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Kamath CC, Espinoza Suarez NR, Vallejo S, Montori VM, Brito JP, Boehmer KR. Not all cost conversations are the same: An exploration of potential value in cost conversations during Atrial fibrillation treatment decision making. PATIENT EDUCATION AND COUNSELING 2024; 128:108366. [PMID: 39032442 DOI: 10.1016/j.pec.2024.108366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVES To explore the cost conversations taking place when patients with atrial fibrillation and their clinicians decide on whether and how to use anticoagulation to prevent strokes. METHODS Secondary qualitative thematic analysis of conversations from 476 clinical encounters in three sites of a multicenter randomized trial comparing usual care with and without a shared decision-making tool. RESULTS We identified three themes with subthemes: (1) What was discussed: conversation content (2) How content was transmitted: communication patterns and (3) Implicit conversation drivers. Due to each patient's unique circumstances, bi-directional conversations focused on relationship- and solution-based content enabled better cost burden discovery. Conversation drivers included affordability, comorbidities, preferences, and uncertainty about future costs. CONCLUSIONS Cost conversations were often initiated by clinicians, and if they did not invite a response, patients passively received information without understanding or weighing cost burden. When clinicians discussed cost information using relational or solution-focused content and bi-directional communication patients were more likely to engage in discussion including their unique situation. PRACTICE IMPLICATIONS Solution-focused cost conversations can reduce financial treatment burden, but require estimates of out-of-pocket costs, insurance coverage, and long-term financial effects of various options. Conversation tools and information on financial resources are valuable to patients and clinicians.
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Affiliation(s)
- Celia C Kamath
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Nataly R Espinoza Suarez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | | | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
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Jones SMW, Ohlsen TJD, Karvonen KA, Sorror M. Addressing financial hardship in malignant hematology and hematopoietic cell transplant: a team approach. Blood Adv 2024; 8:5146-5155. [PMID: 39146495 DOI: 10.1182/bloodadvances.2024012998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/06/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024] Open
Abstract
ABSTRACT Financial hardship is a common experience for patients and their families after the diagnosis of a hematologic malignancy and is associated with worse outcomes. Health care costs, increased costs of living, income poverty, and inadequate wealth contribute to financial hardship after the diagnosis and treatment of a hematologic malignancy and/or hematopoietic cell transplant. Given the multidimensional nature of financial hardship, a multidisciplinary team-based approach is needed to address this public health hazard. Hematologists and oncologists may mitigate the impact of financial hardship by matching treatment options with patient goals of care and reducing symptom burden disruptive to employment. Social workers and financial navigators can assist with screening and resource deployment. Policymakers and researchers can identify structural and policy changes to prevent financial hardship. By alleviating this major health care burden from patients, care teams may improve survival and quality of life for patients with hematologic malignancies.
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Affiliation(s)
- Salene M W Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Timothy J D Ohlsen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Kristine A Karvonen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Washington, Seattle, WA
- Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, Seattle, WA
| | - Mohamed Sorror
- Clinical Research Division, Fred Hutchinson Cancer Center and Department of Medicine, University of Washington, Seattle, WA
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3
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Yabroff KR, Mittu K, Halpern MT. Cost-of-care discussions for individuals with advanced non-small cell lung cancer and melanoma: Findings from a large, population-based pilot study. Cancer 2024; 130:3364-3374. [PMID: 38869706 DOI: 10.1002/cncr.35380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/28/2024] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high-quality care. In this pilot study, the authors examined patient-provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non-small cell lung cancer (NSCLC) and melanoma-cancers with recently approved, high-cost treatment options. METHODS Individuals who were newly diagnosed in 2017-2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. RESULTS Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37-0.80). Patients who did not receive systemic therapy or did not receive any cancer-directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19-0.81] and 0.46 [95% CI, 0.30-0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42-0.98). CONCLUSIONS Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost-of-care discussions and relevant referrals, as well as their documentation, are warranted.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Karen Mittu
- Information Management Services, Calverton, Maryland, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland, USA
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Shih YCT, Yabroff KR, Bradley C. The utility of value frameworks in cost communications: making them real for patients. J Natl Cancer Inst 2024; 116:1411-1413. [PMID: 39003520 PMCID: PMC11378310 DOI: 10.1093/jnci/djae156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Affiliation(s)
- Ya-Chen Tina Shih
- University of California Los Angeles Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, School of Medicine, Los Angeles, CA, USA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Cathy Bradley
- University of Colorado Comprehensive Cancer Center and Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
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Lam AB, Nipp RD, Hasler JS, Hu BY, Zahner GJ, Robbins S, Wheeler SB, Tagai EK, Miller SM, Peppercorn JM. National survey of patient perspectives on cost discussions among recipients of copay assistance. Oncologist 2024:oyae148. [PMID: 38864681 DOI: 10.1093/oncolo/oyae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Individuals with cancer and other medical conditions often experience financial concerns from high costs-of-care and may utilize copay assistance programs (CAP). We sought to describe CAP recipients' experiences/preferences for cost discussions with clinicians. METHODS We conducted a national, cross-sectional electronic-survey from 10/2022 to 11/2022 of CAP recipients with cancer or autoimmune conditions to assess patient perspectives on cost discussions. We used multivariable logistic regression models to explore associations of patient perspectives on cost discussions with patient characteristics and patient-reported outcomes (eg, financial toxicity, depression/anxiety, and health literacy). RESULTS Among 1,566 participants, 71% had cancer and 29% had autoimmune conditions. Although 62% of respondents desired cost discussions, only 32% reported discussions took place. Additionally, 52% of respondents wanted their doctor to consider out-of-pocket costs when deciding the best treatment, and 61% of respondents felt doctors should ensure patients can afford treatment prescribed. Participants with depression symptoms were more likely to want doctors to consider out-of-pocket costs (OR = 1.54, P = .005) and to believe doctors should ensure patients can afford treatment (OR = 1.60, P = .005). Those with severe financial toxicity were more likely to desire cost discussions (OR = 1.65, P < .001) and want doctors to consider out-of-pocket costs (OR = 1.52, P = .001). Participants with marginal/inadequate health literacy were more likely to desire cost discussions (OR = 1.37, P = .01) and believe doctors should ensure patients can afford treatment (OR = 1.30, P = .036). CONCLUSIONS In this large sample of CAP recipients with cancer and autoimmune conditions, most reported a desire for cost discussions, but under one-third reported such discussions took place.
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Affiliation(s)
- Anh B Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | - Ryan David Nipp
- Section of Hematology and Oncology, Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, United States
| | - Jill S Hasler
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Bonnie Y Hu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Greg J Zahner
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarina Robbins
- HealthWell Foundation, Germantown, MD 20874, United States
| | - Stephanie B Wheeler
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Erin K Tagai
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Jeffrey M Peppercorn
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
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Scott AM, Harrington NG, Herman AA. Oncologists' Perceptions of Strategies for Discussing the Cost of Care with Cancer Patients and the Meaning of Those Conversations. HEALTH COMMUNICATION 2024; 39:1343-1357. [PMID: 37190672 DOI: 10.1080/10410236.2023.2212419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
To better understand what makes cost-of-care communication between oncologists and cancer patients more or less successful, we conducted in-depth interviews with 32 oncologists (22 male, 10 female) who were board-certified in medical, surgical, or radiation oncology. Through qualitative descriptive analysis by four coders, we found that oncologists used six broad strategies to discuss cost with patients: open discussion, avoidance, reassurance, warning, outsourcing, and educating. We also found that oncologists invoked certain meanings of cost conversations: cost conversations as holistic care, coercion, a matter of timing, risking patient suspicions, advocacy, unwanted distraction, transparency, bad news delivery, problem-solving, pointless, informed decision making, or irrelevant. These meanings appeared to be linked to oncologists enacting certain strategies (e.g., oncologists who invoked cost conversations as holistic care tended to enact open discussion, those who saw cost conversations as risky tended to use avoidance). Theoretically, our results suggest that the invoked meaning of a difficult conversation may be a key explanatory mechanism for differentiating high-quality from low-quality communication in cost conversations. Practically, our findings suggest that oncologists should consider how well the invoked meaning of the cost conversation is serving their own and their patients' goals.
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Wu VS, Shen X, de Moor J, Chino F, Klein J. Financial Toxicity in Radiation Oncology: Impact for Our Patients and for Practicing Radiation Oncologists. Adv Radiat Oncol 2024; 9:101419. [PMID: 38379894 PMCID: PMC10876607 DOI: 10.1016/j.adro.2023.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/16/2023] [Indexed: 02/22/2024] Open
Abstract
With rising costs of diagnosis, treatment, and survivorship, financial burdens on patients with cancer and negative effects from high costs, called financial toxicity (FT), are growing. Research suggests that FT may be experienced by more than half of working-age cancer survivors and a similar proportion may incur debt or avoid recommended prescription medications due to treatment costs. As FT can lead to worse physical, psychological, financial, and survival outcomes, there is a discrete need to identify research gaps around this issue that constrain the development and implementation of effective screening and innovative care delivery interventions. Prior research, including within a radiation oncology-specific context, has sought to identify the scope of FT among patients with cancer, develop assessment tools to evaluate patient risk, quantify financial sacrifices, and qualify care compromises that occur when cancer care is unaffordable. FT is a multifactorial problem and potential solutions should be pursued at all levels of the health care system (patient-provider, institutional, and systemic) with specific regard for patients' individual/local contexts. Solutions may include selecting alternative treatment schedules, discussing financial concerns with patients, providing financial navigation services, low-cost transportation options, and system-wide health policy shifts. This review summarizes existing FT research, describes tools developed to measure FT, and suggests areas for intervention and study to help improve FT and outcomes for radiation oncology patients.
