Quantifying the Effect of Financial Burden on Health-Related Quality of Life among Patients with Non-Hodgkin’s Lymphomas
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
3. Discussions
4. Methods
4.1. Data Source and Collection
4.2. Measurement of HRQoL
4.2.1. The 5-Level EQ-5D (EQ-5D-5L)
4.2.2. EORTC QLQ-C30 (QLQ-C30)
4.3. Measurement of Financial Burden
4.4. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Data Availability Statement
Ethical Consideration
References
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Patients’ Characteristics | n (%) | ||||||||
---|---|---|---|---|---|---|---|---|---|
Overall | Subjective Financial Burden | Objective Financial Burden | |||||||
Low | Moderate | High | p-Value | Low | Moderate | High | p-Value | ||
Sex | |||||||||
Male | 808 (52.2) | 297 (36.8) | 238 (29.5) | 273 (33.8) | 0.078 | 353 (43.7) | 129 (16.0) | 326 (40.3) | 0.254 |
Female | 741 (47.8) | 314 (42.4) | 199 (26.9) | 228 (30.8) | 304 (41.0) | 141 (19.0) | 296 (39.9) | ||
Age | |||||||||
≤30 | 207 (13.4) | 71 (34.3) | 53 (25.6) | 83 (40.1) | 0.267 | 86 (41.5) | 27 (13.0) | 94 (45.4) | 0.218 |
31–40 | 503 (32.5) | 201 (40.0) | 138 (27.4) | 164 (32.6) | 217 (43.1) | 87 (17.3) | 199 (39.6) | ||
41–50 | 430 (27.8) | 171 (39.8) | 121 (28.1) | 138 (32.1) | 184 (42.8) | 79 (18.4) | 167 (38.8) | ||
51–60 | 265 (17.1) | 110 (41.5) | 80 (30.2) | 75 (28.3) | 102 (38.5) | 57 (21.5) | 106 (40.0) | ||
≥61 | 141 (9.1) | 58 (41.1) | 45 (31.9) | 38 (27.0) | 68 (48.2) | 18 (12.8) | 55 (39.0) | ||
Educational attainment | |||||||||
No/Primary | 207 (13.4) | 49 (23.7) | 48 (23.2) | 110 (53.1) | <0.001 | 59 (28.5) | 29 (14.0) | 119 (57.5) | <0.001 |
Secondary/Post-secondary | 699 (45.1) | 223 (31.9) | 212 (30.3) | 264 (37.8) | 272 (38.9) | 125 (17.9) | 302 (43.2) | ||
Tertiary or above | 643 (41.5) | 339 (52.7) | 177 (27.5) | 127 (19.8) | 326 (50.7) | 116 (18.0) | 201 (31.3) | ||
Health Insurance ^ | |||||||||
UEBMI/URBMI | 1165 (75.2) | 128 (33.3) | 94 (24.5) | 162 (42.2) | <0.001 | 511 (43.9) | 211 (18.1) | 443 (38.0) | <0.001 |
NCMS | 203 (13.1) | 36 (17.7) | 52 (25.6) | 115 (56.7) | 64 (31.5) | 28 (13.8) | 111 (54.7) | ||
CIS | 94 (6.1) | 64 (68.1) | 21 (22.3) | 9 (9.6) | 54 (57.4) | 16 (17.0) | 24 (25.5) | ||
No insurance | 12 (0.8) | 3 (25.0) | 3 (25.0) | 6 (50.0) | 2 (16.7) | 0 | 10 (83.3) | ||
Family register | |||||||||
Urban residents | 1170 (75.5) | 513 (43.8) | 332 (28.4) | 325 (27.8) | <0.001 | 529 (45.2) | 209 (17.9) | 432 (36.9) | <0.001 |
Rural residents | 372 (24.5) | 92 (24.7) | 105 (28.2) | 175 (47.0) | 124 (33.3) | 60 (16.1) | 188 (50.5) | ||
Duration of disease (years) | |||||||||
1–3 | 785 (58.5) | 310 (39.5) | 223 (28.4) | 252 (32.1) | 0.552 | 203 (25.9) | 145 (18.5) | 437 (55.7) | <0.001 |
4–6 | 395 (29.5) | 174 (44.1) | 93 (23.5) | 128 (32.4) | 215 (54.4) | 76 (19.2) | 104 (26.3) | ||
