Background: Proton therapy is indicated for cancers that would be difficult to treat with conventional radiotherapy. Compulsory healthcare insurance covers the costs of this therapy in Switzerland, but this does not mean that proton therapy is cost-neutral for every cancer patient. Significant out-of-pocket (OOP) costs may arise due to expenses associated with proton therapy, and patients may experience treatment-related financial distress—an effect known as “financial toxicity.” This study investigates the financial toxicity of patients undergoing proton therapy in a high-income country with a compulsory health insurance policy. Methods: Between September 2019 and November 2021, 146 Swiss cancer patients treated with proton therapy participated in this study, of whom 90 (62%) were adults and 56 (38%) were caregivers of child cancer patients. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). OOP costs during proton therapy were recorded weekly, and financial coping strategies were captured at the end of treatment. Findings: The median COST score, indicating financial toxicity, was 29.9 (IQR 21.0; 36.0) for all patients, 30.0 (IQR 21.3; 37.9) for adults, and 28.0 (IQR 20.5; 34.0) for children’s caregivers. Higher income (estimate 8.1, 95% CI 3.7 to 12.4,p≤ 0.001) was significantly associated with higher COST scores, indicating less financial toxicity. Further distance from home to the treatment centre per 100 km (estimate −3.7, 95% CI −5.7 to −1.9,p≤ 0.001) was significantly associated with lower COST scores, indicating increased financial toxicity. Married adult patients had substantially lower COST scores than single patients (estimate: −9.1, 95% CI −14.8 to −3.4,p≤ 0.001). The median OOP cost was 2050 Swiss francs (CHF) and was spent mainly on travel, accommodation, and eating out. Sixty-three (43%) patients used their savings; 54 (37%) cut spending on leisure activities; 21 (14.4%) cut living expenses; 14 (9.6%) borrowed money; nine (6.2%) worked more; and four (2.7%) sold property. Patients with high COST scores used significantly fewer coping strategies such as saving on leisure activities (estimate −9.5, 95% CI −12.4 to −6.6,p≤ 0.001), spending savings (estimate −3.9, 95% CI −6.3 to −1.4,p= 0.002), borrowing money (estimate −6.3, 95% CI −10.4 to −2.2,p= 0.003), and increasing workload (estimate −5.5, 95% CI −10.5 to −0.4,p= 0.035). Interpretation: A substantial number of cancer patients treated with proton therapy experience financial toxicity in Switzerland. Long travel distances to the proton therapy centre and low income negatively affect the financial well-being of these patients during proton therapy.
背景：质子治疗适用于常规放疗难以治疗的癌症。在瑞士，强制医疗保险覆盖了该疗法的费用，但这并不意味着质子治疗对每位癌症患者都是成本中性的。由于质子治疗相关支出，患者可能产生显著的自付费用，并经历治疗相关的财务困境——这一效应被称为"财务毒性"。本研究旨在探究在实施强制医疗保险政策的高收入国家中，接受质子治疗患者的财务毒性情况。 方法：2019年9月至2021年11月期间，146名接受质子治疗的瑞士癌症患者参与本研究，其中90名（62%）为成年患者，56名（38%）为儿童癌症患者的照护者。采用FACIT财务毒性综合评分量表评估财务毒性。质子治疗期间每周记录自付费用，治疗结束时收集财务应对策略信息。 结果：所有患者的财务毒性中位COST评分为29.9（四分位距21.0-36.0），成年患者为30.0（21.3-37.9），儿童照护者为28.0（20.5-34.0）。较高收入（估计值8.1，95% CI 3.7-12.4，p≤0.001）与较高COST评分显著相关，表明财务毒性较低。家庭至治疗中心距离每增加100公里（估计值-3.7，95% CI -5.7至-1.9，p≤0.001）与较低COST评分显著相关，表明财务毒性增加。已婚成年患者的COST评分显著低于单身患者（估计值：-9.1，95% CI -14.8至-3.4，p≤0.001）。自付费用中位数为2050瑞士法郎，主要用于交通、住宿和外食支出。63名（43%）患者动用储蓄；54名（37%）减少休闲活动支出；21名（14.4%）削减生活开支；14名（9.6%）借款；9名（6.2%）增加工作量；4名（2.7%）变卖资产。高COST评分患者显著减少使用应对策略，包括减少休闲支出（估计值-9.5，95% CI -12.4至-6.6，p≤0.001）、动用储蓄（估计值-3.9，95% CI -6.3至-1.4，p=0.002）、借款（估计值-6.3，95% CI -10.4至-2.2，p=0.003）及增加工作量（估计值-5.5，95% CI -10.5至-0.4，p=0.035）。 结论：在瑞士，接受质子治疗的癌症患者中有相当比例经历财务毒性。前往质子治疗中心的较长通勤距离和较低收入水平对这些患者质子治疗期间的财务状况产生负面影响。
肿瘤(癌症)患者之家