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Affiliation(s)
- Victoria S. Wu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Medical Center, Kansas City, Kansas
| | - Janet de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Klein
- Department of Radiation Oncology, Maimonides Medical Center and State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
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Yabroff KR, Sylvia Shi K, Zhao J, Freedman AN, Zheng Z, Nogueira L, Han X, Klabunde CN, de Moor JS. Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions. JCO Oncol Pract 2024; 20:429-437. [PMID: 38194620 DOI: 10.1200/op.23.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/14/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Use of genomic testing, especially multimarker panels, is increasing in the United States. Not all tests and related treatments are covered by health insurance, which can result in substantial patient out-of-pocket (OOP) costs. Little is known about oncologists' treatment decisions with respect to patient insurance coverage and OOP costs for genomic testing. METHODS We identified 1,049 oncologists who used multimarker tumor panels from the 2017 National Survey of Precision Medicine in Cancer Treatment. Separate multivariable ordinal logistic regressions examined associations of oncologist-, practice-, and area-level characteristics and oncologists' ratings of importance (very, somewhat, or a little/not important) of insurance coverage and OOP costs for genomic testing in treatment decisions, adjusting for oncologist years of experience, sex, race and ethnicity, specialty, use of next-generation sequencing (NGS) tests, region, tumor boards, patient insurance mix, and area-level socioeconomic characteristics. RESULTS Among oncologists, 47.3%, 32.7%, and 20.0% reported that patient insurance coverage for genomic testing was very, somewhat, or a little/not important, respectively, in treatment decisions. In addition, 56.9%, 28.0%, and 15.2% reported that OOP costs for testing were very, somewhat, or a little/not important, respectively. In adjusted analyses, oncologists who used NGS tests were more likely to report patient insurance and OOP costs as important (odds ratio [OR], 2.00 [95% CI, 1.16 to 3.45] and OR, 2.12 [95% CI, 1.22 to 3.68], respectively) in treatment decisions compared with oncologists who did not use these tests, as were oncologists who treated solid tumors, rather than only hematological cancers. More years of experience and higher percentages of Medicaid or self-paid/uninsured patients in the practice were associated with reporting insurance coverage (OR, 1.43 [95% CI, 1.09 to 1.89]) and OOP costs (OR, 1.51 [95% CI, 1.13 to 2.01]) as important. Oncologists in practices with molecular tumor boards for genomic tests were less likely to report coverage (OR, 0.63 [95% CI, 0.47 to 0.85]) and OOP costs (OR, 0.72 [95% CI, 0.53 to 0.97]) as important than their counterparts in practices without these tumor boards. CONCLUSION Most oncologists rate patient health insurance and OOP costs for genomic tests as important considerations in subsequent treatment recommendations. Modifiable factors associated with these ratings can inform interventions to support patient-physician decision making about care.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Rockville, MD
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Salazar MM, Khera N, Chino F, Johnston E. Financial hardship for patients with cancer and caregivers at end of life in the USA: narrative review. BMJ Support Palliat Care 2024; 14:25-35. [PMID: 38123962 DOI: 10.1136/spcare-2023-004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients and their families face financial hardship during cancer treatment, which may intensify at end of life (EOL) due to increased symptoms and care needs. We undertook a narrative literature review to describe the current understanding of the causes, impacts and factors associated with financial hardship at EOL. We identify gaps in research, policy and clinical practice and propose steps to mitigate financial hardship for patients and caregivers at EOL. METHODS We conducted a Medline search to identify US studies since 2000 that examined EOL financial hardship for patients with cancer and their caregivers. RESULTS Twenty-seven adult and four paediatric studies met review criteria. Adults with cancer and their caregivers face significant financial hardship at EOL and in bereavement, especially due to employment changes and informal caregiving time costs. Financial hardship may be higher for younger caregivers and for patients who are uninsured, low income, rural, with high symptom burdens or with certain cancer types. The few paediatric studies showed high financial hardship and employment impact lasting well beyond a child's death. CONCLUSIONS There is limited literature examining financial hardship at EOL in the USA, especially in paediatrics. Priorities for future research include longitudinal studies in diverse populations of patients with cancer and informal caregivers using standardised financial hardship measures. Policies to address financial hardship at EOL, especially with hospice care, should include insurance coverage for family caregiving and medical leave policies. There is need for increased financial hardship screening at EOL and in bereavement and a need for financial navigation interventions.
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Affiliation(s)
- Marisa Martinez Salazar
- School of Medicine, Mayo Clinic School of Medicine-Scottsdale Campus, Scottsdale, Arizona, USA
| | - Nandita Khera
- Mayo Clinic School of Medicine, Phoenix, Arizona, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emily Johnston
- Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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10
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Miller MF, Olson JS, Doughtie K, Zaleta AK, Rogers KP. The interplay of financial toxicity, health care team communication, and psychosocial well-being among rural cancer patients and survivors. J Rural Health 2024; 40:128-137. [PMID: 37449966 DOI: 10.1111/jrh.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/15/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Financial toxicity contributes to psychosocial distress among cancer patients and survivors. Yet, contextual factors unique to rural settings affect patient experiences, and a deeper understanding is needed of the interplay between financial toxicity and health care team communication and its association with psychosocial well-being among rural oncology patients. PURPOSE We examined associations between financial toxicity and psychosocial well-being among rural cancer patients, exploring variability in these linkages by health care team communication. METHODS Using data from 273 rural cancer patients who participated in Cancer Support Community's Cancer Experience Registry, we estimated multivariable regression models predicting depression, anxiety, and social function by financial toxicity, health care team communication, and the interplay between them. RESULTS We demonstrate robust associations between financial toxicity and psychosocial outcomes among our sample of rural cancer patients and survivors. As financial toxicity increased, symptoms of depression and anxiety increased. Further, financial toxicity was linked with decreasing social function. Having health care team conversations about treatment costs and distress-related care reduced the negative impact of financial toxicity on depressive symptoms and social function, respectively, in rural cancer patients at greatest risk for financial burden. CONCLUSIONS Financial toxicity and psychosocial well-being are strongly linked, and these associations were confirmed in a rural sample. A theorized buffer to the detrimental impacts of financial toxicity-health care team communication-played a role in moderating these associations. Our findings suggest that health care providers in rural oncology settings may benefit from tools and resources to bolster communication with patients about costs, financial distress, and coordination of care.
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Affiliation(s)
- Melissa F Miller
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kara Doughtie
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kimberly P Rogers
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
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Lam AB, Moore V, Nipp RD. Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies. Healthcare (Basel) 2023; 12:30. [PMID: 38200936 PMCID: PMC10779432 DOI: 10.3390/healthcare12010030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gastrointestinal malignancies represent a particularly challenging condition, often requiring a multidisciplinary approach to management in order to meet the unique needs of these individuals and their caregivers. PURPOSE In this literature review, we sought to describe care delivery interventions that strive to improve the quality of life and care for patients with a focus on gastrointestinal malignancies. CONCLUSION We highlight patient-centered care delivery interventions, including patient-reported outcomes, hospital-at-home interventions, and other models of care for individuals with cancer. By demonstrating the relevance and utility of these different care models for patients with gastrointestinal malignancies, we hope to highlight the importance of developing and testing new interventions to address the unique needs of this population.
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Affiliation(s)
- Anh B. Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Vanessa Moore
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Ryan D. Nipp
- Division of Hematology and Oncology, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
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12
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Amin K, Bethel G, Jackson LR, Essien UR, Sloan CE. Eliminating Health Disparities in Atrial Fibrillation, Heart Failure, and Dyslipidemia: A Path Toward Achieving Pharmacoequity. Curr Atheroscler Rep 2023; 25:1113-1127. [PMID: 38108997 PMCID: PMC11044811 DOI: 10.1007/s11883-023-01180-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Pharmacoequity refers to the goal of ensuring that all patients have access to high-quality medications, regardless of their race, ethnicity, gender, or other characteristics. The goal of this article is to review current evidence on disparities in access to cardiovascular drug therapies across sociodemographic subgroups, with a focus on heart failure, atrial fibrillation, and dyslipidemia. RECENT FINDINGS Considerable and consistent disparities to life-prolonging heart failure, atrial fibrillation, and dyslipidemia medications exist in clinical trial representation, access to specialist care, prescription of guideline-based therapy, drug affordability, and pharmacy accessibility across racial, ethnic, gender, and other sociodemographic subgroups. Researchers, health systems, and policy makers can take steps to improve pharmacoequity by diversifying clinical trial enrollment, increasing access to inpatient and outpatient cardiology care, nudging clinicians to increase prescription of guideline-directed medical therapy, and pursuing system-level reforms to improve drug access and affordability.
