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Timbie JW, Reynolds KA, Evans EL, Brown DS, Cohen JW, Darien G, DeVoe JE, Grosse SD, Holve E, Meltzer DO, Merritt JG, Neumann PJ, Yabroff KR, Smith SR. Advancing Data Capacity for Economic Outcomes in Patient-Centered Outcomes Research: Challenges and Opportunities. Med Care 2023; 61:S161-S165. [PMID: 37963036 PMCID: PMC10635327 DOI: 10.1097/mlr.0000000000001901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Affiliation(s)
| | | | - Emily L. Evans
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Joel W. Cohen
- Agency for Healthcare Research and Quality, Rockville, MD
| | - Gwen Darien
- National Patient Advocate Foundation, Washington, DC
| | - Jennifer E. DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin Holve
- Patient Centered Outcomes Research Institute, Washington, DC
| | - David O. Meltzer
- Departments of Economics and Medicine, University of Chicago Harris School of Public Policy, Chicago, IL
| | | | | | | | - Scott R. Smith
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC
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Stone BV, Labban M, Filipas DK, Beatrici E, Lipsitz SR, Reis LO, Feldman AS, Kibel AS, Cole AP, Morgans AK, Trinh QD. The Risk of Catastrophic Healthcare Expenditures Among Prostate and Bladder Cancer Survivors in the United States. Clin Genitourin Cancer 2023; 21:617-625. [PMID: 37316413 DOI: 10.1016/j.clgc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Little is known about the rates of catastrophic health care expenditures among survivors of prostate and bladder cancer or the factors that place patients at highest risk for undue cost. MATERIALS AND METHODS The Medical Expenditure Panel Survey was utilized to identify prostate and bladder cancer survivors from 2011 to 2019. Rates of catastrophic health care expenditures (out-of-pocket health care spending >10% household income) were compared between cancer survivors and adults without cancer. A multivariable regression model was used to identify risk factors for catastrophic expenditures. RESULTS Among 2620 urologic cancer survivors, representative of 3,251,500 (95% CI 3,062,305-3,449,547) patients annually after application of survey weights, there were no significant differences in catastrophic expenditures among respondents with prostate cancer compared to adults without cancer. Respondents with bladder cancer had significantly greater rates of catastrophic expenditures (12.75%, 95% CI 9.36%-17.14% vs. 8.33%, 95% CI 7.66%-9.05%, P = .027). Significant predictors of catastrophic expenditures in bladder cancer survivors included older age, comorbidities, lower income, retirement, poor health status, and private insurance. Though White respondents with bladder cancer had no significantly increased risk of catastrophic expenditures, among Black respondents the risk of catastrophic expenditures increased from 5.14% (95% CI 3.95-6.33) without bladder cancer to 19.49% (95% CI 0.84-38.14) with bladder cancer (OR 6.41, 95% CI 1.28-32.01, P = .024). CONCLUSIONS Though limited by small sample size, these data suggest that bladder cancer survivorship is associated with catastrophic health care expenditures, particularly among Black cancer survivors. These findings should be taken as hypothesis-generating and warrant further investigation with larger sample sizes and, ideally, prospective investigation.
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Affiliation(s)
- Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muhieddine Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart R Lipsitz
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Leonardo O Reis
- UroScience, School of Medical Sciences, University of Campinas, UNICAMP, and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Sao Paulo, Brazil
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alicia K Morgans
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Girda E, Randall LM, Chino F, Monk BJ, Farley JH, O'Cearbhaill RE. Cervical cancer treatment update: A Society of Gynecologic Oncology clinical practice statement. Gynecol Oncol 2023; 179:115-122. [PMID: 37980766 PMCID: PMC11001261 DOI: 10.1016/j.ygyno.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
Cervical cancer is the most commonly diagnosed gynecologic cancer worldwide. Although the incidence has declined with increased screening and higher uptake of human papillomavirus (HPV) vaccination in high-income countries, this disease remains the second highest cause of cancer mortality among women in low- and middle-income countries. In this clinical practice statement, we describe therapies for cervical cancer by treatment setting, as well as quality of life, financial toxicity, and disparities associated with this disease. In addition to chemotherapy and radiation, therapeutic strategies for cervical cancer include immune checkpoint blockade, antiangiogenics, and antibody-drug conjugates. Optimal treatment for recurrent cervical cancer remains an area of unmet need, necessitating further exploration of rational and innovative treatment approaches, including cell and immune-based therapies. Importantly, development of effective therapies for cervical cancer must incorporate strategies to ensure universal equitable access to HPV vaccination, screening, and treatment. Important consequences of the disease and treatment that impact quality of life must also be addressed. Patients with cervical cancer are at increased risk for financial toxicity, which can lead to downstream detrimental effects on physical, financial, and career outcomes. Underrepresentation of racial and ethnic minorities in gynecologic oncology clinical trials highlights the urgent need for collaborative and focused initiatives to bridge the significant divide and alleviate inequalities in the prevention and treatment of cervical cancer.
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Affiliation(s)
- Eugenia Girda
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America
| | - Leslie M Randall
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology and Massey Cancer Center, Virginia Commonwealth University Health, Richmond, VA, United States of America
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona, Creighton University, Phoenix, AZ, United States of America
| | - John H Farley
- Department of Obstetrics and Gynecology, St Joseph's Hospital and Medical Center, Phoenix, AZ, United States of America
| | - Roisin E O'Cearbhaill
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America; Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America.
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Tie H, Shi L, Wang L, Hao X, Fang H, Li L. Symptom clusters and characteristics of cervical cancer patients receiving concurrent chemoradiotherapy: A cross-sectional study. Heliyon 2023; 9:e22407. [PMID: 38107307 PMCID: PMC10724552 DOI: 10.1016/j.heliyon.2023.e22407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/19/2023] Open
Abstract
Background Cervical cancer patients have a high symptom burden during concurrent chemoradiotherapy (CCRT) and urgently need precise symptom management strategies. Nonetheless, the symptom profile and influencing factors are unclear. Methods A total of 234 patients with cervical cancer who underwent CCRT in a tertiary care hospital clinical oncology center in Guangxi Zhuang Autonomous Region from March 2022 to March 2023 were included in the study. The general information questionnaire, M.D. Anderson symptom inventory, Fatigue Scale-14, Pittsburgh Sleep Quality Index, and grip strength test were used for the investigation. Symptom clusters were extracted by exploratory factor analysis, and latent profile analysis was performed using Mplus 8.0 software. Multinomial logistic regression was used to explore the factors influencing the potential categories of symptom clusters. Results Exploratory factor analysis extracted four symptom clusters: a fatigue-related symptom cluster, a gastrointestinal-related symptom cluster, a mood-related symptom cluster, and a physical-related symptom cluster, of which the fatigue-related symptom cluster was more severe and was divided into three potential categories: low fatigue-good muscle fitness type (25.63%), general fatigue-moderate muscle fitness type (68.37%) and high fatigue-low muscle fitness type (6%). Multinomial logistic regression analysis showed that hemoglobin levels, tumor stage, absence of complications, and unemployment were factors influencing the fatigue-related symptom cluster in patients undergoing CCRT for cervical cancer. Conclusions Cervical cancer patients experience multiple symptom clusters during CCRT. Different characteristics appeared in different clusters. Among them, fatigue-related symptom clusters were more severe and heterogeneous. In clinical practice, we should pay attention to and use high symptom feature predictors, focusing on the core symptoms that play a dominant role, achieving early identification and management, and reducing patients' symptom burden.
