51
|
Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors. J Cancer Surviv 2019; 13:429-437. [PMID: 31144264 DOI: 10.1007/s11764-019-00764-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/26/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Estimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost. METHODS We used data from 994 participants (411 white, 583 African American) in a hospital-based cohort study of survivors diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Financial hardship included decreased income, borrowing money, cancer-related debt, and accessing assets to pay for cancer care. Limiting care included skipping doses of prescribed medication, refusing treatment, or not seeing a doctor when needed due to cost. Logistic regression models controlled for sociodemographic factors. RESULTS More African American than white survivors reported financial hardship (50.3% vs. 41.0%, p = 0.005) and limiting care (20.0% vs. 14.2%, p = 0.019). More white than African American survivors reported utilizing assets (9.3% vs. 4.8%, p = 0.006), while more African American survivors reported cancer-related debt (30.5% vs. 18.5%, p < 0.001). Survivors who experienced financial hardship were 4.4 (95% CI: 2.9, 6.6) times as likely to limit care as those who did not. Borrowing money, cancer-related debt, and decreased income were each independently associated with limiting care, while accessing assets was not. CONCLUSIONS The prevalence of some forms of financial hardship differed by race, and these were differentially associated with limiting care due to cost. IMPLICATIONS FOR CANCER SURVIVORS The ability to use assets to pay for cancer care may protect survivors from limiting care due to cost. This has differential impacts on white and African American survivors.
Collapse
|
52
|
Hastert TA, Kyko JM, Reed AR, Harper FWK, Beebe-Dimmer JL, Baird TE, Schwartz AG. Financial Hardship and Quality of Life among African American and White Cancer Survivors: The Role of Limiting Care Due to Cost. Cancer Epidemiol Biomarkers Prev 2019; 28:1202-1211. [PMID: 31061097 DOI: 10.1158/1055-9965.epi-18-1336] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/08/2019] [Accepted: 04/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the association between financial hardship and HRQOL. METHODS We used data from 988 participants (579 African American, 409 white) in the Detroit Research on Cancer Survivors (ROCS) pilot, a hospital-based cohort of breast, colorectal, lung, and prostate cancer survivors. We assessed associations between financial hardship, limiting care, and HRQOL [measured by the Functional Assessment of Cancer Therapy-General (FACT-G)] using linear regression and mediation analysis controlling for demographic, socioeconomic, and cancer-related variables. RESULTS FACT-G scores were 4.2 [95% confidence interval (CI), 2.0-6.4] points lower among survivors who reported financial hardship compared with those who did not in adjusted models. Limiting care due to cost was associated with a -7.8 (95% CI, -5.1 to -10.5) point difference in FACT-G scores. Limiting care due to cost explained 40.5% (95% CI, 25.5%-92.7%) of the association between financial hardship and HRQOL overall, and 50.5% (95% CI, 29.1%-188.1%) of the association for African American survivors. CONCLUSIONS Financial hardship and limiting care due to cost are both associated with lower HRQOL among diverse cancer survivors, and this association is partially explained by limiting care due to cost. IMPACT Actions to ensure patients with cancer can access appropriate care could lessen the impact of financial hardship on HRQOL.
Collapse
Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jaclyn M Kyko
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
- Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Amanda R Reed
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Felicity W K Harper
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Jennifer L Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Tara E Baird
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| |
Collapse
|
53
|
Khera N, Hamilton BK, Pidala JA, Wood WA, Wu V, Voutsinas J, Onstad L, Alousi AM, Broady R, Chen GL, Arora M, Cutler C, Flowers ME, Ganetsky A, Jagasia M, McCarthy PL, Sarantopoulos S, Abel GA, Majhail NS, Lee SJ. Employment, Insurance, and Financial Experiences of Patients with Chronic Graft-versus-Host Disease in North America. Biol Blood Marrow Transplant 2018; 25:599-605. [PMID: 30296479 DOI: 10.1016/j.bbmt.2018.09.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Understanding the socioeconomic impact of chronic graft-versus-host disease (GVHD) on affected patients is essential to help improve their overall well-being. Using data from the Chronic GVHD Consortium, we describe the insurance, employment, and financial challenges faced by these patients and the factors associated with the ability to work/attend school and associated financial burdens. A 15-item cross-sectional questionnaire designed to measure financial concerns, income, employment, and insurance was completed by 190 patients (response rate, 68%; 10 centers) enrolled on a multicenter Chronic GVHD Consortium Response Measures Validation Study. Multivariable logistic regression models examined the factors associated with financial burden and ability to work/attend school. The median age of respondents was 56years, and 87% of the patients were white. A higher proportion of nonrespondents had lower income before hematopoietic cell transplantation and less than a college degree. All but 1 patient had insurance, 34% had faced delayed/denied insurance coverage for chronic GVHD treatments, and 66% reported a financial burden. Patients with a financial burden had greater depression/anxiety and difficulty sleeping. Nonwhite race, lower mental functioning, and lower activity score were associated with a greater likelihood of financial burden. Younger age, early risk disease, and higher mental functioning were associated with a greater likelihood of being able to work/attend school. In this multicenter cohort of patients with chronic GVHD, significant negative effects on finances were observed even with health insurance coverage. Future research should investigate potential interventions to provide optimal and affordable care to at-risk patients and prevent long-term adverse financial outcomes in this vulnerable group.
Collapse
Affiliation(s)
- Nandita Khera
- Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Betty K Hamilton
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph A Pidala
- Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - William A Wood
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Vicky Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Amin M Alousi
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Raewyn Broady
- Leukemia/Bone Marrow Transplant Program of British Columbia, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - George L Chen
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Mukta Arora
- Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Corey Cutler
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mary E Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Alex Ganetsky
- Hematology/BMT, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Madan Jagasia
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Philip L McCarthy
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Stefanie Sarantopoulos
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University, Durham, North Carolina
| | - Gregory A Abel
- Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Navneet S Majhail
- Blood and Marrow Transplantation, Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| |
Collapse
|
54
|
Hastert TA, Young GS, Pennell ML, Padamsee T, Zafar SY, DeGraffinreid C, Naughton M, Simon M, Paskett ED. Financial burden among older, long-term cancer survivors: Results from the LILAC study. Cancer Med 2018; 7:4261-4272. [PMID: 30019387 PMCID: PMC6143934 DOI: 10.1002/cam4.1671] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 01/08/2023] Open
Abstract
Background Increasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long‐term survivors. Methods We used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and Longevity After Cancer (LILAC) ancillary study to estimate prevalence and identify predictors of financial burden. We used logistic regression to identify sociodemographic, socioeconomic, health‐ and cancer‐related factors associated with financial burden and backward selection to build a final multivariable model. Results Average age at LILAC participation was 79 and 9.2 years had elapsed since cancer diagnosis. Overall, 6% experienced some form of financial burden, including having an insurance company refuse a claim (2.6%), being denied loans or insurance due to cancer history (2.2%), or experiencing significant indebtedness (1.8%, including facing large debts or bills or declaring bankruptcy). Eight predictors remained associated (P < 0.05) with financial burden in the fully‐adjusted model: younger age, shorter time since diagnosis, African‐American race, household income <$20 000/year, modified Charlson comorbidity score ≥2, receipt of chemotherapy, regional stage at diagnosis, and no private health insurance. Education, cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with financial burden. Predictors differed between types of financial burden experienced and age at diagnosis (<65 vs 65+). Conclusion Cancer‐related financial burden was rare in this population of older, female long‐term cancer survivors. The identification of several socioeconomic, health‐related and demographic predictors of financial burden may suggest targets of intervention to reduce financial burdens. Precis Financial burden was uncommon in older, female, long‐term survivors. Predictors of financial burden included age, race, income, comorbidities, time since diagnosis, stage, insurance, and receipt of chemotherapy.