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Affiliation(s)
- Krunal Amin
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Garrett Bethel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Utibe R Essien
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Center for the Study of Healthcare Innovation, Implementation & Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
| | - Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
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Yuan X, Zhang X, He J, Xing W. Interventions for financial toxicity among cancer survivors: A scoping review. Crit Rev Oncol Hematol 2023; 192:104140. [PMID: 37739147 DOI: 10.1016/j.critrevonc.2023.104140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.
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Affiliation(s)
- Xiaoyi Yuan
- School of nursing, Fudan University, Shanghai, China
| | - Xuehui Zhang
- School of nursing, Fudan University, Shanghai, China
| | - Jing He
- School of nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of nursing, Fudan University and core research member of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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14
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Waters AR, Biddell CB, Killela M, Kasow KA, Page K, Wheeler SB, Drier SW, Kelly MS, Robles J, Spees LP. Financial burden and recommended multilevel solutions among caregivers of pediatric hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 2023; 70:e30700. [PMID: 37776093 PMCID: PMC10615841 DOI: 10.1002/pbc.30700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The healthcare costs of patients who receive hematopoietic stem cell transplantation (HSCT) are substantial. At the same time, the increasing use of pediatric HSCT leaves more caregivers of pediatric HSCT recipients at risk for financial burden-an understudied area of research. METHODS Financial burden experienced by caregivers of recipients who received autologous or allogeneic transplants was assessed using an explanatory mixed-methods design including a one-time survey and semi-structured interviews. Financial burden was assessed through an adapted COmprehensive Score for financial Toxicity (COST) as well as questions about the types of out-of-pocket costs and cost-coping behaviors. Chi-squared or Fisher's exact tests were used to assess differences in costs incurred and coping behaviors by financial toxicity and financial toxicity by demographic factors. Interviews were audio recorded, transcribed, and analyzed using directed content analysis. RESULTS Of 99 survey participants, 64% experienced high financial toxicity (COST ≤ $ \le \;$ 22). Caregivers with high financial toxicity were more likely to report costs related to transportation and diet. High financial toxicity was associated with nearly all cost-coping behaviors (e.g., borrowed money). High financial toxicity was also associated with increased use of hospital financial support and transportation assistance. Qualitative analysis resulted in four categories that were integrated with quantitative findings: (1) care-related out-of-pocket costs incurred, (2) cost-coping behaviors, (3) financial support resources used, and (4) multilevel recommendations for reducing financial burden. CONCLUSIONS Considering the substantial, long-term financial burden among pediatric HSCT patients and their caregivers, this population would benefit from adapted and tailored financial burden interventions.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
| | - Mary Killela
- School of Nursing, UNC-CH, Chapel Hill, North Carolina, USA
| | - Kimberly A Kasow
- Department of Pediatrics, UNC-CH, Chapel Hill, North Carolina, USA
| | - Kristin Page
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Sarah W Drier
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Matthew S Kelly
- Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanna Robles
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
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15
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Fitzpatrick V, Erwin K, Rivelli A, Shields M, Delfinado L, Cabiya M, Wennerberg K. The potential impact of introducing a cost tool to facilitate cost-of-care conversations in routine OB care: Lessons from the CONTINUE pilot study. PEC INNOVATION 2023; 2:100136. [PMID: 37214536 PMCID: PMC10194338 DOI: 10.1016/j.pecinn.2023.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 05/24/2023]
Abstract
Objective The objective of the CONTINUE study is to gather preliminary data on the potential impact of implementing a "Cost Tool" in routine obstetrics (OB) care. It is hypothesized that by providing prenatal patients with an ability to forecast their care plan, they would be better able to anticipate and plan for the costs associated with their prenatal care. Methods Pilot data from interviews and surveys were collected from 71 prenatal patients across three clinics throughout Chicago, IL. Results As compared to privately insured prenatal patients, prenatal patients with public insurance reported the most benefit in Cost Tool use. Specifically, that the Cost Tool helped to navigate insurance more effectively (OR 4.49, p=0.0254), see the "Big Picture" and link it to the family budget (OR 4.25, p=0.0099), and make the financial tradeoffs needed to get through pregnancy (OR 5.50, p=0.0305). Conclusion The CONTINUE study provides preliminary signals of the Cost Tool's potential to help publicly insured prenatal patients better navigate the costs associated with their care plan. Innovations The CONTINUE study contributes valuable preliminary data about the utility of a cost tool in routine OB care, especially as it may benefit low-income prenatal patients navigate prenatal care better.
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Affiliation(s)
- Veronica Fitzpatrick
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Kim Erwin
- Illinois Institute of Technology Institute of Design, Chicago, IL, USA
| | - Anne Rivelli
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Maureen Shields
- Advocate Aurora Research Institute, Downers Grove, IL, USA
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Leah Delfinado
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
| | - Marie Cabiya
- Advocate Aurora Health; Downers Grove, IL, Milwaukee, WI, USA
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16
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Araich H, Tran J, Jung J, Horný M, Sadigh G. Healthcare price transparency in North America and Europe. Br J Radiol 2023; 96:20230236. [PMID: 37660401 PMCID: PMC10607402 DOI: 10.1259/bjr.20230236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/06/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Healthcare price transparency is an effort to inform patient decision-making, but also to decrease prices and their variation across healthcare systems for equivalent medical services. The initiative is meaningful only for medical services that are shoppable-such as imaging examinations-for which patients incur out-of-pocket costs. Therefore, several countries in which patients commonly share a portion of their healthcare costs have been implementing mandates to improve healthcare price transparency. However, the provisional implementation has many issues, especially in the United States, including provider non-compliance and limited accessibility of price transparency tools by the general public. Many of the existing tools are not user-friendly, are difficult to navigate, focus on charges and health plan negotiated rates rather than patients' out-of-pocket costs, and disclose prices on the service level instead of per episode of care. As such, the disclosed amounts are often not reliable. Many price transparency tools also lack valid and measurable quality metrics, which can result in a selection of high-cost care as a proxy for high-value care, as well as an increase in healthcare prices when providers want to imply they offer high-quality care. Nevertheless, the impact of the initiatives on patients' decision-making and healthcare costs remains unclear. While transparency initiatives are patient-centric, efforts should be made to increase patient engagement, provide accurate patient-specific out-of-pocket cost information, compare available treatment and provider alternatives, and couple price information with quality metrics to enable making fully informed decisions.
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Affiliation(s)
- Harman Araich
- School of Medicine, Case Western Reserve University, Ohio, Cleveland, United States
| | - Julia Tran
- Department of Radiological Sciences, University of California Irvine, Orange, United States
| | - Jinho Jung
- Department of Radiological Sciences, University of California Irvine, Orange, United States
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, United States
- Department of Health Policy and Management, Emory University, Atlanta, Georgia, United States
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Orange, United States
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17
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Blinder VS, Deal AM, Ginos B, Jansen J, Dueck AC, Mazza GL, Henson S, Carr P, Rogak LJ, Weiss A, Rapperport A, Jonsson M, Spears PA, Cella D, Gany F, Schrag D, Basch E. Financial Toxicity Monitoring in a Randomized Controlled Trial of Patient-Reported Outcomes During Cancer Treatment (Alliance AFT-39). J Clin Oncol 2023; 41:4652-4663. [PMID: 37625107 PMCID: PMC10564309 DOI: 10.1200/jco.22.02834] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/12/2023] [Accepted: 07/12/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE Financial toxicity (FT) affects 20% of cancer survivors and is associated with poor clinical outcomes. No large-scale programs have been implemented to mitigate FT. We evaluated the effect of monthly FT screening as part of a larger patient-reported outcomes (PROs) digital monitoring intervention. METHODS PRO-TECT (AFT-39) is a cluster-randomized trial of patients undergoing systemic therapy for metastatic cancer. Practices were randomly assigned 1:1 to digital symptom monitoring (PRO practices) or usual care (control practices). Digital monitoring consisted of between-visit online or automated telephone patient surveys about symptoms, functioning, and FT (single-item screening question from Functional Assessment of Chronic Illness Therapy-COmprehensive Score for financial Toxicity) for up to 1 year, with automated alerts sent to practice nurses for concerning survey scores. Clinical team actions in response to alerts were not mandated. The primary outcome of this planned secondary analysis was development or worsening of financial difficulties, assessed via the European Organisation for Research and Treatment of Cancer QLQ-C30 financial difficulties measure, at any time compared with baseline. A randomly selected subset of patients and nurses were interviewed about their experiences with the intervention. RESULTS One thousand one hundred ninety-one patients were enrolled (593 PRO; 598 control) at 52 US community oncology practices. Overall, 30.2% of patients treated at practices that received the FT screening intervention developed, or experienced worsening of, financial difficulties, compared with 39.0% treated at control practices (P = .004). Patients and nurses interviewed stated that FT screening identified patients for financial counseling who otherwise would be reluctant to seek, or unaware of the availability of, assistance. CONCLUSION In this report of a secondary outcome from a randomized clinical trial, FT screening as part of routine digital patient monitoring with PROs reduced the development, or worsening, of financial difficulties among patients undergoing systemic cancer therapy.