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Affiliation(s)
- Hao Tie
- Oncology Center Radiotherapy Ward 1, Guangxi Academy of Medical Sciences, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- School of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Limei Shi
- Oncology Center Radiotherapy Ward 2, Guangxi Academy of Medical Sciences, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Li Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Xinyu Hao
- School of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Hongyan Fang
- Oncology Center Radiotherapy Ward 1, Guangxi Academy of Medical Sciences, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Lirong Li
- Oncology Center Radiotherapy Ward 1, Guangxi Academy of Medical Sciences, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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Yuan X, Zhang X, He J, Xing W. Interventions for financial toxicity among cancer survivors: A scoping review. Crit Rev Oncol Hematol 2023; 192:104140. [PMID: 37739147 DOI: 10.1016/j.critrevonc.2023.104140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.
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Affiliation(s)
- Xiaoyi Yuan
- School of nursing, Fudan University, Shanghai, China
| | - Xuehui Zhang
- School of nursing, Fudan University, Shanghai, China
| | - Jing He
- School of nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of nursing, Fudan University and core research member of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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Chang CT, Chen HH, Chuang CC, Chang SH, Hsiao NW. Ganciclovir as a potential treatment for glioma: a systematic review and meta-analysis. J Neurooncol 2023; 165:399-411. [PMID: 38066255 DOI: 10.1007/s11060-023-04503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/05/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Glioma is a challenging malignant tumor with a low survival rate and no effective treatment. Recently, ganciclovir, an antiviral drug, combined with gene therapy and its own antiviral ability, has been proposed as a potential treatment for glioma. However, there are differences in the results of various clinical trials. In this study, we conducted a systematic review and meta-analysis to evaluate the efficacy of ganciclovir in treating glioma. METHODS We searched databases such as PubMed, EMBASE, and Cochrane Library before March 30, 2023. The search terms included glioma, ganciclovir, valganciclovir and treatment. Calculated 1, 2 and 4-year survival rate by risk difference (RD), and overall survival (OS) by odds ratio (OR). RESULTS Five randomized controlled trials (RCTs) with a total of 606 high-grade glioma patients were included. The results showed that ganciclovir can improve 2-yeaer (RD = 0.179, 95% CI 0.012-0.346, P = 0.036) and 4-year survival rate (RD = 0.185, 95% CI 0.069-0.3, P = 0.002) and OS (OR 2.393, 95% CI 1.212-4.728, P = 0.012) compared with the control group. CONCLUSIONS This meta-analysis showed that ganciclovir significantly improved the prognosis of glioma patients. Therefore, we suggest that more cases of ganciclovir as a glioma treatment can be conducted, or a large clinical trial can be designed.
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Affiliation(s)
- Chun-Tao Chang
- Department of Biology, National Changhua University of Education, No. 1, Jinde Rd, Changhua City, Changhua County, 500207, Taiwan
| | - Hsing-Hui Chen
- Department of Industrial Education and Technology, National Changhua University of Education, No. 1, Jinde Rd, Changhua City, Changhua County, 500207, Taiwan
| | - Chun-Chao Chuang
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd, South Dist., Taichung City, 402306, Taiwan
| | - Shao-Hsun Chang
- Department of Industrial Education and Technology, National Changhua University of Education, No. 1, Jinde Rd, Changhua City, Changhua County, 500207, Taiwan
| | - Nai-Wan Hsiao
- Department of Biology, National Changhua University of Education, No. 1, Jinde Rd, Changhua City, Changhua County, 500207, Taiwan.
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Abdoul-Latif FM, Ainane A, Houmed Aboubaker I, Mohamed J, Ainane T. An Overview of Cancer in Djibouti: Current Status, Therapeutic Approaches, and Promising Endeavors in Local Essential Oil Treatment. Pharmaceuticals (Basel) 2023; 16:1617. [PMID: 38004482 PMCID: PMC10674319 DOI: 10.3390/ph16111617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Djibouti, a developing economy, grapples with significant socioeconomic obstacles and the prevalence of infectious pathologies, including certain forms of neoplasms. These challenges are exacerbated by limited access to affordable medical technologies for diagnosis, coupled with a lack of preventive interventions, particularly in disadvantaged areas. The attention devoted to local phytotherapeutic treatments underscores the uniqueness of Djibouti's flora, resulting from its distinctive geographical position. International focus specifically centers on harnessing this potential as a valuable resource, emphasizing the phytoconstituents used to counter pathologies, notably carcinomas. This comprehensive overview covers a broad spectrum, commencing with an examination of the current state of knowledge, namely an in-depth investigation of oncological risk factors. Essential elements of control are subsequently studied, highlighting the fundamental prerequisites for effective management. The significance of dietary habits in cancer prevention and support is explored in depth, while traditional methods are examined, highlighting the cultural significance of indigenous essential oil therapies and encouraging further research based on the promising results.
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Affiliation(s)
- Fatouma Mohamed Abdoul-Latif
- Medicinal Research Institute, Center for Studies and Research of Djibouti, IRM-CERD, Route de l’Aéroport, Haramous, Djibouti P.O. Box 486, Djibouti;
| | - Ayoub Ainane
- Superior School of Technology of Khenifra (EST-Khenifra), University of Sultan Moulay Slimane, P.O. Box 170, Khenifra 54000, Morocco; (A.A.); (T.A.)
| | | | - Jalludin Mohamed
- Medicinal Research Institute, Center for Studies and Research of Djibouti, IRM-CERD, Route de l’Aéroport, Haramous, Djibouti P.O. Box 486, Djibouti;
| | - Tarik Ainane
- Superior School of Technology of Khenifra (EST-Khenifra), University of Sultan Moulay Slimane, P.O. Box 170, Khenifra 54000, Morocco; (A.A.); (T.A.)