Collapse
Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Gregory S Young
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Michael L Pennell
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Tasleem Padamsee
- Division of Health Services Management & Policy, College of Public Health, The Ohio State University, Columbus, Ohio.,The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Sanford School of Public Policy, Duke University, Durham, North Carolina
| | | | - Michelle Naughton
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Michael Simon
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| |
Collapse
|
55
|
Hanly P, Maguire R, Ceilleachair AO, Sharp L. Financial hardship associated with colorectal cancer survivorship: The role of asset depletion and debt accumulation. Psychooncology 2018; 27:2165-2171. [DOI: 10.1002/pon.4786] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/01/2018] [Accepted: 05/25/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Paul Hanly
- National College of Ireland; Dublin Ireland
| | | | | | - Linda Sharp
- Newcastle University; Newcastle upon Tyne UK
| |
Collapse
|
56
|
Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort). Cancer Epidemiol 2018; 54:38-47. [DOI: 10.1016/j.canep.2018.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/21/2018] [Accepted: 03/14/2018] [Indexed: 01/01/2023]
|
57
|
Mesnil M. What do we mean by the right to be forgotten? An analysis of the French case study from a lawyer’s perspective. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
58
|
Maharjan M, Thapa N, Adhikari RD, Petrini MA, Amatya KS. Quality of Life of Nepalese Women Post Mastectomy. Asian Pac J Cancer Prev 2018; 19:1005-1012. [PMID: 29693969 PMCID: PMC6031789 DOI: 10.22034/apjcp.2018.19.4.1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Worldwide breast cancer is the common invasive cancer among the females. The quality of life of women after treatment, which is often a mastectomy, is frequently decreased. Objective: To determine the life quality of Nepalese women post mastectomy. Materials and Methods: One hundred seven women after a mastectomy were selected and interviewed by using the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire and its Breast Specific Module to assess women’s quality of life. Result: The study findings revealed a good score on global health status/quality of life. The respondents performed well on functional and symptom scales. In the Breast Specific Module, all respondents performed poor regarding sexual function and sexual enjoyment. Global Health Status was found useful among the women involved in service/business/agriculture and the survivors using breast prosthesis. In Breast Specific Module, systemic therapy side effects showed strong statistical associations with age, marital status, occupation, education, use of breast prosthesis and co-morbidity. Body image was highly significant with age, occupation, education, use of breast prosthesis and co-morbidity. Conclusion: Based on the study findings, counseling, and a structured educational programme is recommended to improve the QOL of women after a mastectomy.
Collapse
Affiliation(s)
- Muna Maharjan
- HOPE School of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China.,Nursing Campus Maharajgunj, Institute of Medicine, Tribhuwan University, Kathmandu, Nepal.
| | | | | | | | | |
Collapse
|
59
|
Park J, Look KA. Relationship Between Objective Financial Burden and the Health-Related Quality of Life and Mental Health of Patients With Cancer. J Oncol Pract 2018; 14:e113-e121. [DOI: 10.1200/jop.2017.027136] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: The high and increasing costs of cancer care can lead to financial burden for patients and their families. However, no study has specifically examined the association between objective measures of financial burden and the health-related quality of life (HRQOL) and psychological health of patients with cancer. Methods: Data on patients with cancer were obtained from the 2010 to 2014 Medical Expenditure Panel Survey. High financial burden was defined as a ratio of annual family out-of-pocket health care expenditures to family income exceeding either 10% or 20%. Multivariable linear regressions were used to estimate the relationship between high financial burden and patient HRQOL, nonspecific psychological distress, and depressed mood. Results: Of 6,799 patients with cancer, 15% and 6% experienced high financial burden exceeding 10% and 20% of family income, respectively. Compared with those without high financial burden, patients with cancer with high financial burden were more likely to have significantly lower HRQOL and a greater tendency toward nonspecific psychological distress. Higher levels of financial burden were associated with lower HRQOL, with a stronger relationship observed with physical health than with mental health and a greater tendency toward nonspecific psychological distress. Depressed mood was not significantly associated with high financial burden. Conclusion: High financial burden among patients with cancer was significantly associated with lower HRQOL and poor mental health. Along with efforts to reduce health care costs for cancer survivors, additional interventions are necessary to ensure the HRQOL and psychological health of cancer survivors.
Collapse
Affiliation(s)
- Joohyun Park
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
| | - Kevin A. Look
- University of Wisconsin-Madison School of Pharmacy, Madison, WI
| |
Collapse
|
60
|
Pisu M, Azuero A, Halilova KI, Williams CP, Kenzik KM, Kvale EA, Williams GR, Meneses K, Sullivan M, Yagnik SK, Goertz HP, Rocque GB. Most impactful factors on the health-related quality of life of a geriatric population with cancer. Cancer 2018; 124:596-605. [PMID: 29250775 DOI: 10.1002/cncr.31048] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND As the population of older adults with cancer continues to grow, the most important factors contributing to their health-related quality of life (HRQOL) remain unclear. METHODS A total of 1457 older adults (aged ≥65 years) with cancer participated in a telephone survey. Outcomes were measured using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the 12-Item Short Form Survey (SF-12) from the Medical Outcomes Study (version 2). Statistical techniques used to identify factors in 4 domains (physical, psychological, social, and spiritual) most strongly associated with HRQOL included linear models, recursive partitioning, and random forests. Models were developed in a training data set (920 respondents) and performance was assessed in a validation data set (537 respondents). RESULTS Respondents were a median of 19 months from diagnosis, and 28.1% were receiving active treatment. The most relevant factors found to be associated with PCS were symptom severity, comorbidity scores, leisure-time physical activity, and having physical support needs. The most relevant factors for MCS were having emotional support needs, symptom severity score, and the number of financial hardship events. Results were consistent across modeling techniques. Symptoms found to be strongly associated with PCS included fatigue (adjusted proportion of summary score's variance [R2 ] = 0.34), pain (adjusted R2 = 0.32), disturbed sleep (adjusted R2 = 0.16), and drowsiness (adjusted R2 = 0.16). Symptoms found to be strongly associated with MCS included fatigue (adjusted R2 = 0.23), problems remembering things (adjusted R2 = 0.17), disturbed sleep (adjusted R2 = 0.16), and lack of appetite (adjusted R2 = 0.16). CONCLUSIONS The findings of the current study support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity, and addressing financial challenges. A long-term comprehensive approach is needed to ensure the well-being of older adults with cancer. Cancer 2018;124:596-605. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karina I Halilova
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Courtney P Williams
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Kvale
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Grant R Williams
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Karen Meneses
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Sullivan
- Mitchell Cancer Institute, University of South Alabama, Mobile, Alabama
| | | | | | - Gabrielle B Rocque
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama.,Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
61
|
Higher out-of-pocket expenses for tyrosine kinase-inhibitor therapy is associated with worse health-related quality-of-life in persons with chronic myeloid leukemia. J Cancer Res Clin Oncol 2017; 143:2619-2630. [PMID: 28894944 DOI: 10.1007/s00432-017-2517-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To explore health-related quality-of-life (HRQoL) profiles and identify socio-demographic and clinical variables associated with HRQoL in persons with chronic myeloid leukemia (CML) receiving tyrosine kinase inhibitors (TKIs). METHODS A cross-sectional questionnaire was distributed to adults with chronic-phase CML receiving tyrosine kinase-inhibitor (TKI) therapy >3 months in complete cytogenetic response (CCyR). Respondents were anonymous. SF-36 Health Survey was used to measure HRQoL. RESULTS Data from 828 respondents were analyzable. 524 (63%) were male. Median age was 42 years (range 18-88 years). 648 (78%) were receiving imatinib. Median TKI-therapy duration was 36 months (range 3-178 months). 638 (77%) paid some or all of their TKI costs. Annual out-of-pocket expenses >$4600 USD was associated with lower physical component summary (PCS; -2.8 to -3.8; P = 0.0081 and 0.0009) and mental component summary (MCS; -2.1 to -4.3; P = 0.0394 and 0.0080) in multivariate analyses. Other variables significantly associated with a lower PCS and/or MCS included: (1) female sex; (2) increasing age; (3) education level < bachelor degree; (4) co-morbidity(ies); and (5) generic drug use. TKI-therapy duration 3-5 years was associated with higher PCS and MCS. CONCLUSIONS Higher out-of-pocket expense for TKI therapy is significantly associated with worse HRQoL in persons with chronic-phase CML in CCyR receiving TKI therapy. These data indicate the importance of drug cost and health insurance policies on people's HRQoL.
