Ocena finančnega bremena pri bolnikih z rakom v Sloveniji Assessment of financial burden in cancer patients in Slovenia

Abstract

Izhodišče: Finančna toksičnost (FT) predstavlja vse objektivne finančne posledice in subjektivne finančne skrbi, ki se pojavljajo pri bolnikih z rakom in njihovih svojcih zaradi bolezni in zdravljenja. Finančno breme, ki ga imajo slovenski bolniki z rakom, pred našo raziskavo še ni bilo opredeljeno, prav tako ni bil poznan vpliv FT na kakovost življenja (QoL). Namen: Cilj raziskave je bila ocena FT pri bolnikih z rakom v Sloveniji, njen vpliv na QoL bolnikov in preizkus dosedanjih inštrumentov za oceno FT in QoL. Metode: Za merjenje FT smo uporabili anketno metodologijo. Razvili smo lasten vprašalnik za oceno FT in uporabili mednarodno validirana vprašalnika FACIT-COST in EORTC QLQ-C30. Raziskava je bila prospektivna in presečna, potekala je na Onkološkem inštitutu Ljubljana od junija do oktobra 2023. Rezultati: Analizirali smo 590 veljavnih anket. Na podlagi vprašalnika FACIT-COST smo ugotovili, da večina anketiranih bolnikov (53,7 %) nima FT, pri 42,9 % anketiranih bolnikov pa je bila ta večinoma blaga do zmerna. Nizko FT med slovenskimi bolniki z rakom smo potrdili tudi z vprašalnikom EORTC QLQ-C30 in lastnim vprašalnikom. Večina bolnikov (85,1 %) je ocenila, da zaradi bolezni in zdravljenja niso imeli večjih stroškov. Na podlagi kazalnika finančnega bremena FACIT-COST in EORTC QLQ-C30 smo ugotovili, da so rizične skupine za večjo FT predvsem bolniki z nižjim neto dohodkom na gospodinjstvo (p ≤ 0,001), mlajši bolniki (p < 0,001), bolniki z rakom dojk (p = 0,016), zaposleni (p < 0,001), pa tudi bolniki na aktivnem onkološkem zdravljenju (p = 0,039). Pri lastnem vprašalniku so se za statistično pomembne pokazali še nižja stopnja izobrazbe (p ≤ 0,001), podeželsko okolje (p = 0,033) in vrsta zdravstvenega zavarovanja (p = 0,006). Vpliv veroizpovedi na FT na podlagi lastnega vprašalnika ni povezan z večjo FT, kot je to razvidno iz vprašalnikov FACIT- COST in EORTC QLQ-C30. Potrdili smo tudi vpliv nižjega dohodka na slabšo QoL, ostali parametri, ki vplivajo na QoL, pa so še: zelo nizka ali zelo visoka stopnja izobrazbe, rak glave in vratu in aktivnost onkološkega zdravljenja. Zaključki: V Sloveniji večina bolnikov z rakom ne občuti FT, v 42,9 % pa je ta blaga do zmerna. FT je statistično značilno povezana z višino dohodka, starostjo, vrsto raka, zaposlitvenim statusom, aktivnostjo onkološkega zdravljenja, pa tudi s stopnjo izobrazbe, podeželskim okoljem in vrsto zdravstvenega zavarovanja. Večja FT je povezana s slabšo QoL. Ta je povezana prav tako z višino dohodka, stopnjo izobrazbe, vrsto raka in aktivnostjo onkološkega zdravljenja.

Abstract (Eng)

Background: This study aims to define the financial burden experienced by Slovenian cancer patients, including both objective financial consequences and subjective financial worries resulting from their disease and treatment. Additionally, we investigate the impact of financial toxicity (FT) on quality of life (QoL). Prior to this study, no research had been conducted on this topic in Slovenia. Aim: The objective of this study was to evaluate the financial burden experienced by cancer patients in Slovenia, its impact on their QoL, and to test the effectiveness of existing tools for assessing FT and QoL. Methods: A survey methodology was employed to measure FT. We developed our own questionnaire to assess FT, and the internationally validated FACIT-COST and EORTC QLQ-C30 questionnaires were used. The study was prospective and cross-sectional and was held at the Institute of Oncology Ljubljana from June to October 2023. Results: We analysed 590 valid surveys. Based on the FACIT- -COST questionnaire, we found that the majority of surveyed patients (53.7%) had no FT, and 42.9% of surveyed patients mostly had mild to moderate FT. The low FT among Slovenian cancer patients was also confirmed by the EORTC QLQ-C30 questionnaire and our own questionnaire. The majority of patients (85.1%) estimated that they did not incur any major costs due to their disease and treatment. Based on the FACIT-COST and the EORTC QLQ-C30 indicator for financial burden, we found that the risk groups for increased FT were mainly patients with a lower net household income (p ≤ 0.001), younger patients (p < 0.001), breast cancer patients (p = 0.016), working patients (p < 0.001) and patients undergoing active oncological treatment (p = 0.039). In our own questionnaire, a lower level of education (p ≤ 0.001), a rural environment (p = 0.033) and the type of health insurance (p = 0.006) also proved to be important for FT. The effect of religion on FT is not associated with higher FT based on our own questionnaire, as shown by the FACIT-COST and EORTC QLQ-C30 questionnaires. We also confirmed the effect of lower income on poorer QoL. Other parameters influencing QoL are: a very low or very high level of education, head and neck cancer and treatment activity. Conclusions: In Slovenia, the majority of cancer patients do not suffer from FT, and 42.9% have mild to moderate FT. FT is statistically significantly associated with income level, age, type of cancer, employment status, oncological treatment activity, education level, rural environment and type of health insurance. Higher FT is associated with poorer QoL. It is also associated with income level, education level, cancer type and oncological treatment activity.