Financial toxicity (FT) is prevalent among older adults with cancer due to the expensive costs of cancer treatment and causes a decline in quality of life (QoL). This study aimed to get insights into the potential mechanisms of how FT impacts QoL through a moderated mediation model and explore the mediating role of loneliness and the moderating role of social support. A cross-sectional survey from May to October 2021 was conducted to recruit older adults with cancer aged 60 years and above in Shanghai, China. A total of 832 participants were included and answered questionnaires. SPSS PROCESS macro 4.2 software was administered to perform moderated mediation analysis. In the conceptual model, FT serves as the independent variable, QoL as the outcome variable, and loneliness as the mediator. Social support is hypothesized as moderator, influencing all three paths in the mediation model. Loneliness partially mediated the relationship of FT on QoL (β = 0.129, P < 0.001, 95

Objective:This study aims to develop a financial navigation program among patients with breast cancer in China and assess its feasibility, acceptability, and preliminary effects on cost-related health literacy and financial toxicity (FT). Methods:The Medical Research Council (MRC) framework were adopted to guide the development of the financial navigation program, providing a structured approach to complex intervention development and evaluation. It consisted of three phases: evidence identification via a scoping review, intervention content modeling through qualitative study analysis, and outcome mapping based on social stress theory. The feasibility, acceptability and primary effectiveness were examined in a single-center, assessor-blinded pilot randomized controlled trial with 26 recruited patients. Results:The financial navigation program consists of needs assessment, cost-related health education, resource/service referral and personalized counseling. The consent rate and a 1-month attrition rate for the feasibility study of the intervention were 55.9% and 7.7%, respectively. Most (91.7%) participants were satisfied with the program and perceived benefits. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed. Conclusions:The MRC framework serves as a useful scientific basis for developing financial navigation program with a culturally sensitive approach. The financial navigation program was feasible, acceptable, effective in improving cost-related health literacy and has the potential to enhance FT among patients with breast cancer in China. Trial registration:ClinicalTrials.gov Identifier NCT06355440.

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.

Background: Financial toxicity (FT) is a global challenge for breast cancer patients due to high costs of care. Financial navigation is a promising intervention to alleviate FT, but evidence remains limited, especially within the Chinese healthcare system. To assess the feasibility, acceptability, and preliminary effects of a financial navigation program among breast cancer patients in China. Methods: In this single-center, single-blinded pilot randomized controlled trial, a financial navigation program comprising needs assessment, cost-related health education, resource/service referral, and personalized counseling was evaluated. Feasibility was assessed through recruitment, attrition, and adherence rates. Acceptability was measured via participant satisfaction surveys and semi-structured interviews. Preliminary effects were evaluated through cost-related health literacy and three domains of FT. Results: Twenty-six breast cancer patients were recruited, with a consent rate of 55.9% and a 1-month attrition rate of 7.7%. All participants in the intervention group completed needs assessment and cost-related health education, with resource / service referral and personalized counseling provided as needed. The intervention significantly improved cost-related health literacy, although no statistically significant between-group difference in FT was observed. Most participants reported satisfaction and perceived the program as useful. Conclusions: The financial navigation program was feasible, acceptable, and effective in improving cost-related health literacy among breast cancer patients in China. Implications for Practice: This study generated insights to guide future implementation of full-scale RCTs with larger samples and longer durations to further explore the intervention’s effectiveness.