Collapse
|
62
|
Khera N, Holland JC, Griffin JM. Setting the stage for universal financial distress screening in routine cancer care. Cancer 2017; 123:4092-4096. [PMID: 28817185 DOI: 10.1002/cncr.30940] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 11/07/2022]
Abstract
Financial burden from cancer treatment is increasingly being recognized as a threat to optimal access, quality, and outcomes of cancer care for patients. Although research in the area is moving at a fast pace, multiple questions remain unanswered, such as how to practically integrate the assessment and management of financial burden into routine health care delivery for patients with cancer. Although psychological distress screening for patients undergoing cancer treatment now is commonplace, the authors raise the provocative idea of universal screening for financial distress to identify and assist vulnerable groups of patients. Herein, the authors outline the arguments to support screening for financial burden in addition to psychological distress, examining it as an independent patient-reported outcome for all patients with cancer at various time points during their treatment. The authors describe the proximal and downstream impact of such a strategy and reflect on some challenges and potential solutions to help integrate this concept into routine cancer care delivery. Cancer 2017;123:4092-4096. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic Phoenix, Phoenix, Arizona
| | - Jimmie C Holland
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joan M Griffin
- Division of Health Care Policy and Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota
| |
Collapse
|
63
|
Shao Z, Zhu T, Zhang P, Wen Q, Li D, Wang S. Association of financial status and the quality of life in Chinese women with recurrent ovarian cancer. Health Qual Life Outcomes 2017; 15:144. [PMID: 28716032 PMCID: PMC5512840 DOI: 10.1186/s12955-017-0714-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/27/2017] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Very few studies have examined the association between financial status and the quality of life (QOL) of patients with specific cancers. Ovarian cancer survivors frequently suffer repeat recurrence and subsequent treatment and, as a result, a significant added financial burden. Financial burdens disproportionally affect patients of low income. This study examines the association between financial status, based upon family income and expenses, and QOL in Chinese women with recurrent ovarian cancer. METHODS We assessed baseline and follow-up (3-month) QOL of Chinese women with recurrent ovarian cancer using the European Organization for Research and Treatment of Cancer 30-Item Core Quality of Life Questionnaire (EORTC QLQ-C30), and the Quality of Life Ovarian Cancer 28 Questionnaire (QLQ-OV28). Financial status was stratified based upon self-reported disposable income. Linear or logistic regression models were applied to determine the relationship between QOL in each financial status category, and key demographic and clinical factors. RESULTS Among all 473 ovarian cancer patients, 123 of them met enrollment criteria were recruited to this study and completed baseline questionnaires; 95 of these patients completed the 3-month follow-up questionnaires. Our results showed that low financial status was significantly associated with worse QOL on all functioning domains and several symptom domains. QOL deteriorated during the follow-up. A significantly greater number of patients with low financial status experienced deteriorating QOL in several domains. Occupation and insurance type, two factors related to financial status, were significantly associated with QOL as well, but to a lesser extent. Education, recurrence interval, age and BMI were also significantly related to certain domains of QOL. CONCLUSIONS Financial status is associated with QOL of Chinese women with recurrent ovarian cancer. These patients showed worsening QOL during active chemotherapy. Lower financial status is associated with a higher risk of deteriorating QOL in several domains.
Collapse
Affiliation(s)
- Zhuyan Shao
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Tao Zhu
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China.
| | - Ping Zhang
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Qiang Wen
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Dan Li
- Department of Gynecologic Oncology, Zhejiang Cancer Hospital, 1 Banshan East Road, Hangzhou, Zhejiang, 310022, China
| | - Shihua Wang
- Department of Cancer Biology, Wake Forest School of Medicine, Winston Salem, NC, USA
| |
Collapse
|
64
|
Pisu M, Azuero A, Benz R, McNees P, Meneses K. Out-of-pocket costs and burden among rural breast cancer survivors. Cancer Med 2017; 6:572-581. [PMID: 28229562 PMCID: PMC5345680 DOI: 10.1002/cam4.1017] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/05/2016] [Accepted: 12/20/2016] [Indexed: 01/20/2023] Open
Abstract
Little is known about out‐of‐pocket (OOP) costs incurred for medical and health needs by rural breast cancer survivors and what factors may be associated with higher OOP costs and the associated economic burden. Data were examined for 432 survivors participating in the Rural Breast Cancer Survivor Intervention trial. OOP costs were collected using the Work and Finances Inventory survey at baseline and four assessments every 3 months. Mean and median OOP costs and burden (percent of monthly income spent on OOP costs) were reported and factors associated with OOP costs and burden identified with generalized linear models fitted with over‐dispersed gamma distributions and logarithmic links (OOP costs) and with beta distributions with logit link (OOP burden). OOP costs per month since the end of treatment were on average $232.7 (median $95.6), declined at the next assessment point to $186.5 (median $89.1), and thereafter remained at that level. Mean OOP burden was 9% at baseline and between 7% and 8% at the next assessments. Factors suggestive of contributing to higher OOP costs and OOP burden were the following: younger age, lower income, time in survivorship from diagnosis, and use of supportive services. OOP costs burden rural breast cancer survivors, particularly those who are younger and low income. Research should investigate the impact of OOP costs and interventions to reduce economic burden.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel Benz
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick McNees
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.,School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.,Kirchner Group, Birmingham, Alabama
| | - Karen Meneses
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.,School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
65
|
Banegas MP, Guy GP, de Moor JS, Ekwueme DU, Virgo KS, Kent EE, Nutt S, Zheng Z, Rechis R, Yabroff KR. For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships. Health Aff (Millwood) 2017; 35:54-61. [PMID: 26733701 DOI: 10.1377/hlthaff.2015.0830] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719 cancer survivors ages 18-64, we examined the proportions of survivors who reported going into debt or filing for bankruptcy as a result of cancer, as well as the amount of debt incurred. Approximately one-third of the survivors had gone into debt, and 3 percent had filed for bankruptcy. Of those who had gone into debt, 55 percent incurred obligations of $10,000 or more. Cancer survivors who were younger, had lower incomes, and had public health insurance were more likely to go into debt or file for bankruptcy, compared to those who were older, had higher incomes, and had private insurance, respectively. Future longitudinal population-based studies are needed to improve understanding of financial hardship among US working-age cancer survivors throughout the cancer care trajectory and, ultimately, to help stakeholders develop evidence-based interventions and policies to reduce the financial hardship of cancer.