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Buchbinder D, Bhatt NS, Wang H, Yasui Y, Armenian S, Bhatia S, Chow EJ, Huang IC, Kirchoff AC, Leisenring W, Park ER, Yabroff KR, Armstrong GT, Nathan PC, Khera N. Financial Hardship in Childhood Cancer Survivors Treated with Hematopoietic Cell Transplantation: A Report from the Childhood Cancer Survivor Study. Transplant Cell Ther 2023; 29:705.e1-705.e9. [PMID: 37541329 PMCID: PMC10834839 DOI: 10.1016/j.jtct.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
Long-term survivors of childhood cancer are at risk for financial hardship. However, it is not known if HCT leads to an incremental change in financial hardship for survivors who received it versus those who did not. We examined financial outcomes among adult survivors of childhood cancer who had undergone HCT. Using a cross-sectional survey in the Childhood Cancer Survivor Study population between 2017 and 2019, self-reported financial hardship was compared between survivors who received HCT, survivors treated without HCT ("non-HCT"), and siblings and categorized into 3 domains: material hardship/financial sacrifices, behavioral, and psychological hardship. The standardized score of each domain of financial hardship was calculated by adding the item responses and dividing by the standard deviation among siblings. Multivariable linear and logistic regression were used to evaluate associations between sociodemographic characteristics, cancer diagnosis, post-treatment complications, and financial hardship among survivors. The mean adjusted score for each hardship domain was not significantly different between HCT survivors (n = 133) and non-HCT survivors (n = 2711); mean differences were .18 (95% confidence interval [CI], -.05 to .41) for material hardship/financial sacrifices, .07 (95% CI, -.18 to .32) for behavioral hardship, and .19 (95% CI, -.04 to .42) for psychological hardship. Within specific items, a higher proportion of survivors treated with HCT reported greater financial hardship compared to non-HCT survivors. HCT survivors also had significantly higher mean domain scores compared to sibling controls (n = 1027) in all domains. Household income and chronic health conditions, but not HCT, were associated with financial hardship among all survivors. Adult survivors of childhood cancer treated with HCT do not report greater overall financial hardship compared to non-HCT survivors but do report greater overall financial hardship compared to sibling controls. Surveillance and intervention may be necessary for all survivors regardless of HCT status.
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Affiliation(s)
- David Buchbinder
- Department of Pediatrics, University of California at Irvine, Irvine, California; Division of Hematology, Oncology at Children's Hospital of Orange County, Orange, California.
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Huiqi Wang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Saro Armenian
- Department of Pediatrics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eric J Chow
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Anne C Kirchoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Elyse R Park
- Mongan Institute, Harvard Medical School, Boston, Massachusetts
| | - K Robin Yabroff
- Surveillane and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, Ontario, Canada; Division of Hematology, Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nandita Khera
- Division of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
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Bigdeli Shamloo MB, Shamsi A, Elahi N. Find Meaning and Help: The Lived Experiences and Support Needs of Iranian Muslim Husbands of Women Undergoing Mastectomy From Diagnosis to the End of Life. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231211627. [PMID: 37902105 DOI: 10.1177/00302228231211627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The husbands of women undergoing mastectomy have been introduced as the patient's primary caregivers. This research was conducted to investigate the lived experiences of Iranian Muslim husbands of women undergoing mastectomy. In this phenomenological research, 18 participants were interviewed, and Van Menan's method of interpretation was used to interpret the data. 8 themes were extracted from the data analysis: physical problems, living in the shadow of fear and discomfort, and destiny is not blameless, modified roles, marital coldness, imposing a financial burden, spiritual care, and support failure. It is concluded that the husbands of these patients need comprehensive support, and the current support is not enough.
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Affiliation(s)
| | - Aziz Shamsi
- Assistant Professor of Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Nasrin Elahi
- Department of Nursing, School of Nursing and Midwifery, Nursing Care Research Center in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Parsons HM, Banegas MP, Bar-Sela G, Jones SM. Editorial: Financial anxiety in cancer prevention and control. Front Psychol 2023; 14:1304079. [PMID: 37908816 PMCID: PMC10615129 DOI: 10.3389/fpsyg.2023.1304079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/02/2023] Open
Affiliation(s)
- Helen M. Parsons
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Matthew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, CA, United States
| | - Gil Bar-Sela
- Cancer Center, Emek Medical Center, Afula, Israel
| | - Salene M. Jones
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Waters AR, Kaddas HK, van Thiel Berghuijs KM, Vaca Lopez PL, Warner EL, Ou JY, Ramsay JM, Palmer A, Ray N, Tsukamoto T, Fair DB, Lewis MA, Linder L, Gill D, Kirchhoff AC. COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2023; 12:744-751. [PMID: 36951664 PMCID: PMC10623459 DOI: 10.1089/jayao.2022.0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.
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Affiliation(s)
- Austin R. Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Heydon K. Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Perla L. Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Judy Y. Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Joemy M. Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Alexandra Palmer
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Nicole Ray
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Douglas B. Fair
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | | | - Lauri Linder
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - David Gill
- Intermountain Health, Salt Lake City, Utah, USA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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Lee MK, Durani U, Zhang N, Hilal T, Warsame RM, Borah B, Khera N, Griffin JM. Relationships Among Health Insurance Literacy, Financial Toxicity, and Sociodemographic Factors in Patients With Cancer. JCO Oncol Pract 2023; 19:888-898. [PMID: 37616546 PMCID: PMC10615437 DOI: 10.1200/op.22.00829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/02/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE The objective of the study was to describe the prevalence of health insurance literacy (HIL) and investigate how patient-reported outcome measures assessing HIL are related to financial toxicity in patients with cancer. METHODS We assessed HIL and financial toxicity in 404 patients enrolled between December 2019 and January 2021 at two medical centers in the United States. We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and test the relationships among the factors and items. We fit structural equation models (SEMs) to find the relationships among the factors and sociodemographic/clinical characteristics. RESULTS The EFA revealed items loaded on four factors: knowledge about health insurance, confidence related to HIL (HIL confidence), information-seeking behavior related to health insurance, and financial toxicity. The four-factor CFA model had good fit statistics (comparative fit index, 0.960; Tucker-Lewis index, 0.958; root mean square error of approximation, 0.046; and standardized root mean square residual, 0.086). In SEM, income, education level, and race positively predicted knowledge about health insurance. Knowledge about health insurance and number of total lines of cancer treatment was positively associated with HIL confidence. Higher income, older age, and HIL confidence were associated with less financial toxicity. Higher levels of financial toxicity, HIL confidence, and knowledge were associated with greater information-seeking behavior. CONCLUSION Our findings showed how different aspects of HIL are related to financial toxicity even after adjustment for sociodemographic and clinical characteristics. Future studies should investigate the longitudinal relationships among these factors to help develop interventions to mitigate financial toxicity.
