Hematologic malignancy outcomes have remarkably improved in the past decade with further advancement expected in future years. However, the detrimental effects of financial toxicity (FT) on patients with hematologic malignancies, because of both diagnoses and subsequent treatments, have not been studied comprehensively. We performed a systematic review of all studies reporting FT as a primary or secondary outcome among adult or pediatric patients with hematological malignancies. A total of 55 studies met the inclusion criteria for analysis. Across studies, 20–50% of patients reported some form of FT, including loss of work productivity, food and transportation costs, and depletion of savings. Younger age, lower-income level, unemployment, and rural residence were the most commonly identified risk factors for FT. Two studies looked at survival outcomes, with one reporting improvement in survival with a decrease in financial toxicity. However, significant heterogeneity in FT definitions was found between countries and payor systems. Only half of the studies (51%, n = 28) used validated survey instruments such as the COST assessment. The present systematic review identified that FT is common in patients with hematological malignancies and may be associated with poorer outcomes. However, studies of FT generally use non-standardized methods with cross-sectional analyses rather than longitudinal, prospective assessments. Further work is needed to standardize FT reporting and investigate measures to alleviate FT among patients with hematologic malignancies.
过去十年间，血液系统恶性肿瘤的预后显著改善，预计未来几年将进一步取得进展。然而，由于诊断本身及后续治疗所致的经济毒性对血液系统恶性肿瘤患者的有害影响，尚未得到全面研究。我们对所有以成人或儿童血液系统恶性肿瘤患者为研究对象、并将经济毒性作为主要或次要结局报告的研究进行了系统综述。共55项研究符合分析纳入标准。综合各项研究，20%-50%的患者报告了某种形式的经济毒性，包括工作生产力下降、食品与交通成本增加以及储蓄耗尽。年龄较小、收入水平较低、失业及农村居住是最常见的经济毒性风险因素。两项研究关注了生存结局，其中一项指出随着经济毒性降低，患者生存期有所改善。然而，不同国家及支付体系之间对经济毒性的定义存在显著异质性。仅半数研究（51%，n=28）使用了经过验证的调查工具（如COST评估）。本系统综述表明，经济毒性在血液系统恶性肿瘤患者中普遍存在，且可能与不良预后相关。然而现有研究多采用非标准化方法及横断面分析，而非纵向前瞻性评估。未来需进一步规范经济毒性报告标准，并探索减轻血液系统恶性肿瘤患者经济毒性的干预措施。
Financial toxicity in hematological malignancies: a systematic review
肿瘤(癌症)患者之家