Financial difficulty among patients with cancer participating in clinical trials and its association with patient survival and quality of life
Bibliographic record
Abstract
BACKGROUND: The incidence and worsening of financial difficulty among patients with cancer participating in clinical trials and their relationship with mortality, quality of life, and toxicity outcomes have been understudied. The objective of this study was to understand the incidence of financial difficulty among Canadian patients participating in systemic therapy trials at baseline and after trial participation and to assess the relationship between financial difficulty and clinical outcomes. METHODS: This retrospective cohort study included patients participating in 14 systemic therapy trials conducted by the Canadian Cancer Trials Group for adult patients with advanced cancer. Incidence of financial toxicity at baseline and after trial participation were measured using the European Organisation for Research and Treatment of Cancer QLQ Core Questionnaire. The association of financial difficulty with trial characteristics and patient outcomes (mortality, quality of life, and toxicity) was studied. RESULTS: Overall, 2766 patients from 14 trials were included, of whom 37% had financial difficulty at baseline and 25% experienced worsening of financial difficulty after trial enrollment compared with their baseline status. Baseline financial difficulty but not the worsening of financial difficulty was associated with worse mortality outcomes. Worsening of financial difficulty was, however, associated with poor global quality of life outcomes and increased odds of clinical toxicities. CONCLUSIONS: Even in the setting of a public health system in Canada, one-third of patients experience financial difficulty, with one-quarter of them experiencing worsening of financial difficulty with trial participation, and both were related to worse patient outcomes. Targeted policy-level interventions are needed to understand and address the cause of financial difficulty in patients with cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.031 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".