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Affiliation(s)
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Brenda Ginos
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Amylou C. Dueck
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | - Gina L. Mazza
- Alliance Statistics and Data Management Center, Mayo Clinic, Scottsdale, AZ
| | - Sydney Henson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | | | - Anna Weiss
- Brigham and Women's Hospital, Boston, MA
| | | | - Mattias Jonsson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Patricia A. Spears
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - David Cella
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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18
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Liu BY, Kazi DS. Economic and Ethical Case for Eliminating Patient Out-of-Pocket Costs. Circ Cardiovasc Qual Outcomes 2023; 16:e010142. [PMID: 37847752 DOI: 10.1161/circoutcomes.123.010142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Affiliation(s)
- Benjamin Y Liu
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (B.Y.L.)
| | - Dhruv S Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (D.S.K.)
- Harvard Medical School, Boston, MA (D.S.K.)
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19
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Sears-Smith M, Knight TG. Financial Toxicity in Patients with Hematologic Malignancies: a Review and Need for Interventions. Curr Hematol Malig Rep 2023; 18:158-166. [PMID: 37490228 DOI: 10.1007/s11899-023-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Financial toxicity is a developing research area to quantify the financial stress experienced by patients and caregivers, as well as the mechanisms by which they manage the costs associated with treatment and the very real harms that this stress can inflict upon cancer care. Patients with blood malignancies experience increased costs associated with their diagnosis due to possible inpatient admissions for treatment, frequent office visits, and even more frequent lab evaluations and testing. PURPOSE OF REVIEW Multiple studies have examined the causes and effects of financial toxicity on patient care and outcomes, and there have been several validated tools developed to identify patients experiencing or at risk for financial harm. DISCUSSION However, few studies to date have focused on implementing successful interventions to assist in mitigating financial difficulties for patients diagnosed with hematologic malignancies and their families. In this review, we examine the current literature with an emphasis on levels of care, including providers, systems, and policies. Specifically, we discuss published interventions including physician education about treatment costs, financial navigation in cancer centers, and novel institutional multidisciplinary review of patients' financial concerns. We also discuss the urgent need for societal and governmental interventions to lessen financial distress experienced by these highly vulnerable blood cancer patients.
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Affiliation(s)
- Megan Sears-Smith
- Levine Cancer Institute, Atrium Health, 1020 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Thomas G Knight
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI Building 2, Suite 60100, Charlotte, NC, 28204, USA.
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20
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Joyce DD, Dusetzina SB. Financial toxicity of oral therapies in advanced prostate cancer. Urol Oncol 2023; 41:363-368. [PMID: 37029039 DOI: 10.1016/j.urolonc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 04/09/2023]
Abstract
The treatment landscape of advanced prostate cancer (CaP) has evolved significantly over the past 20 years. As the number of oral anticancer treatment options continues to increase, so do the costs of these drugs. Furthermore, payment responsibility for these treatments is increasingly shifted from insurers to patients. In this narrative review, we sought to summarize existing assessments of financial toxicity (FT) associated with oral advanced CaP treatments, describe efforts targeted at limiting FT from these agents, and identify areas in need of further investigation. FT is understudied in advanced CaP. Oral treatment options are associated with significantly higher direct costs to patients compared to standard androgen deprivation therapy or chemotherapy. Financial assistance programs, Medicare low-income subsidies, and recent health policy changes help offset these costs for some patients. Physicians are reluctant to discuss treatment costs with patients and further work is needed to better understand best practices for inclusion of FT discussions in shared decision-making. Oral therapies for advanced CaP are associated with significantly higher patient out-of-pocket costs which may contribute to FT. Currently, little is known regarding the extent and severity of these costs on patients' lives. While recent policy changes have helped reduce these costs for some patients, more work is needed to better characterize FT in this population to inform interventions that improve access to care and lessen the harms associated with the cost of novel treatments.
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Affiliation(s)
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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21
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Pockros B, Shabet C, Stensland K, Herrel L. Out-of-Pocket Costs for Prostate Cancer Medications Substantially Vary by Medicare Part D Plan: An Online Tool Presents an Opportunity to Mitigate Financial Toxicity. UROLOGY PRACTICE 2023; 10:467-475. [PMID: 37347766 PMCID: PMC10597673 DOI: 10.1097/upj.0000000000000421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Patients with advanced prostate cancer are frequently prescribed enzalutamide or abiraterone, often requiring high out-of-pocket costs. Many of these patients are insured through Medicare and have an option to select among 54 different Part D drug plans. However, less than 30% of patients report comparing costs before selecting a plan. An online Part D plan navigator is publicly available and allows patients to compare estimated out-of-pocket prescriptions costs. In this study, we examine the variability of out-of-pocket costs based on available Part D drug plans for patients with prostate cancer and demonstrate how an online tool could save patients thousands of dollars. METHODS We identified drug plans available for selection in 2023 using the online Medicare Part D Plan Finder. We sampled plan options for 12 different zip codes within the United States. A university-sponsored specialty cancer pharmacy and online mail-order pharmacy were included for comparison. We identified out-of-pocket costs for enzalutamide and abiraterone based on all Part D plans available for selection. RESULTS On average, 24 Part D drug plans were available for each zip code. Median annual out-of-pocket costs were $11,626 for enzalutamide and $9,275 for abiraterone. The range of annual out-of-pocket costs were $9,854 to $13,061 for enzalutamide and $1,379 to $13,274 for abiraterone. Within certain zip codes, potential out-of-pocket cost savings were $2,512 for enzalutamide and $9,321 for abiraterone. Median difference of out-of-pocket cost between enzalutamide and abiraterone was $8,758. CONCLUSIONS Out-of-pocket costs vary considerably across Part D drug plans. The Medicare Part D Plan Finder is a simple and effective tool to identify affordable drug plans. Guidance on plan selection could save patients thousands of dollars and help mitigate the financial toxicity of treatment. Comprehensive cancer centers could include plan navigators as an essential component of treatment.
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Affiliation(s)
| | | | | | - Lindsey Herrel
- Department of Urology, University of Michigan, Ann Arbor, MI
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22
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McLoone J, Chan RJ, Varlow M, Whittaker K, Lindsay D, Thamm C, Leigh L, Muir L, Mackay G, Karikios DJ, Hunt L, Hobbs K, Goldsbury DE, Nabukalu D, Gordon LG. Challenges and solutions to cancer-related financial toxicity according to Australian health professionals: qualitative results from a national survey. Support Care Cancer 2023; 31:441. [PMID: 37402039 DOI: 10.1007/s00520-023-07875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To qualitatively explore Australian healthcare professionals' perspectives on how to improve the care and management of cancer-related financial toxicity, including relevant practices, services, and unmet needs. METHODS We invited healthcare professionals (HCP) who currently provide care to people with cancer within their role to complete an online survey, which was distributed via the networks of Australian clinical oncology professional associations/organisations. The survey was developed by the Clinical Oncology Society of Australia's Financial Toxicity Working Group and contained 12 open-ended items which we analysed using descriptive content analysis and NVivo software. RESULTS HCPs (n = 277) believed that identifying and addressing financial concerns within routine cancer care was important and most believed this to be the responsibility of all HCP involved in the patient's care. However, financial toxicity was viewed as a "blind spot" within a medical model of healthcare, with a lack of services, resources, and training identified as barriers to care. Social workers reported assessment and advocacy were part of their role, but many reported lacking formal training and understanding of financial complexities/laws. HCPs reported positive attitudes towards transparent discussions of costs and actioning cost-reduction strategies within their control, but feelings of helplessness when they perceived no solution was available. CONCLUSION Identifying financial needs and providing transparent information about cancer-related costs was viewed as a cross-disciplinary responsibility, however, a lack of training and services limited the provision of support. Increased cancer-specific financial counselling and advocacy, via dedicated roles or developing HCPs' skills, is urgently needed within the healthcare system.
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Affiliation(s)
- Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.
- Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Megan Varlow
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Kate Whittaker
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Carla Thamm
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Lillian Leigh
- Rare Cancers Australia, Bowral, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Louisa G Gordon
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
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23
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Hastert TA, Nair M, Eggly S. Providers' communication-related concerns in helping patients address the financial impact of cancer. PATIENT EDUCATION AND COUNSELING 2023; 114:107860. [PMID: 37421848 DOI: 10.1016/j.pec.2023.107860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES This study describes the communication-related concerns of oncology providers in addressing financial issues with patients. METHODS We conducted semi-structured interviews with 17 providers (9 clinicians, 5 social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcripts using qualitative thematic analysis. Interview topics included cost-related concerns of patients, resources providers used, and unmet needs related to addressing financial issues. Here we present codes and content related to a cross-cutting cost communication, stratified by provider discipline. RESULTS Communication-related issues varied by provider type. Clinicians identified lack of information, lack of time, and the need for additional support as major barriers to effective cost discussions. Social workers/navigators expressed the importance of establishing a relationship before discussing costs and on the need to revisit cost concerns over time to meet patients' changing needs. The attorneys endorsed the need for more and earlier cost communication to prevent financial hardship. CONCLUSION Communication concerns and strategies were central to providers' experiences of addressing cancer patient cost concerns. PRACTICE IMPLICATIONS Understanding the experiences of diverse oncology providers can inform the development and implementation of interventions to prevent and mitigate financial hardship in people with cancer.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
| | - Mrudula Nair
- Department of Public Health Sciences, Henry Ford Medical Group, Detroit, MI, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
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24
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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25
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Shirato H, Harada H, Iwasaki Y, Notsu A, Yamada K, Uezono H, Koide Y, Wada H, Kubota H, Shikama N, Yamazaki T, Ito K, Heianna J, Okada Y, Tonari A, Takahashi S, Kosugi T, Ejima Y, Katoh N, Yoshida K, Komiyama T, Uchida N, Miwa M, Watanabe M, Nagakura H, Saito T, Ikeda H, Asakawa I, Seiichiro T, Takahashi T, Shigematsu N. Income and Employment of Patients at the Start and in the Follow-up of Palliative Radiotherapy for Bone Metastasis. Adv Radiat Oncol 2023; 8:101205. [PMID: 37077179 PMCID: PMC10106830 DOI: 10.1016/j.adro.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose The aim of this study was to understand the income and employment status of patients at the start of and during follow-up after palliative radiation therapy for bone metastasis. Methods and Materials From December 2020 to March 2021, a prospective multi-institutional observational study was conducted to investigate income and employment of patients at the start of administration of radiation therapy for bone metastasis and at 2 and 6 months after treatment. Of 333 patients referred to radiation therapy for bone metastasis, 101 were not registered, mainly because of their poor general condition, and another 8 were excluded from the follow-up analysis owing to ineligibility. Results In 224 patients analyzed, 108 had retired for reasons unrelated to cancer, 43 had retired for reasons related to cancer, 31 were taking leave, and 2 had lost their jobs at the time of registration. The number of patients who were in the working group was 40 (30 with no change in income and 10 with decreased income) at registration, 35 at 2 months, and 24 at 6 months. Younger patients (P = 0), patients with better performance status (P = 0), patients who were ambulatory (P = .008), and patients with lower scores on a numerical rating scale of pain (P = 0) were significantly more likely to be in the working group at registration. There were 9 patients who experienced improvements in their working status or income at least once in the follow-up after radiation therapy. Conclusions The majority of patients with bone metastasis were not working at the start of or after radiation therapy, but the number of patients who were working was not negligible. Radiation oncologists should be aware of the working status of patients and provide appropriate support for each patient. The benefit of radiation therapy to support patients continuing their work and returning to work should be investigated further in prospective studies.
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Liang MI, Harrison R, Aviki EM, Esselen KM, Nitecki R, Meyer L. Financial toxicity: A practical review for gynecologic oncology teams to understand and address patient-level financial burdens. Gynecol Oncol 2023; 170:317-327. [PMID: 36758422 DOI: 10.1016/j.ygyno.2023.01.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
Financial toxicity describes the adverse impact patients experience from the monetary and time costs of cancer care. The financial burden patients experience comes from substantially increased out-of-pocket spending that often occurs concurrent with reduced income due to sick leave from work. Financial toxicity is common affecting approximately half of patients with a gynecological cancer depending on the validated instrument used for measurement. Financial toxicity is experienced by patients in three domains: economic hardship affecting patients' material conditions (i.e., medical debt), psychological response (i.e., distress), and health-related coping behaviors that patients adopt (i.e., foregoing care due to costs). Higher financial toxicity among cancer patients has been associated with decreased quality of life, impaired adherence to recommended care, and worse overall survival. In this review, we describe the current literature on financial toxicity, including how it can be assessed with validated tools, the downstream impact on patients, risk factors, and employment concerns of survivors. Whenever possible, we highlight data from research featuring patients with gynecologic cancer specifically. We also review studies with interventions aimed to mitigate financial toxicity and offer the reader real world examples of interventions currently being used. Lastly, we provide an overview of health policy developments relevant to financial toxicity and advocate for innovation in the development and implementation of strategies to decrease the financial toxicity patients experience following a diagnosis of gynecologic cancer.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ross Harrison
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larissa Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Communication of costs and financial burdens between cancer patients and healthcare providers: a qualitative systematic review and meta-synthesis. Support Care Cancer 2023; 31:192. [PMID: 36847898 DOI: 10.1007/s00520-023-07647-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVES The aim of this study was to synthesize qualitative research regarding communication of costs and financial burdens between patients and healthcare providers to provide evidence for the subsequent development of intervention programs. METHODS Studies published prior to 11 February 2023 were collected from electronic databases, including PubMed/MEDLINE, MEDLINE (Ovid), Web of Science, EMBASE (Ovid), CINAHL (EBSCO), and ProQuest. A checklist for qualitative research drawn from the Joanna Briggs Institute Reviewer's Manual was applied to assess the quality of the included studies. Meta-aggregation was performed to synthesize the findings of the included studies. RESULTS Four synthesized findings were derived from 15 studies: cost communication offered more benefits than drawbacks, and most patients were willing to engage in cost communication; cost communication has been implemented in clinical practice but continued to face shortcomings and barriers; an expected cost communication should take into account timing, location, personnel, personality, and content; healthcare providers required education, information, tools, standardized processes, and policy and organizational support to increase their ability to deliver cost communication. CONCLUSIONS Cost communication can help optimize decision-making and reduce the risk of financial difficulties, as has been widely recognized by patients and healthcare providers. However, a complete clinical practice plan to facilitate cost communication has not yet been created.
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Everson J, Henderson SC, Cheng A, Senft N, Whitmore C, Dusetzina SB. Demand for and Occurrence of Medication Cost Conversations: A Narrative Review. Med Care Res Rev 2023; 80:16-29. [PMID: 35808853 DOI: 10.1177/10775587221108042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
High medication prices can create a financial burden for patients and reduce medication initiation. To improve decision making, public policy is supporting development of tools to provide real-time prescription drug prices. We reviewed the literature on medication cost conversations to characterize the context in which these tools may be used. Our review included 42 articles: a median of 84% of patients across four clinical specialties reported a desire for cost conversations (n = 7 articles) but only 23% reported having held a cost conversation across six specialties (n = 16 articles). Non-White and older patients were less likely to report having held a cost conversation than White and younger patients in 9 of 13 and 5 of 9 articles, respectively, examining these associations. Our review indicates that tools providing price information may not result in improved decision making without complementary interventions that increase the frequency of cost conversations with a focus on protected groups.
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Affiliation(s)
- Jordan Everson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Audrey Cheng
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | | | - Stacie B Dusetzina
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
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Gordon LG, Nabukalu D, Chan RJ, Goldsbury DE, Hobbs K, Hunt L, Karikios DJ, Mackay G, Muir L, Leigh L, Thamm C, Lindsay D, Whittaker K, Varlow M, McLoone J, Financial Toxicity Working Group OBOTC. Opinions and strategies of Australian health professionals on tackling cancer-related financial toxicity: A nationwide survey. Asia Pac J Clin Oncol 2023; 19:126-135. [PMID: 35589922 DOI: 10.1111/ajco.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/20/2023]
Abstract
AIM To understand the opinions and current practices of health professionals on the topic of addressing cancer-related financial toxicity among patients. METHODS A cross-sectional online survey was distributed through Australian clinical oncology professional organizations/networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient-clinician discussions, opinions about their role, strategies used, and barriers to providing solutions for patients. Descriptive statistics were used and subgroup analyses were undertaken by occupational groups. RESULTS Two hundred and seventy-seven health professionals completed the survey. The majority were female (n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed that it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed that these discussions were an important part of high-quality care. However, 73 (28%) stated that they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group; 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation. CONCLUSION Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial-related discussions for all health professionals are urgently needed to advance action in this field.
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Affiliation(s)
- Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia.,Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia.,Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | | | - Carla Thamm
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | | | | | - Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.,Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia
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Belcher SM, Lee H, Nguyen J, Curseen K, Lal A, Zarrabi AJ, Gantz L, Rosenzweig MQ, Hill JL, Yeager KA. Financial Hardship and Quality of Life Among Patients With Advanced Cancer Receiving Outpatient Palliative Care: A Pilot Study. Cancer Nurs 2023; 46:3-13. [PMID: 34974507 PMCID: PMC11195536 DOI: 10.1097/ncc.0000000000001052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes. OBJECTIVE The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC). METHODS Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL. RESULTS The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health ( P = .008), pain ( P = .003), and emotional well-being ( P = .017) QOL dimensions. CONCLUSIONS Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer. IMPLICATIONS FOR PRACTICE Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.
