Financial toxicity and patient experience associated with financial burden of molecular-targeted and immune therapies for cancer: an observational study under public health insurance.

BACKGROUND: Financial burden of cancer treatment can negatively affect patients and their families. This study aimed to evaluate the financial toxicity of patients treated with molecular-targeted and immune therapies and explore the relationship between financial toxicity and patient experiences associated with the financial burden of cancer treatment. METHODS: This anonymous, self-administered questionnaire survey conducted across nine hospitals in Japan included patients aged 20-60 years who were receiving molecular-targeted agents or immune checkpoint inhibitors for any type of cancer for ≥ 2 months. Financial toxicity was evaluated using the COmprehensive Score for Financial Toxicity (COST). Patient experience was examined using 11 items based on previous studies. Independent factors related to financial toxicity were explored using multiple regression analyses. RESULTS: The mean COST score was 17.0 ± 8.4, and 68 (49.3%) participants reported COST scores at or below the cutoff point. The factors contributing to financial toxicity were "hesitation regarding continuing treatment based on finances" (sß = - 0.410, p < 0.001), "cutting through my deposits and savings" (sß = - 0.253, p = 0.003), and "reducing spending on basics like food or clothing" (sß = - 0.205, p = 0.046) along with comorbidities (sß = - 0.156, p = 0.032). CONCLUSION: Patients receiving molecular-targeted and immune therapies are at risk of experiencing profound financial toxicity and a reduced quality of life. The independently related factors that we identified have the potential to serve as indicators of profound financial toxicity and the need for specialized intervention.

[Assessment of hand-foot syndrome in cancer patients treated with capecitabine-containing chemotherapy].

Capecitabine is one of the most effective oral chemotherapeutic drugs for advanced or recurrent colorectal cancer and gastric cancer. Capecitabine-containing chemotherapy is recommended as a first-line option for gastrointestinal tract cancer. The incidence of hand-foot syndrome (HFS), an adverse event of chemotherapy with capecitabine, is high. Moreover, once the symptoms of HFS are identified, they can significantly impair the quality of life (QOL) of patients. HFS should be managed by dose interruption and, if necessary, by dose reduction. Pharmacists and oncology nurses play an increasingly important role in the early identification and prevention of HFS through patient education and close clinical assessment. The aim of this study was to evaluate the efficacy of support tools for the early identification, prevention, and management of HFS and to assess the effectiveness of "patient self-check sheets". The patient was detected as having HFS of mild severity and had used a moisturizer at the time of initiation of therapy. Maintaining moisture retention is important in the management of HFS. The ambulatory team plays a key role by using self-check sheets to educate patients on how to recognize HFS, when to interrupt treatment, and how to adjust the dose so as to maintain effective therapy with capecitabine. For the continuation and completion of treatment and for maintaining an improved QOL in the home environment, supportive measures for adverse effects such as HFS and an ambulatory team are indispensable.

[Assessment of hand-foot syndrome in cancer outpatients undergoing chemotherapy].

Capecitabine, an oral prodrug of 5 -fluorouracil, is a promising treatment for colorectal, breast, and gastric cancers, but often causes hand-foot syndrome(HFS), which is the most common dose-limiting toxicity. The aim of this study was to evaluate of the efficacy of the pharmacist in providing support at ambulatory therapy centers, especially for HFS. The HFS is a higher-incidence adverse event that may develop during chemotherapy with capecitabine. Once developed, the symptoms significantly impair quality of life(QOL), leading to a reduction in the dosage or discontinuation of the treatment. Patient symptoms may therefore increase in severity. This study was performed to analyze the treatment adherence and adverse events resulting from capecitabine therapy provided by pharmacists to cancer outpatients. All patients were prescribed vitamin B6(pyridoxine), which can help to reduce or prevent HFS. A lesser or milder extent of HFS was detected in patients who had used a moisturizer at the same time as the introduction of capecitabine therapy. Adherence to this approach will benefit the patients' selfcare in maintaining moisture retention, which is an important countermeasure for HFS. Additionally, early introduction of effective countermeasures for skin care, dose reduction, and rest periods is important for HFS management; in addition, team care support is dispensable. Our support system may be useful for management strategies for HFS. We suggest that improved quality of lif e is needed in cancer outpatients being treated with chemotherapy.