7–10 | 120 (9.0) | 47 (39.2) | 34 (28.3) | 39 (32.5) | 70 (58.3) | 19 (15.8) | 31 (25.8) | ||
≥10 | 40 (3.0) | 17 (42.5) | 13 (32.5) | 10 (25.0) | 24 (60.0) | 5 (12.5) | 11 (27.5) | ||
Family income (USD/year) | |||||||||
≤20000 | 496 (51.3) | 199 (40.1) | 151 (30.4) | 146 (29.4) | <0.001 | 198 (39.9) | 87 (17.5) | 211 (42.5) | <0.001 |
20001–30000 | 268 (27.7) | 152 (56.7) | 77 (28.7) | 39 (14.6) | 146 (54.5) | 54 (20.1) | 68 (25.4) | ||
30001–50000 | 115 (11.9) | 77 (67.0) | 23 (20.0) | 15 (13.0) | 72 (62.6) | 28 (24.3) | 15 (13.0) | ||
≥50001 | 88 (9.1) | 72 (81.8) | 11 (12.5) | 5 (5.7) | 75 (85.2) | 12 (13.6) | 1 (1.1) | ||
Chemotherapy | |||||||||
Yes | 1292 (90.2) | 487 (37.7) | 356 (27.6) | 449 (34.8) | 0.009 | 489 (37.8) | 233 (18.0) | 570 (44.1) | <0.001 |
No | 141 (9.8) | 65 (46.1) | 45 (31.9) | 31 (22.0) | 78 (55.3) | 22 (15.6) | 41 (29.1) | ||
Immunotherapy | |||||||||
Yes | 609 (42.5) | 241 (39.6) | 176 (28.9) | 192 (31.5) | 0.396 | 244 (40.1) | 105 (17.2) | 260 (42.7) | 0.882 |
No | 824 (57.5) | 311 (37.7) | 225 (27.3) | 288 (35.0) | 323 (39.2) | 150 (18.2) | 351 (42.6) | ||
Radiation therapy | |||||||||
Yes | 308 (21.5) | 140 (45.5) | 79 (25.6) | 89 (28.9) | 0.017 | 109 (35.4) | 61 (19.8) | 138 (44.8) | 0.217 |
No | 1125 (78.5) | 412 (36.6) | 322 (28.6) | 391 (34.8) | 458 (40.7) | 194 (17.2) | 473 (42.0) | ||
Surgery | |||||||||
Yes | 221 (15.4) | 80 (36.2) | 59 (26.7) | 82 (37.1) | 0.46 | 94 (42.5) | 32 (14.5) | 95 (43.0) | 0.332 |
No | 1212 (84.6) | 472 (38.9) | 342 (28.2) | 398 (32.8) | 473 (39.0) | 223 (18.4) | 516 (42.6) | ||
Treatment status | |||||||||
Never be treated (no need for treatment) | 116 (7.5) | 59 (50.9) | 36 (31.0) | 21 (18.1) | <0.001 | 90 (77.6) | 15 (12.9) | 11 (9.5) | <0.001 |
Currently not undertreatment (improved due to last treatment) | 122 (7.9) | 59 (48.4) | 26 (21.3) | 37 (30.3) | 70 (57.4) | 20 (16.4) | 32 (26.2) | ||
Under treatment | 612 (39.5) | 180 (29.4) | 197 (32.2) | 235 (38.4) | 240 (39.2) | 117 (19.1) | 255 (41.7) | ||
Treatment just completed | 699 (45.1) | 313 (44.8) | 178 (25.5) | 208 (29.8) | 257 (36.8) | 118 (16.9) | 324 (46.4) | ||
Sub-types | |||||||||
CLL | 158 (10.2) | 66 (41.8) | 50 (31.6) | 42 (26.6) | <0.001 | 98 (62.0) | 27 (17.7) | 33 (20.9) | <0.001 |
FL | 359 (23.2) | 149 (41.5) | 106 (29.5) | 104 (29.0) | 159 (44.3) | 76 (21.2) | 124 (34.5) | ||
LPL | 31 (2.0) | 12 (38.7) | 9 (29.0) | 10 (32.3) | 17 (54.8) | 3 (9.7) | 11 (35.5) | ||
MALT | 86 (5.6) | 42 (48.8) | 22 (25.6) | 22 (25.6) | 41 (47.7) | 16 (18.6) | 29 (33.7) | ||
MCL | 76 (4.9) | 10 (13.2) | 22 (28.9) | 44 (57.9) | 23 (30.3) | 17 (22.4) | 36 (47.4) | ||
DLBCL | 583 (37.6) | 249 (42.7) | 159 (27.3) | 175 (30.0) | 238 (40.8) | 91 (15.6) | 254 (43.6) | ||
BL | 27 (1.7) | 6 (22.2) | 8 (29.6) | 13 (48.1) | 11 (40.7) | 2 (7.4) | 14 (51.9) | ||