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Affiliation(s)
- Minji K. Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Urshila Durani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ
| | - Talal Hilal
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ
- Division of Hematology/Oncology, University of Mississippi, Jackson, MS
| | - Rahma M. Warsame
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bijan Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Joan M. Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
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Sears-Smith M, Knight TG. Financial Toxicity in Patients with Hematologic Malignancies: a Review and Need for Interventions. Curr Hematol Malig Rep 2023; 18:158-166. [PMID: 37490228 DOI: 10.1007/s11899-023-00707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Financial toxicity is a developing research area to quantify the financial stress experienced by patients and caregivers, as well as the mechanisms by which they manage the costs associated with treatment and the very real harms that this stress can inflict upon cancer care. Patients with blood malignancies experience increased costs associated with their diagnosis due to possible inpatient admissions for treatment, frequent office visits, and even more frequent lab evaluations and testing. PURPOSE OF REVIEW Multiple studies have examined the causes and effects of financial toxicity on patient care and outcomes, and there have been several validated tools developed to identify patients experiencing or at risk for financial harm. DISCUSSION However, few studies to date have focused on implementing successful interventions to assist in mitigating financial difficulties for patients diagnosed with hematologic malignancies and their families. In this review, we examine the current literature with an emphasis on levels of care, including providers, systems, and policies. Specifically, we discuss published interventions including physician education about treatment costs, financial navigation in cancer centers, and novel institutional multidisciplinary review of patients' financial concerns. We also discuss the urgent need for societal and governmental interventions to lessen financial distress experienced by these highly vulnerable blood cancer patients.
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Affiliation(s)
- Megan Sears-Smith
- Levine Cancer Institute, Atrium Health, 1020 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Thomas G Knight
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI Building 2, Suite 60100, Charlotte, NC, 28204, USA.
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Saeki S, Iwatani T, Kitano A, Sakurai N, Tanabe Y, Yamauchi C, Igarashi A, Kajimoto Y, Kuba S, Hara F, Sagara Y, Ohno S. Factors associated with financial toxicity in patients with breast cancer in Japan: a comparison of patient and physician perspectives. Breast Cancer 2023; 30:820-830. [PMID: 37310584 PMCID: PMC10404186 DOI: 10.1007/s12282-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Financial toxicity (FT) is a notable concern for patients with breast cancer worldwide. The situation regarding FT in Japan, however, has not been well explored. This study examined FT in patients with breast cancer in Japan and presented an overview of the group study's overall findings. METHODS The survey used the Questant application and primarily targeted patients with breast cancer attending research facilities and physicians who are members of the Japanese Breast Cancer Society. The Japanese version of the Comprehensive Score for FT (COST) was used to quantify patients' FT. Multiple regression analysis was used to identify factors related to FT in patients with breast cancer in Japan and evaluate the sufficiency of information support level (ISL) for medical expenses. RESULTS We collected 1558 responses from patients and 825 from physicians. In terms of factors affecting FT, recent payments had the highest impact, followed by stage, and related departments positively affecting FT. Conversely, factors such as income, age, and family support were found to negatively affect FT. A significant discrepancy was identified between patients and physicians in perceived information support, with patients frequently feeling unsupported and physicians believing that they have provided adequate support. Furthermore, differences in the frequency of explanations and opportunities to ask questions about medical costs across FT grades were found. The analysis also showed that physicians with a better understanding of information support needs and greater knowledge of medical costs tended to provide more support that is comprehensive. CONCLUSION This study emphasizes the importance of addressing FT in patients with breast cancer in Japan and highlights the need for enhanced information support, deeper understanding by physicians, and collaborative efforts among professionals to mitigate financial burden and provide personalized, tailored support for individual needs.
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Affiliation(s)
- Sumito Saeki
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
- Graduate School of Medicine, Department of Cancer Therapy and Surgery, Tohoku University, Sendai, Japan.
| | - Tsuguo Iwatani
- Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Atsuko Kitano
- Department of Medical Oncology, St Luke's International Hospital, Tokyo, Japan
| | | | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Chikako Yamauchi
- Radiation Therapy Center, Shiga General Hospital, Moriyama, Japan
| | - Ataru Igarashi
- Department of Pharmaceutical Policy, The University of Tokyo, Tokyo, Japan
| | - Yusuke Kajimoto
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
- Oncology Science Unit, MSD K.K, Tokyo, Japan
| | - Sayaka Kuba
- Graduate School of Biomedical Sciences, Department of Surgery, Nagasaki University, Nagasaki, Japan
| | - Fumikata Hara
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Yabroff KR, Zhao J, Chen MH, Hoque J, Arias G, Han X, Zheng Z. Financial hardship and psychosocial well-being and quality of life among prostate cancer survivors in the United States. Urol Oncol 2023; 41:380-386. [PMID: 37202329 DOI: 10.1016/j.urolonc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
Prostate cancer is the most common cancer diagnosis among men in the United States and the prevalence of prostate cancer survivors is growing. Cancer treatment and lasting or late effects of disease and treatment can adversely affect financial health, psychosocial well-being, and health-related quality of life for prostate cancer survivors, even many years after cancer diagnosis and treatment. These outcomes are important, especially because most men live for many years following a prostate cancer diagnosis. In this essay, we describe health care spending associated with prostate cancer, including patient out-of-pocket costs, and summarize research examining medical financial hardship and associations of financial hardship and psychosocial well-being and health-related quality of life among cancer survivors. We then discuss implications for health care delivery and opportunities to mitigate financial hardship for patients with prostate cancer and their families.
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Affiliation(s)
- K Robin Yabroff
- Department of Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA.
| | - Jingxuan Zhao
- Department of Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA
| | - Min Hsuan Chen
- Department of Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA; Department of Public Policy, American Cancer Society Cancer Action Network, Washington, DC
| | - Jennifer Hoque
- Department of Public Policy, American Cancer Society Cancer Action Network, Washington, DC
| | - Gladys Arias
- Department of Public Policy, American Cancer Society Cancer Action Network, Washington, DC
| | - Xuesong Han
- Department of Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA
| | - Zhiyuan Zheng
- Department of Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA
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Shi JJ, Maldonado JA, Wu CF, Peterson SK, Chen YS, Diao K, Volk RJ, Giordano SH, Shih YCT, Kaiser K, Smith GL. Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization. Front Psychol 2023; 14:1209526. [PMID: 37663351 PMCID: PMC10469858 DOI: 10.3389/fpsyg.2023.1209526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Acute care (AC) visits by cancer patients are costly sources of healthcare resources and can exert a financial burden of oncology care both for individuals with cancer and healthcare systems. We sought to identify whether cancer patients who reported more severe initial financial toxicity (FT) burdens shouldered excess risks for acute care utilization. Methods In 225 adult patients who participated in the Economic Strain and Resilience in Cancer (ENRICh) survey study of individuals receiving ambulatory cancer care between March and September 2019, we measured the baseline FT (a multidimensional score of 0-10 indicating the least to most severe global, material, and coping FT burdens). All AC visits, including emergency department (ED) and unplanned hospital admissions, within 1-year follow-up were identified. The association between the severity of FT and the total number of AC visits was tested using Poisson regression models. Results A total of 18.6% (n = 42) of patients had any AC visit, comprising 64.3% hospital admissions and 35.7% ED visits. Global FT burden was associated with the risk of repeat AC visits within 1-year follow-up (RR = 1.17, 95% CI 1.07-1.29, P < 0.001 for every unit increase), even after adjusting for sociodemographic and disease covariates. When examining subdimensions of FT, the burden of depleted FT coping resources (coping FT) was strongly associated with the risk of repeat AC visits (RR = 1.27, 95% CI 1.15-1.40, P < 0.001) while material FT burden showed a trend toward association (RR = 1.07, 95% CI 0.99-1.15, P = 0.07). Conclusion In this prospective study of acute oncology care utilization outcomes among adult cancer patients, FT was a predictor of a higher burden of acute care visits. Patients with severely depleted material and also practical and social coping resources were at particular risk for repeated visits. Future studies are needed to identify whether early FT screening and intervention efforts may help to mitigate urgent acute care utilization burdens.