Collapse
Affiliation(s)
- Matthew P Banegas
- Matthew P. Banegas is an investigator at the Kaiser Permanente Center for Health Research, in Portland, Oregon
| | - Gery P Guy
- Gery P. Guy Jr. is a health economist at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Janet S de Moor
- Janet S. de Moor is a program director in the Division of Cancer Control and Population Sciences, at the National Cancer Institute (NCI), in Bethesda, Maryland
| | | | - Katherine S Virgo
- Katherine S. Virgo is an adjunct professor in the Department of Health Policy and Management at Emory University, in Atlanta
| | - Erin E Kent
- Erin E. Kent is an epidemiologist and program director in the Outcomes Research Branch, Applied Research Program, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, at the NCI
| | - Stephanie Nutt
- Stephanie Nutt is a program manager at the LIVESTRONG Foundation, in Austin, Texas
| | - Zhiyuan Zheng
- Zhiyuan Zheng is a senior epidemiologist at the American Cancer Society in Atlanta, Georgia
| | - Ruth Rechis
- Ruth Rechis is vice president of programs and strategy at the LIVESTRONG Foundation
| | - K Robin Yabroff
- K. Robin Yabroff is an epidemiologist in the Division of Cancer Control and Population Sciences at the NCI
| |
Collapse
|
66
|
Patient-reported outcome measures of the impact of cancer on patients' everyday lives: a systematic review. J Cancer Surviv 2016; 11:211-232. [PMID: 27834041 PMCID: PMC5357497 DOI: 10.1007/s11764-016-0580-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/22/2016] [Indexed: 11/25/2022]
Abstract
Purpose Patients with advanced disease are living longer and commonly used patient-reported outcome measures (PROMs) may miss relevant elements of the quality of extended survival. This systematic review examines the measures used to capture aspects of the quality of survival including impact on patients’ everyday lives such as finances, work and family roles. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO restricted to English language articles. Information on study characteristics, instruments and outcomes was systematically extracted and synthesised. A predefined set of criteria was used to rate the quality of studies. Results From 2761 potentially relevant articles, 22 met all inclusion criteria, including 10 concerning financial distress, 3 on roles and responsibilities and 9 on multiple aspects of social well-being. Generally, studies were not of high quality; many lacked bias free participant selection, had confounding factors and had not accounted for all participants. High levels of financial distress were reported and were associated with multiple demographic factors such as age and income. There were few reports concerned with impacts on patients’ roles/responsibilities in everyday life although practical and emotional struggles with parenting were identified. Social difficulties were common and associated with multiple factors including being a caregiver. Many studies were single time-point surveys and used non-validated measures. Exceptions were employment of the COST and Social Difficulties Inventory (SDI), validated measures of financial and social distress respectively. Conclusions Impact on some important parts of patients’ everyday lives is insufficiently and inconsistently captured. Further PROM development focussing on roles and responsibilities, including work and caring for dependents, is warranted. Implications for Cancer Survivors Factors such as finances, employment and responsibility for caring for dependants (e.g. children and elderly relatives) can affect the well-being of cancer survivors. There is a need to ensure that any instruments used to assess patients’ social well-being are broad enough to include these areas so that any difficulties arising can be better understood and appropriately supported.
Collapse
|
67
|
Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial Hardships Experienced by Cancer Survivors: A Systematic Review. J Natl Cancer Inst 2016; 109:djw205. [PMID: 27754926 DOI: 10.1093/jnci/djw205] [Citation(s) in RCA: 536] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/05/2016] [Indexed: 01/09/2023] Open
Abstract
Background With rising cancer care costs, including high-priced cancer drugs, financial hardship is increasingly documented among cancer survivors in the United States; research findings have not been synthesized. Methods We conducted a systematic review of articles published between 1990 and 2015 describing the financial hardship experienced by cancer survivors using PubMed, Embase, Scopus, and CINAHL databases. We categorized measures of financial hardship into: material conditions (eg, out-of-pocket costs, productivity loss, medical debt, or bankruptcy), psychological responses (eg, distress or worry), and coping behaviors (eg, skipped medications). We abstracted findings and conducted a qualitative synthesis. Results Among 676 studies identified, 45 met the inclusion criteria and were incorporated in the review. The majority of the studies (82%, n = 37) reported financial hardship as a material condition measure; others reported psychological (7%, n = 3) and behavioral measures (16%, n = 7). Financial hardship measures were heterogeneous within each broad category, and the prevalence of financial hardship varied by the measure used and population studied. Mean annual productivity loss ranged from $380 to $8236, 12% to 62% of survivors reported being in debt because of their treatment, 47% to 49% of survivors reported experiencing some form of financial distress, and 4% to 45% of survivors did not adhere to recommended prescription medication because of cost. Conclusions Financial hardship is common among cancer survivors, although we found substantial heterogeneity in its prevalence. Our findings highlight the need for consistent use of definitions, terms, and measures to determine the best intervention targets and inform intervention development in order to prevent and minimize the impact of financial hardship experienced by cancer survivors.
Collapse
Affiliation(s)
- Cheryl K Altice
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | | | - Reginald D Tucker-Seeley
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.,Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
68
|
Ah D, Storey S, Tallman E, Nielsen A, Johns S, Pressler S. Cancer, Cognitive Impairment, and Work-Related Outcomes: An Integrative Review. Oncol Nurs Forum 2016; 43:602-16. [DOI: 10.1188/16.onf.602-616] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
69
|
Girotra S, Yeghiazaryan K, Golubnitschaja O. Potential biomarker panels in overall breast cancer management: advancements by multilevel diagnostics. Per Med 2016; 13:469-484. [PMID: 29767597 DOI: 10.2217/pme-2016-0020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Breast cancer (BC) prevalence has reached an epidemic scale with half a million deaths annually. Current deficits in BC management include predictive and preventive approaches, optimized screening programs, individualized patient profiling, highly sensitive detection technologies for more precise diagnostics and therapy monitoring, individualized prediction and effective treatment of BC metastatic disease. To advance BC management, paradigm shift from delayed to predictive, preventive and personalized medical services is essential. Corresponding step forwards requires innovative multilevel diagnostics procuring specific panels of validated biomarkers. Here, we discuss current instrumental advancements including genomics, proteomics, epigenetics, miRNA, metabolomics, circulating tumor cells and cancer stem cells with a focus on biomarker discovery and multilevel diagnostic panels. A list of the recommended biomarker candidates is provided.
Collapse
|
70
|
Abstract
The substantial economic burden of cancer is increasingly being shifted to patients. Financial burden experienced by patients as a result of medical treatment has an impact on their lifestyle choices, health behaviors, and quality of life. Variation in treatment recommendations based on the patients' economic status or affordability may be against the basic tenet of social justice and is a growing challenge for policy makers. This review summarizes the multifaceted constructs and current trends associated with financial hardship within the context of cancer care and healthcare economics focusing mainly on hematological malignancies but supplemented by nonhematological cancer and general medical literature. We also highlight the patient and physician perspectives about this issue and identify important areas for future research. We discuss the need for more proactive solutions so that patients can achieve good clinical outcomes, without catastrophic financial consequences for themselves and their families.
