support, friend support, and other support were significant positively associated with FT (all p < 0.05). These results indicate that patients with better social support had lesser FT. Hamilton²⁹ noted that family support serves as a vital source of spiritual strength for patients in their battle against malignant tumors. Similarly, Calderon³⁰ believed that good social support could enhance the happiness of cancer patients and encouraging them to adopt constructive medical behaviors and effective coping strategies. Therefore, medical staffs should conduct a comprehensive assessment of the social support characteristics of NPC patients. They should provide diverse social support interventions to alleviate the financial burden, such as identifying avenues for public welfare assistance related to NPC and actively engaging in the improvement of nasopharyngeal cancer-related medical insurance policies. Meanwhile, multiple interventions should be employed to cultivate and enhance the perception of social support among NPC patients, such as peer support programs, WeChat online communication groups of NPC patients, and the three good things exercise³¹.

Limitations

Several limitations to the present study need to be acknowledged. Firstly, this study employed convenience sampling and only investigated nasopharyngeal cancer patients from one tertiary hospital, which may lead to selection bias. Secondly, despite this study observed a significant negative correlation between MCMQ scores and COST scores, as well as a significant positive correlation between PSSS scores and COST scores, these correlations were found to be weak to modest. Therefore, additional research are required to further validate these correlations. Thirdly, this study was a cross-sectional survey that only included Medical Coping Modes Questionnaire and Perceived Social Support Scale, making it unable to establish causal relationship between medical coping behavior, perceived social support, and financial toxicity. In the future, larger-scale and multi-center longitudinal survey studies could be conducted to validate the findings of this study. Additionally, it would be beneficial to consider incorporating more relevant variables to further explore the relationships between these variables and FT in NPC patients.

This cross-sectional study aimed to investigate the incidence and related factors of financial toxicity among nasopharyngeal carcinoma patients, and propose suggestions for improvement. High FT incidence was observed, with personal and household monthly income, annual household income, and tumor stage identified as significant factors influencing FT. Additionally, MCMQ and PSSS scores showed a significant correlation with FT in NPC patients. Our findings provide a basis for future prevention and intervention strategies against FT among NPC patients. Medical managers should encourage innovative treatment and nursing practices to help patients return to work. Workflow optimization is crucial in minimizing treatment-related expenses. Timely identification of FT is key, and medical staff could adopt strategies including peer support programs, the three good things exercise to guide patients towards positive medical coping modes and access greater social support.

Ethics approval and consent to participate: The experimental protocol was established, according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Xiangya Hospital. Informed consent was obtained from all subjects (IRB No. 202212288).

Consent for publication: Written informed consent for publication was obtained from all participants.

Availability of data and material: All data generated or analysed during this study are included in this published article.

Competing interests: The authors declared no competing interest with respect to the authorship and/or publication of this article.

Funding: This work was supported by the Research Project of China Hunan Provincial Science and Technology Department (2022ZK4059), the Research Project of Natural Science Foundation of Hunan Province (2023JJ40922), and the Scientific Research Project of The Chinese Nursing Association (ZHKYQ202107).

Authors' contributions:

Have made substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data: Qin Luo, Xiuwen Chen

Been involved in drafting the manuscript or revising it critically for important intellectual content: Qin Luo, Xiuwen Chen, Li liu, Jing Peng, Fan Tang

Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content: Qin Luo, Xiuwen Chen, Li liu, Jing Peng, Fan Tang

Agreed to be accountable for all aspects of the work in ensuring that questions related to the

accuracy or integrity of any part of the work are appropriately investigated and resolved: Qin Luo, Xiuwen Chen, Li liu, Jing Peng, Fan Tang

Acknowledgements: Not applicable.

