The relationship between hope, medical expenditure and survival among advanced cancer patients

Frontiers in Psychology

Psychology

Lai Heng Lee¹  Ravindran Kanesvaran²  Junxing Chay³  Chetna Malhotra³  Eric Andrew Finkelstein³  Vinh Anh Huynh³  Yin Bun Cheung⁴ 

[1] Department of Haematology, Singapore General Hospital, Singapore, Singapore;Division of Medical Oncology, National Cancer Centre, Singapore, Singapore;Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore;Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore;Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore;

关键词: cancer;    hope;    survival;    healthcare utilization;    healthcare expenditure;   

DOI  :  10.3389/fpsyg.2023.1151976

 received in 2023-01-27, accepted in 2023-05-02,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionAmong those with advanced illness, higher levels of hope may offer physiological benefits. Yet, greater levels of hope may also encourage aggressive treatments. Therefore, higher levels of hope may lead to greater healthcare utilization, higher expenditure, and longer survival. We test these hypotheses among patients with advanced cancer.MethodsA secondary data analysis from a cross-sectional survey of 195 advanced cancer patients with high mortality risk linked to subsequent healthcare utilization (outpatient, day surgeries, non-emergency admissions), health expenditures, and death records. The survey collected data on hope, measured generally by the Herth Hope Index (HHI) and more narrowly by two questions on illness-related hope. Generalized linear regression and Cox models were used to test our hypotheses.Results142 (78%) survey participants died during the period of analysis, with close to half (46%) doing so within a year of the survey. Contrary to expectation, HHI scores did not have a significant association with healthcare utilization, expenditure or survival. Yet, illness-related hope, defined as those who expected to live at least 2 years, as opposed to the likely prognosis of 1 year or less as determined by the primary treating oncologist, had 6.6 more planned hospital encounters (95% CI 0.90 to 12.30) in the 12-months following the survey and 41% lower mortality risk (hazard ratio: 0.59, 95% CI 0.36 to 0.99) compared to those who were less optimistic. Secondary analysis among decedents showed that patients who believed that the primary intent of their treatment is curative, had higher total expenditure (S$30,712; 95% CI S$3,143 to S$58,282) in the last 12 months of life than those who did not have this belief.ConclusionWe find no evidence of a relationship between a general measure of hope and healthcare utilization, expenditure, or survival among advanced cancer patients. However, greater illness-related hope is positively associated with these outcomes.

【 授权许可】

Unknown   
Copyright © 2023 Chay, Huynh, Cheung, Kanesvaran, Lee, Malhotra and Finkelstein.