Collapse
|
71
|
Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 2016; 122:283-9. [PMID: 26991528 DOI: 10.1002/cncr.29808] [Citation(s) in RCA: 246] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/06/2015] [Accepted: 11/02/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer-related financial burden has been linked to cancer survivors (CS) forgoing/delaying medical care, skipping follow-up visits, and discontinuing medications. To the authors' knowledge, little is known regarding the effect of financial burden on the health-related quality of life of CS. METHODS The authors analyzed 2011 Medical Expenditure Panel Survey data. Financial burden was present if one of the following problems was reported: borrowed money/declared bankruptcy, worried about paying large medical bills, unable to cover the cost of medical care visits, or other financial sacrifices. The following outcomes were evaluated: Physical Component Score (PCS) and Mental Component Score (MCS) of the 12-Item Short-Form Health Survey (SF-12), depressed mood, psychological distress, and worry related to cancer recurrence. The authors also assessed the effect of the number of financial problems on these outcomes. RESULTS Of the 19.6 million CS analyzed, 28.7% reported financial burden. Among them, the average PCS (42.3 vs 44.9) and MCS (48.1 vs 52.1) were lower for those with financial burden versus those without. In adjusted analyses, CS with financial burden had significantly lower PCS (β = -2.45), and MCS (β = -3.05), had increased odds of depressed mood (odds ratio, 1.95), and were more likely to worry about cancer recurrence (odds ratio, 3.54). Survivors reporting ≥ 3 financial problems reported statistically significant and clinically meaningful differences (≥3 points) in the mean PCS and MCS compared with survivors without financial problems. CONCLUSIONS Cancer-related financial burden was associated with lower health-related quality of life, increased risk of depressed mood, and a higher frequency of worrying about cancer recurrence among CS.
Collapse
Affiliation(s)
- Hrishikesh P Kale
- Division of Pharmacoeconomics and Health Outcomes, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| | - Norman V Carroll
- Division of Pharmacoeconomics and Health Outcomes, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
| |
Collapse
|
72
|
Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D. Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer. J Clin Oncol 2016; 34:1732-40. [PMID: 26926678 DOI: 10.1200/jco.2015.63.2232] [Citation(s) in RCA: 275] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To measure the association between patient financial strain and symptom burden and quality of life (QOL) for patients with new diagnoses of lung or colorectal cancer. PATIENTS AND METHODS Patients participating in the Cancer Care Outcomes Research and Surveillance study were interviewed about their financial reserves, QOL, and symptom burden at 4 months of diagnosis and, for survivors, at 12 months of diagnosis. We assessed the association of patient-reported financial reserves with patient-reported outcomes including the Brief Pain Inventory, symptom burden on the basis of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30, and QOL on the basis of the EuroQoL-5 Dimension scale. Multivariable linear regression models were fit for each outcome and cancer type, adjusting for age, race/ethnicity, sex, income, insurance, stage at diagnosis, and comorbidity. RESULTS Among patients with lung and colorectal cancer, 40% and 33%, respectively, reported limited financial reserves (≤ 2 months). Relative to patients with more than 12 months of financial reserves, those with limited financial reserves reported significantly increased pain (adjusted mean difference, 5.03 [95% CI, 3.29 to 7.22] and 3.45 [95% CI, 1.25 to 5.66], respectively, for lung and colorectal), greater symptom burden (5.25 [95% CI, 3.29 to .22] and 5.31 [95% CI, 3.58 to 7.04]), and poorer QOL (4.70 [95% CI, 2.82 to 6.58] and 5.22 [95% CI, 3.61 to 6.82]). With decreasing financial reserves, a clear dose-response relationship was present across all measures of well-being. These associations were also manifest for survivors reporting outcomes again at 1 year and persisted after adjustment for stage, comorbidity, insurance, and other clinical attributes. CONCLUSION Patients with cancer and limited financial reserves are more likely to have higher symptom burden and decreased QOL. Assessment of financial reserves may help identify patients who need intensive support.
Collapse
Affiliation(s)
- Christopher S Lathan
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health.
| | - Angel Cronin
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - Reginald Tucker-Seeley
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - S Yousuf Zafar
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - John Z Ayanian
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| | - Deborah Schrag
- Christopher S. Lathan, Angel Cronin, Reginald Tucker-Seeley, and Deborah Schrag, Dana-Farber Cancer Institute, Boston, MA; S. Yousuf Zafar, Duke University School of Medicine; John Z. Ayanian, University of Michigan; and Reginald Tucker-Seeley, Harvard T.H. Chan School of Public Health
| |
Collapse
|
73
|
Yabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, Virgo KS, McNeel TS, Chawla N, Blanch-Hartigan D, Kent EE, Li C, Rodriguez JL, de Moor JS, Zheng Z, Jemal A, Ekwueme DU. Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol 2015; 34:259-67. [PMID: 26644532 DOI: 10.1200/jco.2015.62.0468] [Citation(s) in RCA: 383] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. METHODS We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). RESULTS Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. CONCLUSION Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
Collapse
Affiliation(s)
- K Robin Yabroff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA.
| | - Emily C Dowling
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Gery P Guy
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Matthew P Banegas
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Davidoff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Xuesong Han
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Katherine S Virgo
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy S McNeel
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Neetu Chawla
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Danielle Blanch-Hartigan
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Erin E Kent
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Chunyu Li
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Juan L Rodriguez
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Janet S de Moor
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Zhiyuan Zheng
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Ahmedin Jemal
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Donatus U Ekwueme
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| |
Collapse
|
74
|
Perceived economic burden associated with an inherited cardiac condition: a qualitative inquiry with families affected by arrhythmogenic right ventricular cardiomyopathy. Genet Med 2015; 18:584-92. [PMID: 26513349 DOI: 10.1038/gim.2015.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/18/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Significant gaps remain in the literature on the economic burden of genetic illness. We explored perceived economic burden associated with one inherited cardiac condition, arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS Semistructured interviews were held with individuals from families affected by ARVC. Data on the perceived financial and economic impacts of ARVC were used to identify emerging categories and themes using the method of constant comparison. RESULTS Data analysis revealed four themes that described participants' perceptions of the economic impact ARVC had on them and their families: (i) economic impact during childhood, (ii) impact on current and future employment, (iii) impact on current and future financial well-being, and (iv) no perceived economic impact. CONCLUSIONS This study is the first to explore the economic burden of ARVC from the perspective of affected families. It revealed a number of perceived burdens, from employment and career choices to worry about insurance for self and children, decreased household spending, and the need for childhood employment. Findings highlight potential areas of discussion for genetic counseling sessions, as well as areas for future research.Genet Med 18 6, 584-592.
Collapse
|
75
|
Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA, Chambers SK. Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26423576 PMCID: PMC5297983 DOI: 10.1111/ecc.12392] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to understand the extent, nature and variability of the current economic burden of prostate cancer among Australian men. An online cross‐sectional survey was developed that combined pre‐existing economic measures and new questions. With few exceptions, the online survey was viable and acceptable to participants. The main outcomes were self‐reported out‐of‐pocket costs of prostate cancer diagnosis and treatment, changes in employment status and household finances. Men were recruited from prostate cancer support groups throughout Australia. Descriptive statistical analyses were undertaken. A total of 289 men responded to the survey during April and June 2013. Our study found that men recently diagnosed (within 16 months of the survey) (n = 65) reported spending a median AU$8000 (interquartile range AU$14 000) for their cancer treatment while 75% of men spent up to AU$17 000 (2012). Twenty per cent of all men found the cost of treating their prostate cancer caused them ‘a great deal’ of distress. The findings suggest a large variability in medical costs for prostate cancer treatment with 5% of men spending $250 or less in out‐of‐pocket expenses and some men facing very high costs. On average, respondents in paid employment at diagnosis stated that they had retired 4–5 years earlier than planned.
