PURPOSE To explore strategies related to cancer-related financial toxicity (FT) from the perspectives of cancer survivors and stakeholders in China and to evaluate their views within the context of the social ecological model (SEM). METHODS Between March and July 2022, we conducted a descriptive qualitative study with semistructured interviews of 23 cancer survivors and 14 stakeholders. Qualitative content analysis on the basis of the SEM was used to analyze the data with NVivo 12. RESULTS Guided by the SEM, we identified 12 subthemes that described how to mitigate FT. Individual-level strategies included increasing cost-related health literacy, strengthening adherence to standardized treatments, and improving resilience to cancer and financial changes. Interpersonal-level strategies included strengthening family support and social networks. Organizational-level strategies included using evidence-based treatments, effective communication of costs, and providing financial information support. Community-level strategies included improving symptom management throughout survivorship and providing psychosocial support. Policy-level strategies included optimizing health insurance policies and promoting collaboration among medical institutions. CONCLUSION Our findings provide a comprehensive understanding of strategies pertaining to FT, offering insights that could support the development of future interventions. This research suggests that interventions that encompass multiple levels—individual, interpersonal, organizational, community, and policy—rather than focusing on only one level might be the most beneficial for managing FT.

Purpose To explore the process of coping with financial toxicity among young women with breast cancer and formulate a grounded theory that serves as a foundation for creating intervention strategies aimed at supporting cancer survivors. Methods A qualitative study using the Corbin and Strauss variant of grounded theory. A series of in-depth interviews were carried out with young women with breast cancer ( n = 29) using the theoretical sampling method. We analyzed data by coding core categories in the patients’ coping processes and developing theory around these categories. Data collection and analysis were performed simultaneously. Results A substantial theory of the process of coping with financial toxicity among young female breast cancer survivors was constructed. Two core concepts, suffering and adjustment, were identified. Young women with breast cancer suffered from financial toxicity, which was related to risk factors, coping resources, and unmet needs. To overcome financial toxicity, young women with breast cancer adjusted by reshaping consumption concept, re-dividing of family functions, re-planning of occupation career, and rebuilding life confidence. Conclusion This qualitative study constructed a theory delineating the coping strategies employed by young women with breast cancer in response to financial toxicity, offering profound insights into the intricacies of cancer-related financial toxicity. Identifying risk factors, enhancing coping resources, and meeting unmet needs would be helpful to patients’ adjustment to financial stress.

目的 检索、评价并汇总乳腺癌患者化疗相关认知障碍非药物干预的相关证据.方法 计算机检索UpToDate、BMJ最佳临床实践、国际指南协作网、英国国家卫生与临床优化研究所网站、苏格兰学院间指南网、加拿大安大略注册护士协会网站、美国国家综合癌症网络、Cochrane图书馆、澳大利亚乔安娜布里格斯研究所循证卫生保健数据库、PubMed、Web of Science、CINAHL、中国生物医学文献数据库、中国知网和万方数据平台中所有相关证据,包括临床决策、证据总结、指南、专家共识和系统评价,检索时限为建库至2023年5月14日.由2名研究者独立完成文献方法学质量评价和证据的提取与汇总.结果 纳入21篇文献,包括1篇临床决策、1篇证据总结、1篇指南和18篇系统评价.从安全有效性、自我管理教育与支持、认知康复训练、运动锻炼、正念干预和多策略干预6个领域提取了16条最佳证据.结论 该研究总结的最佳证据的质量和级别整体水平较高,对临床医护人员开展科学有效的乳腺癌患者化疗相关认知障碍的非药物管理具有指导意义,证据应用和转化时需充分考虑国内临床情境和患者的个体差异性.