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Affiliation(s)
- Sarah M Belcher
- Author Affiliations: Department of Health & Community Systems, University of Pittsburgh School of Nursing (Dr Belcher); and Hillman Cancer Center, University of Pittsburgh Medical Center (Drs Belcher and Rosenzweig), Pennsylvania; Nell Hodgson Woodruff School of Nursing (Ms Lee and Dr Yeager) and Department of Neuroscience and Behavioral Biology, Emory University (Ms Nguyen); Emory Healthcare (Drs Curseen and Zarrabi and Mss Gantz and Hill); School of Medicine, Emory University (Drs Curseen, Lal, and Zarrabi); and Grady Memorial Hospital (Dr Lal), Atlanta, Georgia; Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Rosenzweig); and Winship Cancer Institute, Atlanta, Georgia (Dr Yeager)
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Espinoza Suarez NR, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR, Brito JP. ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3249-3258. [PMID: 35918230 DOI: 10.1016/j.pec.2022.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. METHODS A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. RESULTS Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. CONCLUSION Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. PRACTICE IMPLICATIONS We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Laval University, Quebec, QC, Canada
| | | | - Allison S Morrow
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, MN, USA
| | - Celia Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA.
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Mertz S, Benjamin C, Girvalaki C, Cardone A, Gono P, May SG, Comerford E, Than KS, Birch K, Roach M, Myers S, Sasane M, Lavi L, Cameron A, Cardoso F. Progression-free survival and quality of life in metastatic breast cancer: The patient perspective. Breast 2022; 65:84-90. [PMID: 35870420 PMCID: PMC9307669 DOI: 10.1016/j.breast.2022.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/10/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Objective Materials and methods Results Conclusion Overall survival benefit combined with good QoL are the most important endpoints for mBC patients. Time without disease progression is meaningful to patients when coupled with no worsening in or improvements in QoL. Quality of life is highly individual and evolves throughout the treatment journey. Surrogate endpoints are confusing; more patient-centered language is needed. Healthcare professionals should account for disease and psychological well-being.
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Affiliation(s)
- Shirley Mertz
- Metastatic Breast Cancer Network, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Christine Benjamin
- SHARE Cancer Support, 165 West 46th St, Suite 712, New York, NY, 10036, USA
| | - Charis Girvalaki
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Antonella Cardone
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Paulina Gono
- European Cancer Patient Coalition, 40, Rue de Montoyer/Montoyerstraat, B-1000, Brussels, Belgium
| | - Suepattra G May
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA.
| | - Erin Comerford
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Kyi-Sin Than
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Kelly Birch
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Meaghan Roach
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Sky Myers
- PRECISIONheor, 60 E 42nd Street, Suite 1325 New York, NY, 10165, USA
| | - Medha Sasane
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Liat Lavi
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Anna Cameron
- Sanofi Genzyme. 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal
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Smith GL, Banegas MP, Acquati C, Chang S, Chino F, Conti RM, Greenup RA, Kroll JL, Liang MI, Pisu M, Primm KM, Roth ME, Shankaran V, Yabroff KR. Navigating financial toxicity in patients with cancer: A multidisciplinary management approach. CA Cancer J Clin 2022; 72:437-453. [PMID: 35584404 DOI: 10.3322/caac.21730] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022] Open
Abstract
Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.
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Affiliation(s)
- Grace L Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shine Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University School of Business, Boston, Massachusetts
| | - Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Juliet L Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Department of Internal Medicine, The University of Alabama, Birmingham, Alabama
| | - Kristin M Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Veena Shankaran
- Seattle Cancer Care Alliance/University of Washington Medicine and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Brown T, Apenteng BA, Opoku ST. Factors associated with cost conversations in oral health care settings. J Am Dent Assoc 2022; 153:829-838. [PMID: 35589435 DOI: 10.1016/j.adaj.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patient-provider cost conversations can minimize cost-related barriers to health, while improving treatment adherence and patient satisfaction. The authors sought to identify factors associated with the occurrence of cost conversations in dentistry. METHODS This was a cross-sectional study using data from an online, self-administered survey of US adults who had seen a dentist within the past 24 months at the time of the survey. Multivariable hierarchical logistic regression analysis was used to identify patient and provider characteristics associated with the occurrence of cost conversations. RESULTS Of the 370 respondents, approximately two-thirds (68%) reported having a cost conversation with their dental provider during their last dental visit. Cost conversations were more likely for patients aged 25 through 34 years (odds ratio [OR], 2.84; 95% CI, 1.54 to 5.24), 35 through 44 years (OR, 3.35; 95% CI, 1.50 to 7.51), and 55 through 64 years (OR, 3.39; 95% CI, 1.38 to 8.28) than patients aged 18 through 24 years. Cost conversations were less likely to occur during visits with dental hygienists than during visits with general or family dentists (OR, 0.25; 95% CI, 0.11 to 0.58). In addition, respondents from the South (OR, 1.90; 95% CI, 1.04 to 3.48) and those screened for financial hardship were more likely to report having cost conversations with their dental providers (OR, 6.70; 95% CI, 2.69 to 16.71). CONCLUSIONS Within the study sample, cost conversations were common and were facilitated via financial hardship screening. PRACTICAL IMPLICATIONS Modifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care.
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Sloan CE, Gutterman S, Davis JK, Campagna A, Pollak KI, Barks MC, Santanam T, Sharma M, Grande DT, Zafar SY, Ubel PA. How can healthcare organizations improve cost-of-care conversations? A qualitative exploration of clinicians' perspectives. PATIENT EDUCATION AND COUNSELING 2022; 105:2708-2714. [PMID: 35440376 DOI: 10.1016/j.pec.2022.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations. METHODS We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews. RESULTS Twenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with patients to identify costs; provide accurate insurance coverage and/or out-of-pocket cost information via the electronic health record; develop local lists of lowest-cost pharmacies, laboratories, and subspecialists; hire financial counselors; and reduce indirect costs (e.g., parking). CONCLUSIONS Despite considerable barriers to discussing, identifying, and reducing patient costs, clinicians described a variety of strategies for improving cost communication in the clinic. PRACTICE IMPLICATIONS Health systems and clinic leadership can and should implement these strategies to improve the financial health of the patients they serve.
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Affiliation(s)
- Caroline E Sloan
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Sophia Gutterman
- University of Michigan School of Medicine, Ann Arbor, MI, USA; Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - J Kelly Davis
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Ada Campagna
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University, Durham, NC, USA; Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - Mary Carol Barks
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA
| | - Taruni Santanam
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Meghana Sharma
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David T Grande
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Peter A Ubel
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Fuqua School of Business, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Sanford School of Public Policy, Duke University, Durham, NC, USA
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de Moor JS, Williams CP, Blinder VS. Cancer-Related Care Costs and Employment Disruption: Recommendations to Reduce Patient Economic Burden as Part of Cancer Care Delivery. J Natl Cancer Inst Monogr 2022; 2022:79-84. [PMID: 35788373 DOI: 10.1093/jncimonographs/lgac006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer survivors are frequently unprepared to manage the out-of-pocket (OOP) costs associated with undergoing cancer treatment and the potential for employment disruption. This commentary outlines a set of research recommendations stemming from the National Cancer Institute's Future of Health Economics Research Conference to better understand and reduce patient economic burden as part of cancer care delivery. Currently, there are a lack of detailed metrics and measures of survivors' OOP costs and employment disruption, and data on these costs are rarely available at the point of care to guide patient-centered treatment and survivorship care planning. Future research should improve the collection of data about survivors' OOP costs for medical care, other cancer-related expenses, and experiences of employment disruption. Methods such as microcosting and the prospective collection of patient-reported outcomes in cancer care are needed to understand the true sum of cancer-related costs taken on by survivors and caregivers. Better metrics and measures of survivors' costs must be coupled with interventions to incorporate that information into cancer care delivery and inform meaningful communication about OOP costs and employment disruption that is tailored to different clinical situations. Informing survivors about the anticipated costs of their cancer care supports informed decision making and proactive planning to mitigate financial hardship. Additionally, system-level infrastructure should be developed and tested to facilitate screening to identify survivors at risk for financial hardship, improve communication about OOP costs and employment disruption between survivors and their health-care providers, and support the delivery of appropriate financial navigation services.
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Affiliation(s)
- Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Courtney P Williams
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Chen M, Li R, Ding G, Jin C. Needs of cancer patients during the SARS-CoV-2 Omicron lockdown: A population-based survey in Shanghai, China. Biosci Trends 2022; 16:230-237. [PMID: 35718468 DOI: 10.5582/bst.2022.01251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate the medical and healthcare needs of cancer patients during the Shanghai lockdown due to the SARS-CoV-2 Omicron pandemic. From April 15 to April 21, 2022, 4,195 cancer patients from every district in Shanghai were surveyed using quota sampling via an online platform. The questionnaire consisted of three main parts: demographic and sociological data, disease diagnosis, and different dimensions of patients' needs. Correlation analysis was used to examine the relationship between participants' need scores in each dimension, and generalized linear regression models were used to analyze the factors influencing patients' need scores. The mean age of participants was 63.23 years (SD: 7.43 years), with more female than male participants (80.38% vs. 19.62%). Among participants, the three leading groups of patients were those with breast cancer (39.02%), colorectal cancer (12.82%), or tracheal and bronchial lung cancer (10.23%). Social support, dietary/nutritional support, and psychological counselling ranked as the top three needs of cancer patients. In addition, vaccination against SARS-CoV-2 may reduce psychological anxiety in cancer patients. Compared to participants who had never received the SARS-CoV-2 vaccine, participants who had received one, two, or three doses of the vaccine were respectively 36% (odds ratio (OR): 0.64, 95% confidence interval (CI): 0.56-0.73), 38% (OR: 0.62, 95% CI: 0.59-0.54), and 37% (OR: 0.63, 95% CI: 0.60-0.66) less likely to have an increased need for psychological counseling. In light of constraints on offline medical resources for cancer patients during the lockdown, the current authors have begun to re-examine the universal accessibility and spread of telemedicine in the future. In addition, immune barriers can be established for cancer patients and vaccination guidelines for different disease stages, tumor types, and treatment regimens can be explored in detail.