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Affiliation(s)
- Julia J. Shi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Alberto Maldonado
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kelsey Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Berkman AM, Choi E, Cheung CK, Salsman JM, Peterson SK, Andersen CR, Lu Q, Livingston JA, Battle A, Hildebrandt MAT, Parsons SK, Roth ME. Excess risk of chronic health conditions in Black adolescent and young adult cancer survivors. J Cancer Surviv 2023:10.1007/s11764-023-01433-x. [PMID: 37578615 DOI: 10.1007/s11764-023-01433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The US population of adolescent and young adult (age 15-39 years at diagnosis) cancer survivors is growing. Previous studies have identified racial and ethnic disparities in survival and health outcomes in racially minoritized survivors, including Black survivors, compared with White survivors. However, comparisons should be made between those of the same race or ethnicity with and without a history of AYA cancer to fully understand the association of a cancer diagnosis with socioeconomic status (SES) and health outcomes within a minoritized population. METHODS Non-Hispanic Black AYA cancer survivors and non-Hispanic Black age- and sex-matched controls were identified from self-reported data from the National Health Interview Survey (2009-2018). SES factors and chronic health conditions prevalence were compared between survivors and controls using chi-square tests. Survey-weighted logistic regression models were used to determine odds of chronic conditions by SES factors within and between survivors and controls. Interactions between each variable and cancer group were assessed. RESULTS A total of 445 survivors and 4450 controls were included. Survivors were less likely than controls to be married, have family income >45K/year, have completed a bachelor's degree or higher, and have private insurance. Survivors had higher odds than controls of having at least one (odds ratio (OR): 7.02, p<0.001) and ≥3 (OR: 4.44, p<0.001) chronic conditions. Survivors had higher odds of each chronic condition assessed including cardiovascular disease, diabetes, and hypertension. Survivors had higher odds of having chronic health conditions compared with controls across all SES variables. CONCLUSIONS A cancer diagnosis during adolescence and young adulthood is associated with poor SES outcomes and increased odds of comorbidities within the Black population, thus further exacerbating existing disparities. IMPLICATIONS FOR CANCER SURVIVORS Black AYA cancer survivors have a very high risk of developing chronic health conditions after cancer treatment and interventions are needed to improve long-term health outcomes for this population.
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Affiliation(s)
- Amy M Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Institute, Houston, TX, USA
| | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aryce Battle
- McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
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Pisu M, Liang MI, Pressman SD, Ryff CD, Patel MR, Hussein M, Williams CP, Henrikson NB, Schoenberger YM, Pracht LJ, Bradshaw E, Carpenter TT, Matthis A, Schwartz DL, Martin MY. Expanding research on the impact of financial hardship on emotional well-being: guidance of diverse stakeholders to the Emotional Well-Being and Economic Burden of Disease (EMOT-ECON) Research Network. Front Psychol 2023; 14:1196525. [PMID: 37575433 PMCID: PMC10416236 DOI: 10.3389/fpsyg.2023.1196525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
The Emotional Well-Being and Economic Burden (EMOT-ECON) Research Network is one of six research networks funded by the National Institutes of Health (NIH) to advance research about emotional well-being (EWB), and the only one that focuses on addressing how economic burden due to disease or illness affects EWB. The network convened researchers, patients, patient advocates, health care providers and other stakeholders from across the US to discuss the significance of addressing the impact of the economic burden of disease on EWB, the complexity of this prevalent problem for patients and families, and the research gaps that still need to be studied to ultimately develop strategies to reduce the impact of economic burden of disease on EWB and health. Participants identified some important future areas of research as those investigating: (i) prevalent and relevant emotions for patients experiencing economic burden of disease and financial hardship, and how their broader outlook on life is impacted; (ii) constructs and contexts that influence whether the economic burden is stressful; (iii) strategies to deal and cope and their positive or negative effects on EWB and health; and (iv) multi-level and multi-stakeholder interventions to address economic factors (e.g., costs, ability to pay), administrative burdens, education and training, and especially patients' emotional as well as financial status.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Margaret I. Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Sarah D. Pressman
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
| | - Carol D. Ryff
- Department of Psychology and Institute on Aging, University of Wisconsin-Madison, Madison, WI, United States
| | - Minal R. Patel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Mustafa Hussein
- Department of Health Policy and Management, Graduate School of Public Health, The City University of New York, New York, NY, United States
| | - Courtney P. Williams
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nora B. Henrikson
- Kaiser Permanente, Washington Health Research Institute, Seattle, WA, United States
| | - Yu-Mei Schoenberger
- Division of Preventive Medicine and O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Erin Bradshaw
- Patient Advocate Foundation, Patient Insight Institute, Hampton, VA, United States
| | | | - Amy Matthis
- American Diabetes Association, Alexandria, VA, United States
| | - David L. Schwartz
- Departments of Radiation Oncology and Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Michelle Y. Martin
- Department of Preventive Medicine and Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, Memphis, TN, United States
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Boone ER, Tai H, Raich A, Vatsavai A, Qin A, Thompson K, Johri M, Hu R, Golla V, Harris-Gersten M. Financial Health of People Living With Dementia and Their Informal Care Partners: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e47255. [PMID: 37432718 PMCID: PMC10369306 DOI: 10.2196/47255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND There is a growing body of academic literature focusing on the significant financial burdens placed on people living with cancer, but little evidence exists on the impact of rising costs of care in other vulnerable populations. This financial strain, also known as financial toxicity, can impact behavioral, psychosocial, and material domains of life for people diagnosed with chronic conditions and their care partners. New evidence suggests that populations experiencing health disparities, including those with dementia, face limited access to health care, employment discrimination, income inequality, higher burdens of disease, and exacerbating financial toxicity. OBJECTIVE The three study aims are to (1) adapt a survey to capture financial toxicity in people living with dementia and their care partners; (2) characterize the degree and magnitude of different components of financial toxicity in this population; and (3) empower the voice of this population through imagery and critical reflection on their perceptions and experiences relating to financial toxicity. METHODS This study uses a mixed methods approach to comprehensively characterize financial toxicity among people living with dementia and their care partners. To address aim 1, we will adapt elements from previously validated and reliable instruments, including the Comprehensive Score for Financial Toxicity and Patient-Reported Outcomes Measurement Information System, to develop a financial toxicity survey specific to dyads of people living with dementia and their care partners. A total of 100 dyads will complete the survey, and data will be analyzed using descriptive statistics and regression models to address aim 2. Aim 3 will be addressed using the process of "photovoice," which is a qualitative, participatory research method that combines photography, verbal narratives, and critical reflection by groups of individuals to capture aspects of their environment and experiences with a certain topic. Quantitative results and qualitative findings will be integrated using a validated, joint display table mixed methods approach called the pillar integration process. RESULTS This study is ongoing, with quantitative findings and qualitative results anticipated by December 2023. Integrated findings will enhance the understanding of financial toxicity in individuals living with dementia and their care partners by providing a comprehensive baseline assessment. CONCLUSIONS As one of the first studies on financial toxicity related to dementia care, findings from our mixed methods approach will support the development of new strategies for improving the costs of care. While this work focuses on those living with dementia, this protocol could be replicated for people living with other diseases and serve as a blueprint for future research efforts in this space. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47255.