T-LBL | 35 (2.3) | 7 (20.0) | 6 (17.1) | 22 (62.9) | 9 (25.7) | 4 (11.4) | 22 (62.9) | ||
ENKL | 114 (7.4) | 43 (37.7) | 32 (28.1) | 39 (34.2) | 38 (33.3) | 23 (20.2) | 53 (46.5) | ||
PTCL | 34 (2.2) | 11 (32.4) | 10 (29.4) | 13 (38.2) | 3 (8.8) | 6 (17.6) | 25 (73.5) | ||
PC-ALCL | 46 (3.0) | 16 (34.8) | 13 (28.3) | 17 (37.0) | 20 (43.5) | 5 (17.4) | 21 (40.2) |
Objective Financial Burden (Cost-to-Income Ratio) | Subjective Financial Burden | ||||
---|---|---|---|---|---|
Low | Moderate | High | Overall | p-Value | |
Overall | 611 (39.4) | 437 (28.2) | 501 (32.3) | 1549 (100) | |
Low (<40%) | 342 | 178 | 137 | 657 (42.4) | <0.001 |
Moderate (40%~100%) | 104 | 77 | 89 | 270 (17.4) | |
High (>100%) | 165 | 182 | 275 | 622 (40.2) | |
Male | 297 (36.8) | 238 (29.5) | 273 (33.8) | 808 (100) | |
Low (<40%) | 167 | 103 | 83 | 353 (43.7) | <0.001 |
Moderate (40%~100%) | 49 | 42 | 38 | 129 (16.0) | |
High (>100%) | 81 | 93 | 152 | 326 (40.3) | |
Female | 314 (42.4) | 199 (26.9) | 228 (30.8) | 741 (100) | |
Low (<40%) | 175 | 75 | 54 | 304 (41.0) | <0.001 |
Moderate (40%~100%) | 55 | 35 | 51 | 141 (19.0) | |
High (>100%) | 84 | 89 | 123 | 296 (40.0) |
Mean (Standard Deviation) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Treatment Status | Objective Financial Burden | Subjective Financial Burden | Overall | ||||||
Low | Moderate | High | p-Value | Low | Moderate | High | p-Value | Mean (sd) | |
Overall | |||||||||
EQ Index | 0.89 (0.12) | 0.85 (0.16) | 0.84 (0.19) | <0.001 | 0.92 (0.09) | 0.87 (0.13) | 0.79 (0.21) | <0.001 | 0.86 (0.16) |
Physical functioning | 83.8 (15.4) | 78.2 (17.7) | 77.1 (18.4) | <0.001 | 86.9 (13.4) | 79.9 (14.8) | 71.9 (19.9) | <0.001 | 80.1 (17.3) |
Emotional functioning | 68.7 (22.2) | 63.9 (24.9) | 64.3 (24.2) | <0.001 | 77 (17.6) | 65.9 (19.5) | 53 (26.4) | <0.001 | 66.1 (23.6) |
Social functioning | 56.2 (30) | 47.7 (29.7) | 43.3 (28.8) | <0.001 | 70.7 (22) | 47.9 (22.2) | 25.1 (25.2) | <0.001 | 49.5 (30.1) |
Minor | |||||||||
EQ Index | 0.91 (0.1) | 0.87 (0.1) | 0.87 (0.2) | 0.27 | 0.93 (0.08) | 0.9 (0.08) | 0.8 (0.13) | <0.001 | 0.9 (0.11) |
Physical functioning | 88.5 (11.8) | 82.2 (11.82) | 80.6 (13.8) | 0.01 | 90.6 (10.4) | 85.4 (11.8) | 79.4 (13.8) | <0.001 | 87 (12.2) |
Emotional functioning | 70.2 (20.9) | 65 (23) | 59.8 (34.3) | 0.59 | 77.8 (15.5) | 65.3 (19.8) | 48 (29.3) | <0.001 | 68.5 (22.7) |
Social functioning | 68.7 (27.2) | 62.2 (27.8) | 36.4 (35.6) | 0.01 | 81.6 (19.3) | 58.3 (18.9) | 28.6 (31.7) | <0.001 | 64.8 (29.5) |
Moderate | |||||||||
EQ Index | 0.89 (0.1) | 0.84 (0.1) | 0.87 (0.1) | 0.11 | 0.91 (0.08) | 0.84 (0.13) | 0.84 (0.11) | <0.001 | 0.88 (0.11) |
Physical functioning | 85.8 (14.9) | 73 (15.7) | 79.4 (18.8) | 0.002 | 86.2 (15.6) | 81 (16.2) | 76 (17.3) | 0.002 | 82 (16.7) |