IntroductionDue to aging, older adults with cancer (OAC) may be confronted with a complex interplay of multiple age-related issues; coupled with receiving cancer treatment, OAC may experience multiple concurrent symptoms that require the identification of the core symptom for effective management. Constructing symptom networks will help in the identification of core symptoms and help achieve personalized and precise interventions. Currently, few studies have used symptom networks to identify core symptoms in OAC. Our objectives were to construct symptom networks of OAC, explore the core symptoms, and compare the differences in symptom networks among various subgroups.Materials and MethodsSecondary analysis was performed using data from 485 OAC collected in 2021 from a cross-sectional survey named the Shanghai CANcer Survivor (SCANS) Report. The MD Anderson Symptom Inventory (MDASI) was used to assess the incidence and severity of cancer-related symptoms. We used the R package to construct symptom networks and identify the centrality indices. The network comparison test was used to compare network differences among the subgroups.ResultsThe most common and severe symptoms reported were fatigue, disturbed sleep, and difficulty remembering. The network density was 0.718. Vomiting (rs = 1.81, rb = 2.13), fatigue (rs = 1.54, rb = 1.93), and sadness (rs = 0.81, rb = 0.69) showed the highest strength values, which suggested that these symptoms were more likely to co-occur with other symptoms. The network comparison tests showed significant differences in symptom network density between the subgroups categorized as survival “< 5 years” and survival “≥ 5 years” (p = 0.002), as well as between the those with comorbidities and those without comorbidities (p = 0.037).DiscussionOur study identified symptom networks in 485 OAC. Vomiting, fatigue, and sadness were important symptoms in the symptom networks of OAC. The symptom networks differed among populations with different survival durations and comorbidities. Our network analysis provides a reference for future targeted symptom management and interventions in OAC. In the future, conducting dynamic research on symptom networks will be crucial to explore interaction mechanisms and change trends between symptoms.

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.

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.

Objective The aim of this systematic review was to summarise the psychometric properties of patient-reported outcome measures (PROMs) measuring financial toxicity (FT) in cancer survivors. Design This systematic review was conducted according to the guidance of the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. Data sources Comprehensive searches were performed in PubMed, MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, ProQuest and Cochrane Library from database inception to February 2022. Eligibility criteria for selecting studies We included studies that reported any PROMs for measuring FT in cancer survivors who were ≥18 years old. FT was defined as perceived subjective financial distress resulting from objective financial burden. Studies that were not validation studies and that used a PROM only as an outcome measurement were excluded. Data extraction and synthesis Two reviewers independently extracted data from the included papers. We used the COSMIN criteria to summarise and evaluate the psychometric properties of each study regarding structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, cross-cultural validity/measurement invariance, criterion validity and responsiveness. Results A total of 23 articles (21 PROMs) were eligible for inclusion in this study. The findings highlighted that the Comprehensive Score for Financial Toxicity (COST) had an adequate development process and showed better psychometric properties than other PROMs, especially in internal consistency (Cronbach’s α=0.92), reliability (intraclass correlation coefficient=0.80) and hypothesis testing (r=0.42–0.20). Conclusions From a psychometric property perspective, the COST could be recommended as the most suitable worldwide available measure for use in research and clinical practice across different contexts. We suggest that PROMs should be selected only after careful consideration of the local socioeconomic context. Future studies are warranted to develop various FT PROMs based on different social and cultural backgrounds and to clarify the theoretical grounds for assessing FT.

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.

ObjectiveUsing Walker and Avant's method of concept analysis，to analyze the definition and connotation of cancer⁃related financial toxicity concepts.MethodsRelated literature on cancer⁃related financial toxicity were retrieved from China National Knowledge Infrastructure （CNKI），Wanfang Database，VIP Database，China Biomedical Literature Service System，PubMed，Web of Science，OVID，EMbase.Using Walker and Avant's method，to analyze the concept of financial toxicity.ResultsA total of 37 pieces of literature were included in this study.The definition of cancer⁃related financial toxicity included objective financial burden and subjective financial distress.The leading factor was the direct or indirect medical expenses incurred when receiving cancer treatment，which led to increased expenditure and decreased income during treatment or rehabilitation. The consequence included economic loss，subjective well⁃being reduction，health⁃related quality of life impairment，treatment compliance reduction，and low⁃quality treatment and care.ConclusionsCancer⁃related financial toxicity had a profound impact on the treatment and life of patients.Nurses should recognize the existence and importance of cancer⁃related financial toxicity；construct and carry out intervention plans that suit our national conditions for high⁃risk populations to reduce cancer-related financial toxicity.