Background Breast cancer has become the leading cause of global cancer incidence. With the improvement of treatment methods, financial toxicity among breast cancer patients has been widely studied. Objectives The aims of this study were to summarize the risk factors for and outcomes of financial toxicity among breast cancer patients, to identify populations at risk for financial toxicity, to identify the consequent health impacts, and to provide evidence for subsequent intervention programs. Methods We searched the PubMed/MEDLINE, Web of Science, MEDLINE (Ovid), CINAHL (EBSCO), EMBASE (Ovid), ProQuest, and China National Knowledge Infrastructure databases from inception to July 21, 2022. We followed the updated framework for scoping reviews proposed by the Joanna Briggs Institute. Results A total of 31 studies were included. Risk factors and outcomes of financial toxicity among breast cancer patients were identified and extracted. The risk factors included socioeconomic, demographic, disease and treatment, and psychological and cognitive factors, whereas financial toxicity affected the physical, behavioral, and psychological domains of breast cancer patients, resulting in material loss, coping behaviors, and impaired health-related quality of life. Conclusion Financial toxicity among breast cancer patients depends on multiple factors and has profound effects. The findings will be helpful for identifying breast cancer patients at a high risk of financial toxicity and developing intervention programs to reduce financial toxicity and outcomes. Implications for Practice More high-quality prospective, multicenter studies should be conducted in the future to better understand the trajectory of and risk factors for financial toxicity. Further studies should merge symptom management and psychosocial support into intervention programs.

Abstract Background Symptom networks can provide empirical evidence for the development of personalized and precise symptom management strategies. However, few studies have explored the symptom networks of multidimensional symptom experiences in cancer survivors. The objectives of this study were to generate symptom networks of multidimensional symptom experiences in cancer survivors and explore the centrality indices and density in these symptom networks Methods Data from 1065 cancer survivors were obtained from the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory was used to assess the prevalence and severity of 13 cancer‐related symptoms. We constructed contemporaneous networks with all 13 symptoms after controlling for covariates. Results Distress (rs = 9.18, rc = 0.06), sadness (rs = 9.05, rc = 0.06), and lack of appetite (rs = 9.04, rc = 0.06) had the largest values for strength and closeness. The density of the “less than 5 years” network was significantly different from that of the “5–10 years” and “over 10 years” networks (p < 0.001). We found that while fatigue was the most severe symptom in cancer survivorship, the centrality of fatigue was lower than that of the majority of other symptoms. Conclusion Our study demonstrates the need for the assessment of centrality indices and network density as an essential component of cancer care, especially for survivors with <5 years of survivorship. Future studies are warranted to develop dynamic symptom networks and trajectories of centrality indices in longitudinal data to explore causality among symptoms and markers of interventions.

INTRODUCTION:Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS:A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS:From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS:Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.

目的 探索年轻女性乳腺癌生存者应对经济毒性的特征和需求,为构建此类人群经济毒性的干预策略提供建议.方法 目的抽样法选取上海市某三级甲等肿瘤医院29例年轻女性乳腺癌生存者进行半结构式访谈,采用内容分析法分析资料并提炼主题.结果 年轻女性乳腺癌生存者经济毒性的应对策略可归纳为以下5个主题:以"坚强"为特征的独立应对、以"开源节流"为特征的理性应对、以"依从治疗"为特征的科学应对、以"未雨绸缪"为特征的预判性应对、应对经济毒性的需求与期望.结论 医护人员应关注年轻女性乳腺癌群体应对经济毒性的特点与需求,提供充足信息,增强社会支持,从而帮助其更好地应对经济毒性.

目的 调查老年癌症生存者孤独感现状并分析其影响因素.方法 采用方便抽样法,选取2021年5月1日-10月31日上海市3个社区卫生服务中心和1个病友团体的老年癌症生存者832例,使用一般资料问卷、疾病及治疗问卷、癌症孤独量表、癌症低社会期望量表、领悟社会支持量表、中文版M.D.Anderson症状评估量表及心理弹性量表简化版进行调查.采用单因素分析、相关分析及分层回归分析癌症生存者孤独感的影响因素及其影响程度.结果 本研究共纳入832例老年癌症生存者,其孤独感平均得分为(15.31±5.47)分.分层回归分析结果显示、人口学因素(婚姻状况、与配偶同住情况、患病前工作状态、经济困难程度)、疾病相关因素(肿瘤分期、患病时间、共病情况)、症状因素(症状严重程度、症状困扰程度)和心理社会因素(社会支持、心理弹性、低社会期望)分别可解释老年癌症生存者孤独感变异的12.2％、3.7％、13.0％和17.9％,差异均有统计学意义(P＜0.001).结论 老年癌症生存者普遍具有孤独感,在控制人口学因素和疾病相关因素后,症状因素和心理社会因素与孤独感显著相关.应注意评估老年癌症生存者的孤独感,关注孤独感强的生存者群体,及早进行干预,以减轻他们的孤独感,提高其生活质量.

