接受区域淋巴结照射的乳腺癌患者的财务毒性：癌症亚型的变化
Financial toxicity in breast cancer patients receiving regional nodal irradiation: Variation by cancer subtype
影响因子:7.90000
分区:医学2区 / 妇产科学2区 肿瘤学2区
发表日期:2024 Dec
作者:
Grace L Smith, Benjamin D Smith, Chi-Fang Wu, Simona F Shaitelman, Mariana Chavez-MacGregor, Rashmi Murthy, Kelsey Kaiser, Kimberly S Ku, Julia J Shi, Sanjay S Shete, Ying-Shiuan Chen, Robert J Volk, Sharon H Giordano, Ya-Chen T Shih, Karen E Hoffman
摘要
我们评估了具有较高风险临床因素的乳腺癌患者的社会人口统计学和临床预测指标，保证临床因素保证区域淋巴结照射（RNI）。183Among183参与者参加了一项用于常规vs.低效率治疗的临床试验的参与者，使用RNI的临床治疗，使用RNI，125（68％）使用FT测量的癌症经济验证（68％），并在癌症方面进行了调查（均经过验证的经济性（RESIDER），并得到了经济的验证，并得到了经济的验证，并得到了经济的验证。 （最小）至10（重度）ft。使用Pearson相关系数和Kruskal Wallis，Mann-Whitney U和Jonckheere-Terptra测试评估与预测因子的关联。使用可转换为相对风险（RR）的多变量逻辑回归测试了严重FT（富集≥5）的预测因子。样品的相对风险（RR），全部接受RNI，92％的化学疗法，67％的腋窝解剖，26％的乳房切除术，无需重新结构，以及32％的重新结构手术。在1。48年的中位随访中，FT得分中位数为2.13（IQR 0.93-4.6），其中20.8％的患者患有严重的FT。未经调整的较差的FT得分与年轻年龄（P = 0.003），西班牙裔种族（P = 0.006），较低的收入（P = 0.02），从诊断到FT评估的较短间隔（P = 0.02）（P = 0.02）和化学疗法收据（p = 0.05），但与乳房手术类型（P = 0.42），P =0。 （p = 0.68）或n级（p = 0.47）。在多变量分析中，三重阴性亚型是预测严重FT的唯一临床因素（RR = 3.38; 95％CI 1.48-4.99; P = 0.01）。在接受RNI的乳腺癌患者中，三重阴性亚型与严重的FT相关，这表明肿瘤受体Subtype可能会识别出乳腺癌的良好范围。
Abstract
We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI).Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR).Of the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93-4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48-4.99; P = 0.01).Among patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.