Collapse
Affiliation(s)
- L G Gordon
- Centre for Applied Health Economics, Menzies Health Institute of Queensland, Griffith University, Logan City, Qld, Australia
| | - S M Walker
- Centre for Applied Health Economics, Griffith University, Logan City, Qld, Australia
| | - M C Mervin
- Centre for Applied Health Economics, Menzies Health Institute of Queensland, Griffith University, Logan City, Qld, Australia
| | - A Lowe
- Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,Menzies Health Institute of Queensland, Griffith University, Gold Coast, Southport, Qld, Australia
| | - D P Smith
- Cancer Council New South Wales, Sydney, NSW, Australia
| | - R A Gardiner
- School of Medicine, University of Queensland, Brisbane, Qld, Australia.,Centre for Clinical Research, University of Queensland, Brisbane, Qld, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - S K Chambers
- Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.,School of Medicine, University of Queensland, Brisbane, Qld, Australia.,School of Allied Health, Menzies Health Institute of Queensland, Griffith University, Gold Coast, Southport, Qld, Australia.,Cancer Council Queensland, Spring Hill, Qld, Australia
| |
Collapse
|
76
|
Tamminga SJ, Bültmann U, Husson O, Kuijpens JLP, Frings-Dresen MHW, de Boer AGEM. Employment and insurance outcomes and factors associated with employment among long-term thyroid cancer survivors: a population-based study from the PROFILES registry. Qual Life Res 2015; 25:997-1005. [PMID: 26395276 PMCID: PMC4830855 DOI: 10.1007/s11136-015-1135-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 02/05/2023]
Abstract
Purpose To obtain insight into employment and insurance outcomes of thyroid cancer survivors and to examine the association between not having employment and other factors including quality of life. Methods In this cross-sectional population-based study, long-term thyroid cancer survivors from the Netherlands participated. Clinical data were collected from the cancer registry. Information on employment, insurance, socio-demographic characteristics, long-term side effects, and quality of life was collected with questionnaires. Results Of the 223 cancer survivors (response rate 87 %), 71 % were employed. Of the cancer survivors who tried to obtain insurance, 6 % reported problems with obtaining health care insurance, 62 % with life insurance, and 16 % with a mortgage. In a multivariate logistic regression analysis, higher age (OR 1.07, CI 1.02–1.11), higher level of fatigue (OR 1.07, CI 1.01–1.14), and lower educational level (OR 3.22, CI 1.46–7.09) were associated with not having employment. Employment was associated with higher quality of life. Conclusions Many thyroid cancer survivors face problems when obtaining a life insurance, and older, fatigued, and lower educated thyroid cancer survivors may be at risk for not having employment.
Collapse
Affiliation(s)
- S J Tamminga
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - O Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands. .,Comprehensive Cancer Center Netherlands South, Eindhoven Cancer Registry, Eindhoven, The Netherlands.
| | - J L P Kuijpens
- VGZ Health Insurance Company, Eindhoven, The Netherlands
| | - M H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A G E M de Boer
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
77
|
Pisu M, Meneses K, Azuero A, Benz R, Su X, McNees P. Variation in resources needed to implement psychosocial support interventions for rural breast cancer survivors. J Cancer Surviv 2015; 10:375-83. [PMID: 26341349 DOI: 10.1007/s11764-015-0483-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Understanding how resources are used provides guidance to disseminating effective interventions. Here, we report data on implementation resources needed for the Rural Breast Cancer Survivors (RBCS) study that tested a telephone-delivered psychoeducational education and support intervention to survivors in rural Florida. Intervention resources included interventionists' time on one intake assessment (IA) call, three education calls (ED), one follow-up education call (FUE), six support (SUP) calls, and documentation time per survivor. METHODS Interventionists logged start and end times of each type of call. Average interventionist time in minutes was calculated by call type. Associations between interventionists' time and participants' characteristics including age, race/ethnicity, time since treatment, cancer treatment, depressive symptoms, education, income, employment, and support, was assessed using linear mixed models with repeated measures. RESULTS Among 328 survivors, IA calls lasted 66.9 min (SD 21.7); ED lasted 50.6 (SD 16.7), 48.1 (SD 15.9), and 39.6 (SD 14.8); FUE lasted 24.7 (SD 14.8); and SUP 42.8 (SD 29.6) min. Documentation time was 18.4 min for IA, 23-27 for ED, 12.3 for FUE, and 23.0 for SUP. CONCLUSION Interventionists spent significantly more time with participants with depressive symptoms, who already used other support, and who received SUP calls before the ED vs. after. There were no significant differences by time since or type of cancer treatment, or other personal characteristics. IMPLICATIONS FOR CANCER SURVIVORS Resources vary by survivor characteristics. Careful consideration of mental health status or support available is warranted for planning implementation and dissemination of effective survivorship interventions on a broad scale.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen Meneses
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
- University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL, 35294, USA.
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel Benz
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Xiaogang Su
- Department of Mathematical Sciences, University of Texas at El Paso, El Paso, TX, USA
| | - Patrick McNees
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
78
|
Whitney RL, Bell JF, Reed SC, Lash R, Bold RJ, Kim KK, Davis A, Copenhaver D, Joseph JG. Predictors of financial difficulties and work modifications among cancer survivors in the United States. J Cancer Surviv 2015; 10:241-50. [PMID: 26188363 DOI: 10.1007/s11764-015-0470-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study is to examine predictors of cancer-related financial difficulties and work modifications in a national sample of cancer survivors. METHODS Using the 2011 Medical Expenditure Panel Survey and Experiences with Cancer Survivorship Supplement, the prevalence of financial difficulties and work modifications was examined. Logistic regression and survey weights were used to model these outcomes as functions of sociodemographic and health covariates separately among survivors in active treatment and survivors under age 65 years. RESULTS Among all survivors, 33.2% reported any financial concern, with 17.9% reporting financial difficulties such as debt or bankruptcy. Among working survivors, 44.0% made any work modification and 15.3% made long-term work modifications (e.g., delayed or early retirement). Among those in active treatment, predictors of financial difficulty included: race/ethnicity other than white, non-Hispanic [OR = 8.0; 95% CI 2.2-28.4]; income <200% of federal poverty level (FPL) [OR = 15.7; 95% CI 2.6-95.2] or between 200 and 400% of FPL [OR = 8.2; 95% CI 1.3-51.4]; residence in a non-metropolitan service area [OR = 6.4; 95% CI 1.6-25.0]; and good/fair/poor self-rated health [OR = 3.8; 95% CI 1.0-14.2]. Among survivors under age 65 years, predictors of long-term work modifications included good/fair/poor self-rated health [OR = 4.1; 95% CI 1.6-10.2], being married [OR = 2.2; 95% CI 1.0-4.7], uninsured [OR = 3.5; 95% CI 1.3-9.3], or publicly insured [OR = 9.0; 95% CI 3.3-24.4]. CONCLUSIONS A substantial proportion of cancer survivors experience cancer-related financial difficulties and work modifications, particularly those who report race/ethnicity other than white, non-Hispanic, residence in non-metropolitan areas, worse health status, lower income, and public or no health insurance. IMPLICATIONS FOR CANCER SURVIVORS Attention to the economic impact of cancer treatment is warranted across the survivorship trajectory, with particular attention to subgroups at higher risk.