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Affiliation(s)
- Eli Robert Boone
- Duke-Margolis Center for Health Policy, Durham, NC, United States
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Heiley Tai
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Ali Raich
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Amulya Vatsavai
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Annie Qin
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Kayla Thompson
- Duke University School of Medicine, Durham, NC, United States
- Fuqua School of Business, Duke University, Durham, NC, United States
| | - Mohini Johri
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Ruitian Hu
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Vishnukamal Golla
- Duke-Margolis Center for Health Policy, Durham, NC, United States
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC, United States
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Surgery, Duke University, Durham, NC, United States
| | - Melissa Harris-Gersten
- Duke Clinical and Translational Science Institute, Duke University, Durham, NC, United States
- Durham Veterans Affairs Health Care System, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
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Serra-Burriel M, Perényi G, Laube Y, Mitchell AP, Vokinger KN. The cancer premium - explaining differences in prices for cancer vs non-cancer drugs with efficacy and epidemiological endpoints in the US, Germany, and Switzerland: a cross sectional study. EClinicalMedicine 2023; 61:102087. [PMID: 37521033 PMCID: PMC10371812 DOI: 10.1016/j.eclinm.2023.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
Background High treatment prices of new cancer drugs are a global public health challenge to patients and healthcare systems. Policymakers in the US and Europe are debating reforms to drug pricing. The objective of this study was to assess whether drug efficacy or epidemiological characteristics (prevalence, incidence, mortality) explain the gap in treatment prices between cancer and non-cancer drugs in the US, Germany, and Switzerland. Methods This cross-sectional study identified all new drugs approved in the US, Germany, and Switzerland between 2011 and 2020. Drug efficacy was extracted from pivotal trials, drug prices from public and commercial databases, and epidemiological characteristics from the Global Burden of Disease (GBD) 2019 study. We used regression models to explain drug prices with drug efficacy and epidemiological characteristics (prevalence, incidence, mortality). Findings The cohort included 181 drugs, including 68 (37.5%) drugs approved for treatment of cancer. A significant negative correlation was found between incidence/prevalence and treatment prices, and a significant positive correlation was observed between mortality and treatment prices for both, cancer and non-cancer drugs. A significant association between relative drug efficacy and treatment prices of drugs was observed, however, less pronounced for cancer drugs. Our regression estimates indicated that after adjusting for efficacy and epidemiological characteristics, cancer drugs were on average approximately three times more expensive compared to non-cancer drugs in all three countries, indicating a cancer premium; i.e., treatment prices of cancer drugs were on average USD 74,412 (95% CI [62,810; 86,015]) more expensive in the US compared to non-cancer drugs, USD 37,770 (95% CI [26,175; 49,367]) more expensive in Germany, and USD 32,801 (95% CI [27,048; 38,555]) more expensive in Switzerland. Our model explained 72% of the variance in observed prices (R2). Interpretation Drug pricing reforms should target the cancer premium to improve access of patients to cancer drugs as well as to achieve equity across the different therapeutic areas and sustainability in the health care systems. Funding This study was funded by the Swiss National Science Foundation (SNSF, grant number PCEGP1_194607) and the Swiss Cancer Research Foundation (Krebsforschung Schweiz).
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Affiliation(s)
- Miquel Serra-Burriel
- Institute of Law, University of Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Yannic Laube
- Institute of Law, University of Zurich, Switzerland
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72
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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73
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Hastert TA, Nair M, Eggly S. Providers' communication-related concerns in helping patients address the financial impact of cancer. PATIENT EDUCATION AND COUNSELING 2023; 114:107860. [PMID: 37421848 DOI: 10.1016/j.pec.2023.107860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES This study describes the communication-related concerns of oncology providers in addressing financial issues with patients. METHODS We conducted semi-structured interviews with 17 providers (9 clinicians, 5 social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcripts using qualitative thematic analysis. Interview topics included cost-related concerns of patients, resources providers used, and unmet needs related to addressing financial issues. Here we present codes and content related to a cross-cutting cost communication, stratified by provider discipline. RESULTS Communication-related issues varied by provider type. Clinicians identified lack of information, lack of time, and the need for additional support as major barriers to effective cost discussions. Social workers/navigators expressed the importance of establishing a relationship before discussing costs and on the need to revisit cost concerns over time to meet patients' changing needs. The attorneys endorsed the need for more and earlier cost communication to prevent financial hardship. CONCLUSION Communication concerns and strategies were central to providers' experiences of addressing cancer patient cost concerns. PRACTICE IMPLICATIONS Understanding the experiences of diverse oncology providers can inform the development and implementation of interventions to prevent and mitigate financial hardship in people with cancer.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
| | - Mrudula Nair
- Department of Public Health Sciences, Henry Ford Medical Group, Detroit, MI, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
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74
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Esselen KM, Baig RA, Gompers A, Stack-Dunnbier H, Hacker MR, Jang JW. Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer. Support Care Cancer 2023; 31:388. [PMID: 37300721 DOI: 10.1007/s00520-023-07849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. METHODS Patients completed a survey 1 month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. RESULTS Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). CONCLUSION Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.
