老年肺癌患者经济毒性现状及影响因素研究

doi:10.3969/j.issn.1003-9198.2026.10.016

摘要/Abstract

摘要： 目的调查老年肺癌患者经济毒性现状并分析其影响因素。方法采用便利抽样法,选择2025年1—11月复旦大学附属华东医院和上海市松江区泗泾医院收治的409例老年肺癌患者作为研究对象,采用一般资料调查表、患者报告结局的经济毒性综合评分量表(COST-PROM)、心理弹性量表、社会支持量表、恐惧疾病进展简化量表进行调查和分析。采用多元线性回归分析老年肺癌患者经济毒性的影响因素。结果老年肺癌患者COST-PROM得分为(18.09±8.17)分,其经济毒性(得分≤25分)发生率为80.9%。多元线性回归分析结果显示,医疗费用来源、家庭年收入、可支配的家庭存款、治疗自付总费用、为医疗卖房贷款等、到达医疗机构乘车时间、心理弹性水平、恐惧疾病进展是老年肺癌患者经济毒性的主要影响因素(P＜0.05)。该模型共解释经济毒性得分总变异的69.7%(调整R²=0.697)。结论老年肺癌患者经济毒性发生率高,且其影响因素主要体现在医疗费用来源、家庭收入及心理弹性,临床可实施多维动态评估以早期识别高风险人群,优化医疗资源配置以降低自付负担,加强心理社会支持以提升患者韧性。

关键词: 老年人, 肺癌, 经济毒性, 影响因素

Abstract: Objective To survey the prevalence of financial toxicity among elderly patients with lung cancer and to analyze its influencing factors. Methods Using the convenience sampling method, A total of 409 older adults(aged ≥60 years) with lung cancer admitted to Huadong Hospital, Fudan University and Shanghai Songjiang District Sijing Hospital between January and November 2025 were enrolled in this study. Data were collected using a general information questionnaire, the Comprehensive Score for Financial Toxicity Based on Patient-Reported Outcome Measures(COST-PROM), the Connor-Davidson Resilience Scale(CD-RISC), the Social Support Rateing Scale(SSRS), and the Fear of Progression Questionnaire-Short Form(FoP-Q-SF). The influencing factors of financial toxicity in elderly patients with lung cancer were analyzed by multiple linear regression. Results The mean score of financial toxicity for elderly lung cancer patients was 18.09±8.17. Using a cutoff score of ≤25 to define financial toxicity, the prevalence was 80.9%. Multiple linear regression identified eight independent influencing factors: medical payment source, annual household income, household savings, out-of-pocket costs, property sales/loans for medical needs, travel time to medical facilities, psychological resilience, and fear of disease progression(all P<0.05), explaining 69.7% of the variance in financial toxicity scores(adjusted R²=0.697). Conclusions Elderly patients with lung cancer exhibit a high prevalence of financial toxicity, and its influencing factors are mainly reflected in source of medical expenses, household income and psychological resilience. In clinical practice, multi-dimensional dynamic assessment can be implemented to early identify high-risk groups, and medical resource allocation can be optimized to reduce out-of-pocket burden; psychosocial support should be strengthened to improve patients’ resilience.

Key words: aged, lung cancer, financial toxicity, influencing factor

中图分类号:

R473.73

赵雅如, 严珏怡, 韩聪, 于文杰, 顾芬. 老年肺癌患者经济毒性现状及影响因素研究[J]. 实用老年医学, 2026, 40(10): 1056-1062.

ZHAO Yaru, YAN Jueyi, HAN Cong, YU Wenjie, GU Fen. Prevalence and associated factors of financial toxicity in elderly patients with lung cancer[J]. Practical Geriatrics, 2026, 40(10): 1056-1062.