Collapse
Affiliation(s)
- Robin L Whitney
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.
| | - Janice F Bell
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| | - Sarah C Reed
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| | - Rebecca Lash
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| | - Richard J Bold
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.,Comprehensive Cancer Center, UC Davis Health System, University of California, Davis, 4501 X Street, Sacramento, CA, 95817, USA
| | - Katherine K Kim
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| | - Andra Davis
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| | - David Copenhaver
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA.,Comprehensive Cancer Center, UC Davis Health System, University of California, Davis, 4501 X Street, Sacramento, CA, 95817, USA
| | - Jill G Joseph
- Collaborative Cancer Care Research Group (3CRG), Betty Irene Moore School of Nursing, University of California, Davis, 4610 X Street #4202, Sacramento, CA, 95817, USA
| |
Collapse
|
79
|
Kim YA, Oh IH, Yoon SJ, Kim HJ, Seo HY, Kim EJ, Lee YH, Jung JH. The Economic Burden of Breast Cancer in Korea from 2007-2010. Cancer Res Treat 2015; 47:583-90. [PMID: 25687860 PMCID: PMC4614197 DOI: 10.4143/crt.2014.143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 08/13/2014] [Indexed: 02/05/2023] Open
Abstract
Purpose This study estimates the socioeconomic cost and burden for breast cancer patients in Korea between 2007 and 2010. Materials and Methods This study used a prevalence-based approach to estimate the cost of breast cancer. Breast cancer patients were defined as those who were hospitalized or have visited an outpatient clinic during the period from 2007 to 2010. The socioeconomic costs of breast cancer were subdivided into two costs: direct and indirect. Results From 2007 to 2010, the prevalence of treated breast cancer increased from 7.9% to 20.4%. The total socioeconomic costs incurred by breast cancer increased by approximately 40.7% from US $668.49 million in 2007 to US $940.75 million in 2010. The direct medical care costs for 2010 were 1.4 times greater (US $399.22 million) than for 2007 (US $278.71 million). The direct non-medical costs rose from US $50.69 million in 2007 to US $75.83 million in 2010, a 49.6% increase. Regarding the economic burden of breast cancer, the total indirect costs were US $339.09 million in 2007 and increased by 37.3% to US $465.70 million in 2010. In the sensitivity analysis, with the annual discount rate for each year ranging from 0%-5%, the costs increased 1.1-1.2 times. Conclusion Due to the growing incidence of breast cancer, the annual prevalence and related costs are increasing. We must strive to reduce the socioeconomic burden of breast cancer through preventive measures and early screening.
Collapse
Affiliation(s)
- Young Ae Kim
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Public Health, Korea University, Seoul, Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seok-Jun Yoon
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun-Jin Kim
- Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul, Korea
| | - Hye-Young Seo
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Eun-Jung Kim
- Department of Economics, Korea University College of Medicine, Seoul, Korea
| | - Yo Han Lee
- Graduate School of Public Health, Korea University, Seoul, Korea
| | - Jae Hun Jung
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
80
|
Pisu M, Kenzik KM, Oster RA, Drentea P, Ashing KT, Fouad M, Martin MY. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer? Cancer 2015; 121:1257-64. [PMID: 25564986 DOI: 10.1002/cncr.29206] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship. METHODS Patients with lung cancer (LC) and colorectal cancer (CRC) participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium were surveyed approximately 4 months (baseline) and 12 months (follow-up) after diagnosis. Economic hardship at follow-up was present if participants 1) indicated difficulty living on household income; and/or 2) for the following 2 months, anticipated experiencing hardships (inadequate housing, food, or medical attention) or reducing living standards to the bare necessities of life. The authors tested whether African Americans (AAs) and Hispanics were more likely than whites to experience economic hardship controlling for sex, age, education, marital status, cancer stage, treatment, and economic status at baseline (income, prescription drug coverage). RESULTS Of 3432 survivors (39.7% with LC, 60.3% with CRC), 14% were AA, 7% were Hispanic, and 79% were white. AAs and Hispanics had lower education and income than whites. Approximately 68% of AAs, 58% of Hispanics, and 44.5% of whites reported economic hardship. In LC survivors, the Hispanic-white disparity was not significant in unadjusted or adjusted analyses, and the AA-white disparity was explained by baseline economic status. In CRC survivors, the Hispanic-white disparity was explained by baseline economic status, and the AA-white disparity was not explained by the variables that were included in the model. CONCLUSIONS Economic hardship was evident in almost 1 in 2 cancer survivors 1 year after diagnosis, especially AAs. Research should evaluate and address risk factors and their impact on survival and survivorship outcomes.
Collapse
Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | | | | |
Collapse
|
81
|
Schmitz KH, DiSipio T, Gordon LG, Hayes SC. Adverse breast cancer treatment effects: the economic case for making rehabilitative programs standard of care. Support Care Cancer 2014; 23:1807-17. [PMID: 25471182 DOI: 10.1007/s00520-014-2539-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/21/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this work was to evaluate the patient-borne financial cost of common, adverse breast cancer treatment-associated effects, comparing cost across women with or without these side effects. METHODS Two hundred eighty-seven Australian women diagnosed with early-stage breast cancer were prospectively followed starting at 6 months post-surgery for 12 months, with three monthly assessments of detailed treatment-related side effects and their direct and indirect patient costs attributable to breast cancer. Bootstrapping statistics were used to analyze cost data, and adjusted logistic regression was used to evaluate the association between costs and adverse events from breast cancer. Costs were inflated and converted from 2002 Australian to 2014 US dollars. RESULTS More than 90 % of women experienced at least one adverse effect (i.e., post-surgical issue, reaction to radiotherapy, upper-body symptoms or reduced function, lymphedema, fatigue, or weight gain). On average, women paid $5,636 (95 % confidence interval (CI), $4,694, $6,577) in total costs. Women with any one of the following symptoms (fatigue, reduced upper-body function, upper-body symptoms) or women who report ≥4 adverse treatment-related effects, have 1.5 to nearly 4 times the odds of having higher healthcare costs than women who do not report these complaints (p < 0.05). CONCLUSIONS Women face substantial economic burden due to a range of treatment-related health problems, which may persist beyond the treatment period. Improving breast cancer care by incorporating prospective surveillance of treatment-related side effects and strategies for prevention and treatment of concerns (e.g., exercise) has real potential for reducing patient-borne costs.
Collapse
Affiliation(s)
- Kathryn H Schmitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | |
Collapse
|
82
|
Rahman MM, Ahsan MA, Monalisa NN, Rahman K. Influence of socioeconomic status and BMI on the quality of life after mastectomy in Bangladeshi breast cancer patients in a public hospital. Jpn J Clin Oncol 2014; 44:1150-7. [PMID: 25425727 DOI: 10.1093/jjco/hyu144] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Quality of life after diagnosis and during treatment phases of breast cancer varies across individual to individual, country to country and from ethnicity to ethnicity. So factors affecting it are of growing research interest. The aim of the study was to investigate the influence of socioeconomic status and body mass index on the quality of life of breast cancer patients during the phases of treatment-before and after mastectomy. METHODS Two hundred and fifty-one women with breast cancer undergoing surgery were interviewed prior to and after mastectomy in National Institute of Cancer Research and Hospital, Dhaka from January 2012 to March 2013 using European Organization for Research and Treatment of Cancer Core Questionnaire (and QLQ-Br23). Socioeconomic factors like educational status, family income, occupation and body mass index were taken as investigating factors against global health status and breast cancer-related factors. RESULTS Significant reduction of the scores found that means deterioration of function in the following domains of the quality of life were found such as physical well-being (P = 0.019), emotional well-being (P = 0.035), cognitive status (P = 0.05) and the breast-specific subscales like BRBI (body image), BRBS (breast symptoms), BRAS (arm symptoms); (P = 0.013, 0.103, 0.015) was observed after surgery in lower income group. Worker group expressed also similar effect on the global health status/quality-of-life scales (P = 0.05, 0.043, 0.021) and breast subscales (P = 0.002, 0.027, 0.05), patients with lower body mass index also have a lower score also. Educational status does not affect the two groups. Younger age group patients expressed much distress. CONCLUSIONS Improvement of family income, nutritional status and improvement of working environment might have an impact on the improvement of the quality of life of breast cancer patients during the phases of treatment.