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Affiliation(s)
- Minxing Chen
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Ruijia Li
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Gang Ding
- Oncology Department, Shanghai International Medical Center, Shanghai, China
| | - Chunlin Jin
- Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
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Experiences of cancer patients about seeking health information: a qualitative study. Support Care Cancer 2022; 30:7697-7704. [PMID: 35697883 DOI: 10.1007/s00520-022-07210-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Searching for health information is an important strategy in dealing with cancer that contributed to the improved management of cancer. This qualitative study aimed to explore the experiences of cancer patients seeking health information using the conventional content analysis approach. METHODS The 18 participants were selected by purposive sampling and data were collected through semi-structured in-depth interviews. Data were analyzed by software MaxQDA 10 based on conventional content analysis. RESULTS Data analysis led to the emergence of three central categories, including "optimal cancer management," "poor information dissemination system," and "perceived health literacy." CONCLUSION Knowing how cancer patients obtain health information can form the basis to promote patients' health literacy and design a health information dissemination system tailored to the patients' needs.
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Perni S, Azoba C, Gorton E, Park ER, Chabner BA, Moy B, Nipp RD. Financial Toxicity, Symptom Burden, Illness Perceptions, and Communication Confidence in Cancer Clinical Trial Participants. JCO Oncol Pract 2022; 18:e1427-e1437. [PMID: 35666957 DOI: 10.1200/op.21.00697] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer clinical trial (CCT) participants are at risk for experiencing adverse associations from financial toxicity, but these remain understudied. METHODS From July 2015 to July 2017, we prospectively enrolled CCT participants referred for financial assistance and a group of patients matched by age, sex, cancer type, trial, and trial phase. We assessed financial burden of cancer care, cost concerns about CCTs, physical (Edmonton Symptom Assessment Scale [ESAS]) and psychologic (Patient Health Questionnaire-4 [PHQ-4]) symptoms, illness perceptions (Brief Illness Perception Questionnaire), and communication confidence (Perceived Efficacy in Patient-Physician Interactions). Adjusting for age, sex, race, performance status, marital status, income, insurance, and disease status, we examined associations of financial burden and cost concerns with patients' symptoms, illness perceptions, and communication confidence. RESULTS Of 198 patients, 112 (56.6%) reported financial burden and 82 (41.4%) reported cost concerns. Higher ESAS-total (odds ratio [OR] = 1.03; 95% CI, 1.01 to 1.06; P = .001), PHQ-4 depression (OR = 1.58; 95% CI, 1.20 to 2.08; P < .001), PHQ-4 anxiety (OR = 1.26; 95% CI, 1.02 to 1.55; P = .025), and more negative illness perceptions (OR = 1.04; 95% CI, 1.00 to 1.07; P = .029) were associated with financial burden, but not communication confidence (OR = 0.98; 95% CI, 0.02 to 1.05; P = .587). Higher ESAS-total (OR = 1.03; 95% CI, 1.01 to 1.05; P = .004), PHQ-4 depression (OR = 1.36; 95% CI, 1.08 to 1.71; P = .03), PHQ-4 anxiety (OR = 1.26; 95% CI, 1.03 to 1.53; P = .018), more negative illness perceptions (OR = 1.06; 95% CI, 1.02 to 1.10; P = .001), and decreased communication confidence (OR = 0.93; 95% CI, 0.86 to 1.00; P = .029) were associated with cost concerns. CONCLUSION In this study of CCT participants, greater symptom burden, more negative illness perceptions, and lower communication confidence were associated with financial toxicity, underscoring the importance of addressing these issues when seeking to alleviate adverse associations of financial toxicity.
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Affiliation(s)
- Subha Perni
- Harvard Radiation Oncology Program, Massachusetts General Hospital and Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.,Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Chukwuma Azoba
- St George's University School of Medicine, True Blue, Grenada
| | - Emily Gorton
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Bruce A Chabner
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Ryan D Nipp
- Division of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
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Harwood KJ, Pines JM, Andrilla CHA, Frogner BK. Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res 2022; 22:694. [PMID: 35606781 PMCID: PMC9128255 DOI: 10.1186/s12913-022-08092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs. METHODS Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics. RESULTS Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205). CONCLUSION The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.
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Affiliation(s)
- Kenneth J Harwood
- College of Health and Education, Marymount University, Arlington, VA, USA.
| | | | - C Holly A Andrilla
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Henrikson NB, Anderson ML, Dickerson J, Ewing JJ, Garcia R, Keast E, King DA, Lewis C, Locher B, McMullen C, Norris CM, Petrik AF, Ramaprasan A, Rivelli JS, Schneider JL, Shulman L, Tuzzio L, Banegas MP. The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship. Trials 2022; 23:402. [PMID: 35562781 PMCID: PMC9099299 DOI: 10.1186/s13063-022-06344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention. METHODS The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received. DISCUSSION The CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial's strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective. TRIAL REGISTRATION ClinicalTrials.gov NCT05018000 . August 23, 2021.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John J Ewing
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robin Garcia
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Blake Locher
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Consuelo M Norris
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of California San Diego, San Diego, CA, USA
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Chen LW, Cao Y, D'Rummo K, Shen X. Estimation of Patient Out of Pocket Cost for Radiation Therapy by Insurance Type and Treatment Modality. Pract Radiat Oncol 2022; 12:e481-e485. [PMID: 35447387 DOI: 10.1016/j.prro.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE Financial toxicity is increasingly identified as an important issue in cancer care. Limited data are available on direct out of pocket (OOP) costs for radiation therapy, which are important for providers and patients. METHODS Retrospective analysis of 247 consecutive patients with non-metastatic breast and prostate cancer treated with curative intent. Data were collected on demographics, treatments received and insurance plan specifications, including annual OOP maximum, deductibles, co-insurance rates, OOP already paid prior to starting radiation therapy, and actual estimated OOP for radiation therapy. Multivariable logistic regression was used to examine associations between insurance factors, radiation technique, concurrent systemic therapy, and month of treatment with a patient reaching OOP maximum with radiation treatment. RESULTS 137 and 110 breast and prostate cancer patients were evaluated. Mean plan specified annual OOP maximum for commercial and Medicare Advantage plans were $4064 and $4661, respectively; 100% of commercially insured patients and 54.7% Medicare Advantage patients reached their OOP maximum with radiation therapy. Annual OOP maximum for Medicare plus supplement, Medicaid, and Tricare were minimal. On multivariable analysis, concurrent systemic therapy (OR 6.20, p=.03) was associated with patient reaching OOP maximum, but radiation technique was not. CONCLUSION Out of pocket cost for radiation therapy services may be reasonably estimated based on insurance type and structure. Medicare plus supplement and Medicaid plans have negligible OOP, while all patients with commercial plans reached annual OOP maximums. This study provides practical information to help providers to better counsel patients.
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Affiliation(s)
- Luke W Chen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas
| | - Ying Cao
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas
| | - Kevin D'Rummo
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, Kansas.
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Paro A, Hyer JM, Shaikh CF, Pawlik TM. Financial Impact of Out-of-Pocket Costs Among Patients Undergoing Resection for Colorectal Carcinoma. Ann Surg Oncol 2022; 29:5387-5397. [PMID: 35430665 PMCID: PMC9013274 DOI: 10.1245/s10434-022-11755-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/04/2022] [Indexed: 12/14/2022]
Abstract
Introduction Little is known about the societal burden of cancer surgical care in terms of out-of-pocket (OOP) costs. The current study sought to define OOP costs incurred by patients undergoing colorectal cancer resection. Methods Privately insured patients undergoing colorectal cancer resection between 2013 and 2017 were identified from the IBM MarketScan database. Total and OOP costs were calculated within 1 year prior to and 1 year post surgery. A multivariable linear regression model was used to estimate total OOP costs relative to patient demographic and clinical characteristics. Results Among 10,935 patients, 7289 (66.7%) had primary colon cancer while 3643 (33.3%) had rectal cancer. Median total costs were US$93,967 (IQR US$51027–168,251). Median OOP costs were US$4417 (IQR US$2519–6943), or 4.5% (IQR 2.2–8.1%) of total costs. OOP costs varied over the course of patient care; specifically, median OOP costs in the preoperative period were US$432 (IQR US$130–1452) versus US$2146 (IQR US$851–3525) in the perioperative period and US$969 (IQR US$327–2239) in the postoperative period. On multivariable analysis, receipt of chemotherapy (+US$1368, 95%CI +US$1211 to +US$1525) or radiotherapy (+US$842, 95% CI +US$626 to +US$1059) was associated with higher total OOP costs. Patients with a health maintenance organization (HMO) (−US$2119, 95% CI −US$2550 to −US$1689) or a point-of-service plan (−US$938, 95% CI −US$1385 to −US$491) had lower total OOP costs than patients with comprehensive insurance. In contrast, patients with a consumer-driven or a high-deductible health plan had considerably higher total OOP costs than patients with comprehensive insurance (+US$1400, 95% CI +US$972 to +US$1827 and +US$3243, 95% CI +US$2767 to +US$3717, respectively). Conclusions Privately insured colorectal cancer patients undergoing surgical resection pay a median of US$4417 in OOP costs, or 4.5% of total costs. OOP costs varied with receipt of chemotherapy or radiotherapy, region of residence, and insurance plan type. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-022-11755-2.