参考文献

[1] 王培宇, 黄祺, 王少东, 等. 《全球癌症统计数据2022》要点解读[J]. 中国胸心血管外科临床杂志, 2024, 31(7): 933-954.
[2] 辛雯艳, 黄磊, 闫贻忠. 2005—2014年中国老年人肺癌发病的时间趋势分析[J]. 现代预防医学, 2020, 47(12): 2113-2116.
[3] 王祥, 廖鹏强, 李强, 等. 肺癌的早期筛查现状及进展[J]. 肿瘤预防与治疗, 2022, 35(11): 1050-1054.
[4] 洪子强, 金大成, 白向豆, 等. 多原发肺癌诊断与治疗的最新研究进展[J]. 中国全科医学, 2022, 25(27): 3435-3442.
[5] ZAFAR S Y, ABERNETHY A P. Financial toxicity, Part I: a new name for a growing problem[J]. Oncology: Williston Park, 2013, 27(2): 80-81, 149.
[6] 姜男, 白锦兵, 魏思琪, 等. 癌症患者经济毒性的影响因素及管理策略研究进展[J]. 解放军护理杂志, 2020, 37(9): 62-64.
[7] AVIKI E M, THOM B, BRAXTON K, et al. Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment[J]. Support Care Cancer, 2022, 30(3): 2713-2721.
[8] DE LA CRUZ M, DELGADO-GUAY M O. Financial toxicity in people living with advanced cancer: a new, deadly, and poorly addressed effect of cancer and necessary treatment[J]. Semin Oncol Nurs, 2021, 37(4): 151171.
[9] 许可, 张楠, 刘金辉, 等. 肺癌患者经济毒性及影响因素分析[J]. 中华肿瘤防治杂志, 2021, 28(20): 1578-1582.
[10] 倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4): 378-380.
[11] 于慧会, 毕雪, 刘运泳. 中文版癌症患者报告结局的经济毒性量表信度和效度研究[J]. 中华流行病学杂志, 2017, 38(8): 1118-1120.
[12] DOYLE C. New grading system shows impact of financial toxicity on health-related quality of life[J]. J Oncol Navig Surviv, 2016, 7(4):46-47.
[13] 肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994,4(2): 98-100.
[14] 吴奇云, 叶志霞, 李丽, 等. 癌症患者恐惧疾病进展简化量表的汉化及信效度分析[J]. 中华护理杂志, 2015, 50(12): 1515-1519.
[15] YU X N, LAU J T F, MAK W W S, et al. Factor structure and psychometric properties of the Connor-Davidson Resilience Scale among Chinese adolescents[J]. Compr Psychiatry, 2011, 52(2): 218-224.
[16] NORONHA V, TONGAONKAR A, PILLAI A, et al. Prevalence and impact of financial toxicity in older patients with cancer: a prospective observational study in India[J]. Support Care Cancer, 2025, 33(5): 416.
[17] LIU M, HUANG D, LIU Y. Financial toxicity of patients with lung cancer in China: results from a National Survey Study[J]. Cancer Med, 2023, 12(4): 4751-4760.
[18] EZEIFE D A, MORGANSTEIN B J, LAU S, et al. Financial burden among patients with lung cancer in a publically funded health care system[J]. Clin Lung Cancer, 2019, 20(4): 231-236.
[19] 张江, 赵喜娟, 杨秉坤, 等. 肺癌放疗患者经济毒性现状调查[J]. 吉林医学, 2023, 44(4): 1062-1068.
[20] OFFODILE A C 2nd, GALLAGHER K, ANGOVE R, et al. Financial navigation in cancer care delivery: state of the evidence, opportunities for research, and future directions[J]. J Clin Oncol, 2022, 40(21): 2291-2294.
[21] 陈菲, 龚小玲. 乳腺癌病人经济毒性现状及影响因素分析[J]. 全科护理, 2023, 21(14): 1990-1993.
[22] 孙艳玲, 况艺, 袁潇逸, 等. 癌症生存者经济毒性现状及影响因素[J]. 护理学杂志, 2022, 37(15): 24-27, 31.
[23] MOLS F, TOMALIN B, PEARCE A, et al. Financial toxicity and employment status in cancer survivors. A systematic literature review[J]. Support Care Cancer, 2020, 28(12): 5693-5708.
[24] 袁潇逸, 孙艳玲, 况艺, 等. 乳腺癌生存者经济毒性现状与影响因素分析[J]. 中国护理管理, 2022, 22(6): 830-835.
[25] 张雯雯, 郎延梅, 李颖. 癌症患者心理弹性影响因素及干预措施的研究进展[J]. 当代护士, 2024, 31(23): 39-43.
[26] CHAN R J, GORDON L G, TAN C J, et al. Relationships between financial toxicity and symptom burden in cancer survivors: a systematic review[J]. J Pain Symptom Manage, 2019, 57(3): 646-660.e1.