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Affiliation(s)
- Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
| | - Rasha A Baig
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hannah Stack-Dunnbier
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Benedict C, Thom B, Diefenbach M, Schapira L, Simon P, Ford JS. The Impact of Cancer-Related Financial Toxicity on Reproductive Concerns and Family-Building Decision-Making in Post-Treatment Survivorship. J Adolesc Young Adult Oncol 2023; 12:408-415. [PMID: 36169520 PMCID: PMC10282808 DOI: 10.1089/jayao.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors are at-risk for cancer-related financial difficulties (i.e., financial toxicity [FT]). Family building after cancer often requires reproductive medicine or adoption with high costs; AYAs experience financial barriers to family building. This study evaluated the relationships among cancer FT, reproductive concerns, and decision-making processes about family building after cancer. Methods: AYA female (AYA-F) cancer survivors completed a cross-sectional survey including measures of FT, reproductive concerns, decisional conflict about family building, and decision-making self-efficacy. Differences across FT subgroups (i.e., no/mild, moderate, and severe FT) were tested. Linear regression evaluated the relationships between FT and reproductive concerns and decision-making processes. Results: Participants (N = 111) averaged 31.0 years (standard deviation [SD] = 5.49), 90% were nulliparous, and 84% were employed full/part-time. The overall FT levels were in the "moderate" range (M = 20.44, SD = 9.83); 48% worried quite a bit or very much about financial problems because of cancer. AYA-Fs reporting severe FT (24% of sample) experienced higher levels of reproductive concerns compared with those reporting no/mild and moderate FT. Those reporting moderate FT (46% of sample) reported greater decisional conflict about family-building options, compared with the no/mild FT subgroup. Both moderate and severe FT subgroups reported lower decision-making self-efficacy compared with the no/mild FT subgroup. In separate models controlling for covariates, greater FT related to higher levels of reproductive concerns (B = -0.39, p < 0.001), greater decisional conflict about family building (B = -0.56, p = 0.02), and lower decision-making self-efficacy (B = 0.60, p = 0.01). Conclusions: Given the high costs of reproductive medicine and adoption, fertility counseling pre- and post-treatment must address survivors' financial concerns and barriers.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | | | - Pam Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, New York, USA
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76
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Pail O, Knight TG. Financial toxicity in patients with leukemia undergoing hematopoietic stem cell transplantation: A systematic review. Best Pract Res Clin Haematol 2023; 36:101469. [PMID: 37353293 DOI: 10.1016/j.beha.2023.101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
Financial toxicity (FT) is a term used to describe the objective financial burden of cancer care including the associated coping behaviors used by patients and their caregivers. FT has been shown to result in both direct financial burdens and in clinically relevant outcomes, such as non-adherence with care, diminished quality of life, and even decreased overall survival. Much of the data has been described in solid tumors, with limited investigations in the malignant hematology population. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) face a unique financial burden driven by lengthy hospitalizations and acute and chronic morbidity that have downstream implications on their income and costs. In this review, we discuss the prevalence of FT in patients with leukemia who are eligible for HSCT. We review the impact of FT on financial and clinical outcomes and the role of various interventions that have been studied within this population.
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Affiliation(s)
- Orrin Pail
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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77
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Doherty M, Heintz J, Leader A, Wittenburg D, Ben-Shalom Y, Jacoby J, Castro A, West S. Guaranteed Income and Financial Treatment Trial (GIFT Trial or GIFTT): a 12-month, randomized controlled trial to compare the effectiveness of monthly unconditional cash transfers to treatment as usual in reducing financial toxicity in people with cancer who have low incomes. Front Psychol 2023; 14:1179320. [PMID: 37275728 PMCID: PMC10234289 DOI: 10.3389/fpsyg.2023.1179320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial Treatment (GIFT) Trial will use a two-arm randomized controlled trial to compare the efficacy of a 12-month UCT intervention providing $1000/month to treatment as usual on financial toxicity, health-related quality of life and treatment adherence in people with cancer who have low-incomes. The study will recruit 250 Medicaid beneficiaries with advanced cancer from two comprehensive cancer centers in Philadelphia, obtain informed consent, and randomize patients to one of two conditions: (1) $1,000/month UCT or (2) treatment as usual. Both arms will receive information on financial toxicity and the contact information for their hospital social worker or financial advocate upon enrollment. Participants will complete online surveys at baseline, 3, 6, 9, and 12 months from enrollment to collect patient-reported data on primary (i.e., financial toxicity, health-related quality of life, and treatment adherence) and secondary outcomes (i.e., anxiety, depression, food insecurity, housing stability). Social security records will be used to explore the effect on mortality at 2, 3, and 5 years post-enrollment. Linear mixed-models will be used to analyze all primary and secondary continuous outcomes over time and general estimating equations with a logit link and binary distribution for all binary outcomes over time. Differences between treatment and control groups and treatment effects will be determined using models that control for age, gender, race, baseline food security, baseline housing stability, and baseline ECOG. Findings from this study will have significant implications for the development and implementation of programs and policies that address the financial burden of cancer and other serious illnesses.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Heintz
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy Leader
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | | | - Jessica Jacoby
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy Castro
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Stacia West
- College of Social Work, University of Tennessee, Knoxville, TN, United States
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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Yao J, Novosel M, Bellampalli S, Kapo J, Joseph J, Prsic E. Lung Cancer Supportive Care and Symptom Management. Hematol Oncol Clin North Am 2023; 37:609-622. [PMID: 37024385 DOI: 10.1016/j.hoc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Lung cancer carries significant mortality and morbidity. In addition to treatment advances, supportive care may provide significant benefit for patients and their caregivers. A multidisciplinary approach is critical in addressing complications of lung cancer, including disease- and treatment-related complications, oncologic emergencies, symptom management and supportive care, and addressing the psychosocial needs of affected patients.
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Affiliation(s)
- Johnathan Yao
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Madison Novosel
- Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Shreya Bellampalli
- Medical Scientist Training Program, Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Jennifer Kapo
- Department of General Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208025, New Haven, CT 06520, USA
| | - Julia Joseph
- Yale Internal Medicine-Traditional Residency Program, Department of Internal Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208030, New Haven, CT 06520-8030, USA
| | - Elizabeth Prsic
- Section of Medical Oncology, Department of Medicine, Yale School of Medicine, Yale University, 333 Cedar Street, PO Box 208028, New Haven, CT 06520, USA.