Collapse
Affiliation(s)
- Md Mizanur Rahman
- Department of Surgical Oncology, National Institute of Cancer Research and Hospital, Dhaka
| | - Md Abul Ahsan
- Department of Medical Oncology, Shaheed Shurwardy Medical College, Dhaka
| | | | - Khadiza Rahman
- Department of Surgical Oncology, National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
| |
Collapse
|
83
|
Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, Hofstatter EW, Killelea BK, Knobf MT, Lannin DR, Abu-Khalaf M, Horowitz NR, Chagpar AB. Impact of Financial Burden of Cancer on Survivors' Quality of Life. J Oncol Pract 2014; 10:332-8. [DOI: 10.1200/jop.2013.001322] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Increased financial burden as a result of cancer care costs is the strongest independent predictor of poor quality of life among cancer survivors.
Collapse
Affiliation(s)
- Kathleen M. Fenn
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Suzanne B. Evans
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Ruth McCorkle
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | | | - Lajos Pusztai
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Tara Sanft
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | | | | | - M. Tish Knobf
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Donald R. Lannin
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Maysa Abu-Khalaf
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Nina R. Horowitz
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Anees B. Chagpar
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| |
Collapse
|
84
|
Chitre M, Reimers KM. Considerations for payers in managing hormone receptor-positive advanced breast cancer. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:331-9. [PMID: 25031542 PMCID: PMC4096457 DOI: 10.2147/ceor.s57214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Breast cancer (BC) is the second most common cause of death in women. In 2010, the direct cost associated with BC care in the US was $16.5 billion, the highest among all cancers. By the year 2020, at the current rates of incidence and survival, the cost is projected to increase to approximately $20 billion. Although endocrine therapies to manage hormone receptor-positive (HR+) BC are highly effective, endocrine resistance results in disease progression. Increased understanding of endocrine resistance and the mechanisms of disease progression has led to development and subsequent approval of novel targeted treatments, resulting in the expansion of the therapeutic armamentarium to combat HR+ BC. Clear guidelines based on the safety and efficacy of treatment options exist; however, the optimal sequence of therapy is unknown, and providers, payers, and other key players in the health care system are tasked with identifying cost-effective and evidence-based treatment strategies that will improve patient outcomes and, in time, help curb the staggering increase in cost associated with BC care. Safety and efficacy are key considerations, but there is also a need to consider the impact of a given therapy on patient quality of life, treatment adherence, and productivity. To minimize cost associated with overall management, cost-effectiveness, and financial burden that the therapy can impose on patients, caregivers and managed care plans are also important considerations. To help evaluate and identify the optimal choice of therapy for patients with HR+ advanced BC, the available data on endocrine therapies and novel agents are discussed, specifically with respect to the safety, efficacy, financial impact on patients and the managed care plan, impact on quality of life and productivity of patients, and improvement in patient medication adherence.
Collapse
Affiliation(s)
- Mona Chitre
- Pharmacy Management, Excellus BlueCross BlueShield, Rochester, NY, USA
| | | |
Collapse
|
85
|
Beckjord EB, Reynolds KA, van Londen GJ, Burns R, Singh R, Arvey SR, Nutt SA, Rechis R. Population-level trends in posttreatment cancer survivors' concerns and associated receipt of care: results from the 2006 and 2010 LIVESTRONG surveys. J Psychosoc Oncol 2014; 32:125-51. [PMID: 24364920 DOI: 10.1080/07347332.2013.874004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED There is a need to better understand the posttreatment concerns of the nearly 14 million survivors of cancer alive in the United States today and their receipt of care. Using data from 2,910 posttreatment survivors of cancer from the 2006 or 2010 LIVESTRONG Surveys, the authors examined physical, emotional, and practical concerns, receipt of care, and trends in these outcomes at the population level. RESULTS 89% of respondents reported at least one physical concern (67% received associated posttreatment care), 90% reported at least one emotional concern (47% received care), and 45% reported at least one practical concern (36% received care). Female survivors, younger survivors, those who received more intensive treatment, and survivors without health insurance often reported a higher burden of posttreatment concerns though were less likely to have received posttreatment care. These results reinforce the importance of posttreatment survivorship and underscore the need for continued progress in meeting the needs of this population. Efforts to increase the availability of survivorship care are extremely important to improve the chances of people affected by cancer living as well as possible in the posttreatment period.
Collapse
|
86
|
Meneses K, Azuero A, Su X, Benz R, McNees P. Predictors of attrition among rural breast cancer survivors. Res Nurs Health 2013; 37:21-31. [PMID: 24338864 DOI: 10.1002/nur.21576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/06/2022]
Abstract
Attrition can jeopardize both internal and external validity. The goal of this secondary analysis was to examine predictors of attrition using baseline data of 432 participants in the Rural Breast Cancer Survivors study. Attrition predictors were conceptualized based on demographic, social, cancer treatment, physical health, and mental health characteristics. Baseline measures were selected using this conceptualization. Bivariate tests of association, discrete-time Cox regression models and recursive partitioning techniques were used in analysis. Results showed that 100 participants (23%) dropped out by Month 12. Non-linear tree analyses showed that poor mental health and lack of health insurance were significant predictors of attrition. Findings contribute to future research efforts to reduce research attrition among rural underserved populations.
Collapse
Affiliation(s)
- Karen Meneses
- School of Nursing, University of Alabama, Birmingham, AL
| | | | | | | | | |
Collapse
|
87
|
Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 2013; 119:3710-7. [PMID: 23907958 DOI: 10.1002/cncr.28262] [Citation(s) in RCA: 310] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/10/2013] [Accepted: 05/10/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. METHODS The authors identified cancer survivors diagnosed as adults (n=1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented. RESULTS Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%-34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all P<.05). CONCLUSIONS Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer.
Collapse
Affiliation(s)
- Erin E Kent
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | | | | | | | | | | | | |
Collapse
|
88
|
Ezat SWP, Junid SMAS, Khamis N, Ahmed Z, Sulong S, Nur AM, Aizuddin AN, Ismail F, Abdullah N, Zainuddin ZM, Kassim AYM, Haflah NHM. Skeletal-Related Events among Breast and Prostate Cancer Patients: Towards New Treatment Initiation in Malaysia's Hospital Setting. Asian Pac J Cancer Prev 2013; 14:3357-62. [DOI: 10.7314/apjcp.2013.14.5.3357] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
89
|
Azuero A, Su X, McNees P, Meneses K. A revision of the quality of life-breast cancer survivors (QOL-BCS) instrument. Res Nurs Health 2013; 36:423-34. [PMID: 23512217 DOI: 10.1002/nur.21541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 12/24/2022]
Abstract
The importance of quality of life (QOL) measurement among breast cancer survivors (BCS) is well-recognized by researchers and clinicians. With data from 427 rural BCS, the authors used a combination of clinical expertise and statistical analysis to revise a 48-item measure of QOL specific to BCS. The revised 15-item measure showed adequate psychometric properties and provides the basis for a brief yet comprehensive multidimensional measure of QOL applicable to most BCS. Future work includes fine-tuning the measurement model and examining its generalizability among non-rural BCS.
Collapse
Affiliation(s)
- Andres Azuero
- Department of Community Health Outcomes and Systems, University of Alabama at Birmingham, NB1019G 1720 2nd Ave S, Birmingham, AL 35294-1210, USA
| | | | | | | |
Collapse
|