目的 描述乳腺癌生存者自我报告的经济毒性现状,并分析其对生活质量的影响.方法 于2021年6-10月,采用方便抽样方法,应用一般资料调查表、慢性病治疗的经济毒性功能评估综合评分量表(COST-FACIT-v2)和癌症患者生命质量测定量表(FACT-G),对上海市徐汇区3家社区卫生服务中心和1个患者团体组织的乳腺癌生存者进行横断面调查.结果 共收集312例有效问卷,自我报告的经济毒性平均得分为(22.70±8.39)分.乳腺癌生存者经济毒性与生活质量总分(r总=0.283,P＜0.001)和生理状况(r1=0.219,P＜0.001)、社会/家庭状况(r2=0.124,P=0.029)、情感状况(r3=0.251,P＜0.001)以及功能状况(r4=0.227,P＜0.001)各维度呈正相关.分层回归分析结果显示,经济毒性可独立解释乳腺癌生存者生活质量变异的6.1％.结论 我国乳腺癌生存者普遍存在不同程度的经济毒性.在控制人口学、疾病因素变量后,经济毒性是降低乳腺癌生存者生活质量的独立风险因素,应引起医护工作者的关注.

目的 调查癌症生存者经济毒性现状,并分析其影响因素,为制订降低经济毒性的针对性干预策略提供参考.方法 选取1 065例癌症生存者为研究对象,采用一般资料问卷、慢性病治疗的经济毒性功能评估综合评分量表、心理弹性量表简化版、癌症孤独和负面社会期望量表、领悟社会支持量表、安德森症状量表进行横断面调查.结果 癌症生存者经济毒性总分为(24.20±7.75)分,其中535例(50.23％)存在经济毒性.多重线性回归分析结果显示:家庭月收入、可支配的家庭存款、截止目前自付费用、治疗费用信息了解程度、患肿瘤部位、抗肿瘤治疗方式,以及症状严重程度、心理弹性、孤独感、社会期望是癌症相关经济毒性的主要影响因素(均P＜0.05),可解释经济毒性总变异的39.0％.结论 经济毒性在癌症生存者中普遍存在,除人口学、疾病、经济层面因素外,症状严重程度、心理弹性、孤独感和社会期望均会影响癌症生存者相关经济毒性,需采取针对性干预措施以降低其经济毒性水平.

目的:调查乳腺癌生存者的经济毒性现状,并分析其影响因素.方法:采用方便抽样方法,应用一般资料调查表、慢性病治疗经济毒性功能评估综合评分量表、心理弹性量表、领悟社会支持量表和M.D.Anderson症状评估量表,于2021年6月—10月对上海市徐汇区3家社区卫生服务中心和1个患者团体组织的乳腺癌生存者进行横断面调查.结果:共纳入312名乳腺癌生存者,其经济毒性得分为(22.70±8.39)分.多元线性回归结果显示,乳腺癌生存者的年龄、受教育水平、化疗、独居、个人月总收入、家庭可支配存款、心理弹性、症状困扰程度是经济毒性的影响因素,可解释总变异的28.5％.结论:经济毒性在乳腺癌生存者中普遍存在,影响其生活质量.除人口学因素外,心理弹性、症状困扰程度与癌症相关经济毒性存在关系,这为今后开发针对经济毒性的干预策略提供了新的视角.

Objective:To explore the causes and influencing factors of financial toxicity in young breast cancer survivors, and to provide evidence for intervention program development to improve financial toxicity in young breast cancer survivors.Methods:Using descriptive qualitative research methods, 29 young breast cancer patients from September to December 2021 in Breast Surgery Follow-up Clinic of Fudan University Shanghai Cancer Center were interviewed. The Nvivo 12.0 qualitative data analysis software was used to analyze the data.Results:Four themes were extracted as following, direct cost of cancer treatment was the primary cause of financial toxicity, indirect costs related to cancer and treatment cannot be ignored, long-term effects of cancer and treatment further exacerbated financial toxicity, and cancer-related financial toxicity was also influenced by a variety of other factors.Conclusions:Multiple causes affected the experience of financial toxicity in young breast cancer survivors. The occurrence and risks of financial toxicity in young breast cancer survivors should be assessed. Intervention and support should be provided to meet the needs of young breast cancer survivors.