Emotional functioning | 69.1 (23.7) | 55 (26.8) | 72.9 (24.6) | 0.02 | 76.1 (18.6) | 69.9 (22.5) | 52.9 (29) | <0.001 | 67.8 (25) |
Social functioning | 58.8 (30.3) | 45 (30.2) | 53.6 (30.7) | 0.15 | 73.5 (21) | 52.6 (26.5) | 27.9 (24.9) | <0.001 | 55.2 (30.5) |
Severe | |||||||||
EQ Index | 0.86 (0.15) | 0.81 (0.19) | 0.78 (0.22) | <0.001 | 0.89 (0.12) | 0.85 (0.13) | 0.73 (0.25) | <0.001 | 0.82 (0.19) |
Physical functioning | 78 (17.4) | 73.2 (19.3) | 71.7 (20.3) | <0.001 | 82.4 (16) | 76.4 (15.5) | 66.8 (21.3) | <0.001 | 74.5 (19.2) |
Emotional functioning | 65.2 (21.6) | 60.3 (25.9) | 58 (24) | 0.001 | 73.9 (16.3) | 64.3 (19.4) | 49 (25.4) | <0.001 | 61.3 (23.5) |
Social functioning | 45.1 (27.3) | 41.9 (30.2) | 36.7 (26.8) | 0.004 | 63.4 (20.2) | 45.2 (20.9) | 20.4 (22.9) | <0.001 | 41 (27.9) |
Treatment completed | |||||||||
EQ Index | 0.92 (0.1) | 0.9 (0.12) | 0.89 (0.14) | 0.006 | 0.94 (0.07) | 0.89 (0.14) | 0.85 (0.16) | <0.001 | 0.9 (0.13) |
Physical functioning | 87 (13.1) | 83.5 (15.3) | 80.9 (15.7) | <0.001 | 89 (11.1) | 82.6 (13.6) | 76.3 (17.7) | <0.001 | 83.6 (15) |
Emotional functioning | 71.5 (22.5) | 68.7 (23) | 68.6 (23) | 0.2 | 78.7 (18.3) | 67.3 (19.1) | 58.1 (26) | <0.001 | 69.7 (22.8) |
Social functioning | 61.4 (30.3) | 52.1 (28.4) | 47.7 (29) | <0.001 | 72.3 (22.4) | 48.1 (23) | 29.7 (26.4) | <0.001 | 53.5 (30) |
b (95% C.I.) | ||||
---|---|---|---|---|
Financial Burdens | EQ Index | Physical Functioning | Emotional Functioning | Social Functioning |
Objective burden | ||||
< 40% | Ref | Ref | Ref | Ref |
40%~100% | −0.03 (−0.06~0.002) | −4.0 (−6.5~ −1.6) ** | −4.4 (−7.7~ −1.1) * | −6.2 (−10.4~ −1.9) ** |
> 100% | −0.04 (−0.07~ −0.02) *** | −5.3 (−7.3~ −3.4) *** | −4.1 (−7~ −1.6) ** | −8.8 (−12.1~ −5.4) *** |
Subjective burden | ||||
Low | Ref | Ref | Ref | Ref |
Moderate | −0.07 (−0.1~ −0.05) *** | −6.1 (−8.1~ −4.1) *** | −10.8 (−13.6~ −8.0) *** | −21.4 (−24.4~ −18.5) *** |
High | −0.15 (−0.17~ −0.13) *** | −14.4 (−16.4~ −12.4) *** | −24.4 (−27.1~ −21.6) *** | −43.6 (−46.6~ −40.7) *** |
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Xu, R.H.; Wong, E.L.-y.; Su, Y.; Zhang, H.; Zhang, W.; Dong, D. Quantifying the Effect of Financial Burden on Health-Related Quality of Life among Patients with Non-Hodgkin’s Lymphomas. Cancers 2020, 12, 3325. https://doi.org/10.3390/cancers12113325
Xu RH, Wong EL-y, Su Y, Zhang H, Zhang W, Dong D. Quantifying the Effect of Financial Burden on Health-Related Quality of Life among Patients with Non-Hodgkin’s Lymphomas. Cancers. 2020; 12(11):3325. https://doi.org/10.3390/cancers12113325
Chicago/Turabian StyleXu, Richard Huan, Eliza Lai-yi Wong, Yi Su, Hongyu Zhang, Wei Zhang, and Dong Dong. 2020. "Quantifying the Effect of Financial Burden on Health-Related Quality of Life among Patients with Non-Hodgkin’s Lymphomas" Cancers 12, no. 11: 3325. https://doi.org/10.3390/cancers12113325