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
Chen YP, Chan ATC, Le QT, Blanchard P, Sun Y, Ma J. Nasopharyngeal carcinoma. Lancet. 2019;394(10192):64-80.
Zhang YM, Gong GZ, Qiu QT, Han YW, Lu HM, Yin Y. Radiomics for Diagnosis and Radiotherapy of Nasopharyngeal Carcinoma. Front Oncol. 2022;11:767134. Published 2022 Jan5.
Gong L, Kwong DL, Dai W, et al. Comprehensive single-cell sequencing reveals the stromal dynamics and tumor-specific characteristics in the microenvironment of nasopharyngeal carcinoma. Nat Commun. 2021;12(1):1540. Published 2021 Mar 9.
Tang LL, Chen YP, Chen CB, et al. The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma. Cancer Commun (Lond). 2021;41(11):1195-1227.
Chen YP, Ismaila N, Chua MLK, et al. Chemotherapy in Combination With Radiotherapy for Definitive-Intent Treatment of Stage II-IVA Nasopharyngeal Carcinoma: CSCO and ASCO Guideline. J Clin Oncol. 2021;39(7):840-859.
Fitch MI, Sharp L, Hanly P, Longo CJ. Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: a systematic review of qualitative studies. J Cancer Surviv. 2022;16(2):314-328.
Smith GL, Banegas MP, Acquati C, et al. Navigating financial toxicity in patients with cancer: A multidisciplinary management approach. CA Cancer J Clin. 2022;72(5):437-453.
Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153-165.
Kuang Y, Yuan X, Zhu Z, Xing W. Financial Toxicity Among Breast Cancer Patients: A Scoping Review of Risk Factors and Outcomes [published online ahead of print, 2023 Jul 11]. Cancer Nurs. 2023;10.1097.
Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood). 2013;32(6):1143-1152.
Smith GL, Lopez-Olivo MA, Advani PG, et al. Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes. J Natl Compr Canc Netw. 2019;17(10):1184-1192.
Fang FM, Chiu HC, Kuo WR, et al. Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment. Int J Radiat Oncol Biol Phys. 2002;53(4):959-968.
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.
Yu HH,Bi X,Liu YY. Reliability and validity of the Chinese version on Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures[J].Chin J Epidemiol, 2017,38（8）：1118-1120.
Feifel H, Strack S, Nagy VT. Degree of life-threat and differential use of coping modes. J Psychosom Res. 1987;31(1):91-99.
Shen XH,Jiang QJ. Report of 701 cases of Medical Coping Style Questionnaire[J]. Chin Behav,2000,9（1）：22-24.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55(3-4):610-617.
Fabian A, Domschikowski J, Greiner W, et al. Financial toxicity in cancer patients treated with radiotherapy in Germany-a cross-sectional study. Strahlenther Onkol. 2022;198(12):1053-1061.
Baddour K, Fadel M, Zhao M, et al. The cost of cure: Examining objective and subjective financial toxicity in head and neck cancer survivors. Head Neck. 2021;43(10):3062-3075.
Lee AWM, Ng WT, Chan JYW, et al. Management of locally recurrent nasopharyngeal carcinoma. Cancer Treat Rev. 2019;79:101890.
Abrams HR, Durbin S, Huang CX, et al. Financial toxicity in cancer care: origins, impact, and solutions. Transl Behav Med. 2021;11(11):2043-2054.
Donkor A, Atuwo-Ampoh VD, Yakanu F, et al. Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis. Support Care Cancer. 2022;30(9):7159-7190.
Jing J, Feng R, Zhang X, Li M, Gao J. 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.
Smaldone MC, Uzzo RG. The Kubler-Ross model, physician distress, and performance reporting. Nat Rev Urol. 2013;10(7):425-428.
Ayala GX, Chan JCN, Cherrington AL, et al. Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis. Ann Behav Med. 2022;56(9):909-919.
Xia C, Jiang C, Li W, et al. A Phase II Randomized Clinical Trial and Mechanistic Studies Using Improved Probiotics to Prevent Oral Mucositis Induced by Concurrent Radiotherapy and Chemotherapy in Nasopharyngeal Carcinoma. Front Immunol. 2021;12:618150.
Fang KC, Lee CH, Chuang HC, et al. Acute radiation dermatitis among patients with nasopharyngeal carcinoma treated with proton beam therapy: Prognostic factors and treatment outcomes. Int Wound J. 2023;20(2):499-507.
Hamilton JB, Worthy VC, Moore AD, Best NC, Stewart JM, Song MK. Messages of Hope: Helping Family Members to Overcome Fears and Fatalistic Attitudes Toward Cancer. J Cancer Educ. 2017;32(1):190-197.
Calderon C, Gomez D, Carmona-Bayonas A, et al. Social support, coping strategies and sociodemographic factors in women with breast cancer. Clin Transl Oncol. 2021;23(9):1955-1960.
Sato D, Sekizawa Y, Sutoh C, et al. Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy and the Three Good Things Exercise for Insomnia: 3-Arm Randomized Controlled Trial. J Med Internet Res. 2022;24(2):e28747.

No competing interests reported.

Download PDF

Reviewers invited by journal
14 Aug, 2024
Editor assigned by journal
14 Aug, 2024
Submission checks completed at journal
10 Jul, 2024
First submitted to journal
28 Jun, 2024

You are reading this latest preprint version

Financial Toxicity-Related Factors in Patients With Nasopharyngeal Carcinoma: A Cross-Sectional Study.

Status:

Version 1

Abstract

Purpose

Methods

Results

Conclusion

Introduction

Methods

Study design

Sample

Setting and sample size

Variables and outcomes

Statistical analysis

Results

Patient characteristics and financial toxicity

Financial toxicity

Correlation analysis associated with financial toxicity

Predictors associated with financial toxicity

Discussion

Prevelence of financial toxicity

Patient characteristics and financial toxicity

Medical coping modes and financial toxicity

Social support and financial toxicity

Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1