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Affiliation(s)
- Alessandro Paro
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - J Madison Hyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, Columbus, OH, USA.
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Aviki EM, Abu-Rustum NR, Thom B, Moss HA, Chino F. Oncologists' Attitudes Toward Cancer Care Affordability. JAMA Netw Open 2022; 5:e227863. [PMID: 35438759 PMCID: PMC9020205 DOI: 10.1001/jamanetworkopen.2022.7863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This investigator-designed survey study evaluates oncologists’ attitudes about cancer treatment affordability for patients and acceptability of physician-based solutions.
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Affiliation(s)
- Emeline M. Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College of Cornell University, New York, New York
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Medical College of Cornell University, New York, New York
| | - Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haley A. Moss
- Department of Obstetrics and Gynecology, Duke University Hospital, Durham, North Carolina
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Dar MA, Chauhan R, Murti K, Trivedi V, Dhingra S. Development and Validation of Subjective Financial Distress Questionnaire (SFDQ): A Patient Reported Outcome Measure for Assessment of Financial Toxicity Among Radiation Oncology Patients. Front Oncol 2022; 11:819313. [PMID: 35186720 PMCID: PMC8847677 DOI: 10.3389/fonc.2021.819313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Financial toxicity is a consequence of subjective financial distress experienced by cancer patients as a result of treatment expenditures. Financial toxicity has been associated with poor quality of life, early mortality, and non-adherence. It is evident from the literature that the currently available instruments for the assessment of financial toxicity do not measure coping and support seeking domains. The aim of this study was to develop an instrument for the assessment of financial toxicity among radiation oncology patients that captures and integrates all the relevant domains of subjective financial distress. Materials and Methods The study was conducted among Head & Neck cancer (HNC) patients (age ≥18 years) who have completed the radiotherapy either as stand-alone or part of a multimodal treatment. Literature review, expert opinion, and patient interviews were used for scale item generation. The validity and underlying factor structure were evaluated by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The reliability and internal consistency of the final scale was assessed using Cronbach’s alpha coefficient. Results A total of 17 items were identified for scale development. The preliminary 17-item instrument was administered to 142 HNC patients. Among 142 participants, 85.9% were male and 98.6% were from rural areas. EFA was performed on 17 items and three items were removed (factor loadings <0.5). The remaining 14 items loaded onto three factors (eigenvalue >1) explaining 62.0% of the total variance. The Chi-square goodness of fit test in CFA and the values of other model fit indices, namely, RMSEA = 0.045, SRMR = 0.014, GFI = 0.92, CFI = 0.98, and TLI=0.97 indicate a good model fit suggesting the three-factor model adequately fits the data. The Cronbach’s α for the final 14-item scale was 0.87 indicating excellent reliability and the Cronbach’s α coefficient of all the individual 14 items was ≥0.85 (range 0.85–0.88). Conclusion The SFDQ showed excellent validity and reliability. SFDQ captures and integrates all the relevant domains of financial toxicity. However, the provisional SFDQ instrument warrants further larger sample studies for validation and psychometric evaluation in different primary cancer subsites and treatment modalities from multiple cancer centers to improve the generalizability of this instrument.
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Affiliation(s)
- Mukhtar Ahmad Dar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Richa Chauhan
- Department of Radiotherapy, Mahavir Cancer Sansthan and Research Centre (MCSRC), Phulwarisharif, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Vinita Trivedi
- Department of Radiotherapy, Mahavir Cancer Sansthan and Research Centre (MCSRC), Phulwarisharif, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
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Piña IL, Allen LA, Desai NR. Managing the economic challenges in the treatment of heart failure. BMC Cardiovasc Disord 2021; 21:612. [PMID: 34953483 PMCID: PMC8710027 DOI: 10.1186/s12872-021-02408-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Treatment of heart failure is complex and inherently challenging. Patients traverse multiple practice settings as inpatients and outpatients, often resulting in fragmented care. The Center for Medicare and Medicaid Services is implementing payment programs that reward delivery of high-quality, cost-effective care, and one of the newer programs, the Bundled Payment for Care Improvement Advanced program, attempts to improve the coordination of care across practices for a hospitalization episode and post-acute care. The quality and cost of care contribute to its value, but value may be defined in different ways by different entities. Conclusions The rapidly changing world of digital health may contribute to or detract from the quality and cost of care. Health systems, payers, and patients are all grappling with these issues, which were reviewed at a symposium at the Heart Failure Society of America conference in Philadelphia, Pennsylvania on September 14, 2019. This article constitutes the proceedings from that symposium.
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Affiliation(s)
- Ileana L Piña
- Wayne State University, Detroit, USA. .,Central Michigan University, Mount Pleasant, MI, USA. .,Wayne State University, 2627 Fairmount Boulevard, Cleveland Heights, OH, 44106, USA.
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nihar R Desai
- Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
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Abrams HR, Durbin S, Huang CX, Johnson SF, Nayak RK, Zahner GJ, Peppercorn J. Financial toxicity in cancer care: origins, impact, and solutions. Transl Behav Med 2021; 11:2043-2054. [PMID: 34850932 DOI: 10.1093/tbm/ibab091] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term "financial toxicity" has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.
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Affiliation(s)
- Hannah R Abrams
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sienna Durbin
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cher X Huang
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rahul K Nayak
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg J Zahner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Abstract
Oncologists are often ill-prepared for patient-provider communication about the financial costs and burden of treatment. Several barriers to cost communication exist, including provider discomfort, lack of knowledge or access to accurate information, and background historic concerns that cost discussions may negatively impact the doctor-patient relationship. However, clear and transparent cost communication can yield cost-reducing strategies that ultimately mitigate the high costs of cancer care and risk for financial toxicity.
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Affiliation(s)
- Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, 310 Cedar Street, LH 118, New Haven, CT 60510, USA; The Breast Center at Smilow Cancer Hospital at Yale New Haven, New Haven, CT 06511, USA.
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50
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Wallis CJD, Joyce DD, Klaassen Z, Luckenbaugh AN, Laviana AA, Penson D, Dusetzina SB, Barocas DA. Out-of-pocket costs for commercially insured patients with localized prostate cancer. Urol Oncol 2021; 39:797-805. [PMID: 34600803 DOI: 10.1016/j.urolonc.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Financial toxicity is an underappreciated component of cancer survivorship. Treatment-specific out-of-pocket costs for patients undergoing localized prostate cancer treatment have not, to date, been described and may influence patient's decision making. METHODS We performed a retrospective cohort study among commercially-insured patients in the United States with incident prostate cancer from 2013 to 2018. We captured out-of-pocket and total costs in the year following diagnosis and compared these between patients receiving radical prostatectomy, radiotherapy, and no local treatment using propensity-score weighting adjusting for patient demographics and pre-diagnosis health utilization costs. RESULTS Among 30,360 included men [median age 59 years, 83% Charlson score 0], 15,854 underwent surgery, 5,265 radiotherapy, and 9,241 no local therapy in the year following diagnosis. In the 6-months preceding diagnosis, median overall and out-of-pocket health care costs were $2022 (interquartile range $3778) and $466 (interquartile range $781), respectively. Following propensity-score weighting, out-of-pocket costs were significantly lower for patients who received no active treatment (adjusted cost $1746, 95% confidence interval [CI] $1704-1788), followed by those who underwent surgery ($2983, 95% CI $2832-3142, P < 0.001), and those who underwent radiation ($3139, 95% CI $2939-3353, P < 0.001) in the 6-months following diagnosis. Similar patterns were seen with out-of-pocket costs 6 to 12 months following index, with overall costs, and with costs attributable to inpatient, outpatient medical, and outpatient pharmacy services. CONCLUSIONS Among commercially insured men with incident prostate cancer, active treatment with surgery or radiotherapy was associated with significantly higher out-of-pocket costs versus those who received no treatment, with little difference observed between treatment approaches.
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Affiliation(s)
| | - Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Zachary Klaassen
- Department of Surgery, Section of Urology, Medical College of Georgia - Augusta University, Augusta, GA
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron A Laviana
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX
| | - David Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Stacie B Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
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