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Vijayakumar S, Nittala MR, Buddala V, Mobit P, Duggar WN, Yang CC, Lirette ST, Mundra E, Ahmed HZ, Berry SM, Craft BS, Woods WC, Otts J, Rahimi A, Dobbs T. Real World and Public Health Perspectives of Intraoperative Radiotherapy in Early-Stage Breast Cancer: A Multidisciplinary Analysis Beyond the Statistical Facts. Cureus 2023; 15:e36432. [PMID: 37025715 PMCID: PMC10072193 DOI: 10.7759/cureus.36432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
Breast conservation therapy (BCT) (usually a lumpectomy plus radiotherapy (RT)) has become a standard alternative to radical mastectomy in early-stage breast cancers with equal, if not higher, survival rates. The established standard of the RT component of the BCT had been about six weeks of Monday through Friday external beam RT to the whole breast (WBRT). Recent clinical trials have shown that partial breast radiation therapy (PBRT) to the region surrounding the lumpectomy cavity with shorter courses can result in equal local control, survival, and slightly improved cosmetic outcomes. Intraoperative RT (IORT) wherein RT is administered at the time of operation for BCT to the lumpectomy cavity as a single-fraction RT is also considered PBRT. The advantage of IORT is that weeks of RT are avoided. However, the role of IORT as part of BCT has been controversial. The extreme views go from "I will not recommend to anyone" to "I can recommend to all early-stage favorable patients." These divergent views are due to difficulty in interpreting the clinical trial results. There are two modalities of delivering IORT, namely, the use of low-energy 50 kV beams or electron beams. There are several retrospective, prospective, and two randomized clinical trials comparing IORT versus WBRT. Yet, the opinions are divided. In this paper, we try to bring clarity and consensus from a highly broad-based multidisciplinary team approach. The multidisciplinary team included breast surgeons, radiation oncologists, medical physicists, biostatisticians, public health experts, nurse practitioners, and medical oncologists. We show that there is a need to more carefully interpret and differentiate the data based on electron versus low-dose X-ray modalities; the randomized study results have to be extremely carefully dissected from biostatistical points of view; the importance of the involvement of patients and families in the decision making in a very transparent and informed manner needs to be emphasized; and the compromise some women may be willing to accept between 2-4% potential increase in local recurrence (as interpreted by some of the investigators in IORT randomized studies) versus mastectomy. We conclude that, ultimately, the choice should be that of women with detailed facts of the pros and cons of all options being presented to them from the angle of patient/family-focused care. Although the guidelines of various professional societies can be helpful, they are only guidelines. The participation of women in IORT clinical trials is still needed, and as genome-based and omics-based fine-tuning of prognostic fingerprints evolve, the current guidelines need to be revisited. Finally, the use of IORT can help rural, socioeconomically, and infrastructure-deprived populations and geographic regions as the convenience of single-fraction RT and the possibility of breast preservation are likely to encourage more women to choose BCT than mastectomy. This option can also likely lead to more women choosing to get screened for breast cancer, thus enabling the diagnosis of breast cancer at an earlier stage and improving the survival outcomes.
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Affiliation(s)
| | - Mary R Nittala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Vedanth Buddala
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Paul Mobit
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Claus Chunli Yang
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Eswar Mundra
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Hiba Z Ahmed
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Scott M Berry
- Surgery, University of Mississippi Medical Center, Jackson, USA
| | - Barbara S Craft
- Medicine, University of Mississippi Medical Center, Jackson, USA
| | - William C Woods
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Jeremy Otts
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Asal Rahimi
- Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Thomas Dobbs
- Population Health, University of Mississippi Medical Center, Jackson, USA
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Proussaloglou EM, Rosenthal AE, Raker CA, Wilbur JS, Stuckey AR, Robison KM. Financial toxicity in BRCA1 and BRCA2 carriers. Gynecol Oncol 2023; 170:160-166. [PMID: 36701836 DOI: 10.1016/j.ygyno.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Financial toxicity (FT), the cumulative financial burden experienced due to medical care, is a well-established adverse effect of healthcare. Patients with BRCA mutations have significantly increased cancer risks compared to non-affected individuals, requiring more frequent screenings and, at times, prophylactic surgery, increasing their risk for FT. Our primary aim in this study was to describe rates of FT among BRCA carriers. METHODS We performed a novel, cross-sectional study of FT in BRCA1/2 carriers. Participants were recruited via phone and/or email to complete consents and surveys on REDCap. The FACIT-COST tool, a validated tool for measuring FT, was used to assess FT; scores were divided into tertiles, with high FT defined as COST score < 24. RESULTS 265 BRCA positive female participants met enrollment criteria; 76 (28.7%) consented to participate and completed the survey. Participants were primarily non-Hispanic White (97.4%), privately insured (82.9%), and employed full time (67.1%). A significant proportion (22.7%) of participants reported delaying or avoiding care secondary to finances. No statistically significant association was seen between financial toxicity groups and analyzed demographics. Participants with high FT were more likely to engage in all surveyed cost-saving measures, with 41.7% of participants reporting delays/avoidance of care due to cost (p = 0.02). CONCLUSIONS This study of FT in BRCA carriers shows that financial toxicity exists as an issue in this high-risk patient population. This work serves as the first description of FT in BRCA mutation carriers and highlights the importance of incorporating routine counseling on cost when discussing recommendations for screening and clinical care with this patient population.
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Affiliation(s)
- Ellie M Proussaloglou
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Alex E Rosenthal
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christina A Raker
- Women & Infants Hospital/Brown University, Providence, RI, United States of America
| | | | - Ashley R Stuckey
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Katina M Robison
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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Bradley CJ, Shih YCT, Yabroff KR. Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious? J Clin Oncol 2023; 41:970-973. [PMID: 36331244 DOI: 10.1200/jco.22.00929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, CO
| | - Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA
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83
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Bell L, Thom B, Chino F. Value-Based Health Care: Evaluating the Education of Future Radiation Oncologists on Costs and Affordability. J Am Coll Radiol 2023; 20:59-62. [PMID: 36496086 PMCID: PMC9898151 DOI: 10.1016/j.jacr.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Lauren Bell
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bridgette Thom
- Affordability Working Group and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fumiko Chino
- Affordability Working Group and the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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84
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Muacevic A, Adler JR, Nittala MR, Duggar WN. The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch. Cureus 2023; 15:e33665. [PMID: 36788838 PMCID: PMC9917828 DOI: 10.7759/cureus.33665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
Cancer care (CC) is incredibly complex and requires the coordination of multiple disciplines for optimal outcomes. Historically, this has been accomplished with multidisciplinary tumor boards (MDTBs), but the benefits, while perhaps intuitive, have not always been demonstrated with sufficient research robustness and validity. We hypothesize that this difficulty in demonstrating the benefit of MDTBs may be related to a delay in decision-making and operationalizing those decisions. The history and value of MDTBs are presented as well as their weaknesses and limited demonstration of improved outcomes. A major weakness highlighted by the challenges of MDTBs is the concept of total package time (TPT) (rather, the inability to keep it as short as possible); any significant delays in CC for any discipline may have a deleterious impact on any given patient's care outcome. Drawing on our own experience with utilizing information and communication technology (ICT) during an effort to apply accountability theory to improve specifically radiation therapy package time (RTPT), we argue that similar principles will be applicable in the improvement of not only the TPT which relies on multiple disciplines, but other factors of CC as well, such as coordination. Experience with improvement in RTPT is discussed and the underlying theory is demonstrated as a sound methodology to apply beyond RTPT to TPT involving coordination of multiple disciplines and stands to lead to the full realization of the benefits of the multidisciplinary approach. The complexity of cancer means that real solutions to optimal outcomes are also, by nature, complex, but here simple accountability theory is demonstrated that may unlock the next phase of multidisciplinary coordination. In this work, we argue that the benefits of the MDTB format can be fully realized with the addition of ICT, a technological breakthrough in the past two decades, while not forgetting about continued human factors.
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85
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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86
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Baum NH. Editorial Comment. Urology 2022; 170:51-52. [DOI: 10.1016/j.urology.2022.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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87
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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88
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Cancer Prevention Prioritized at AACR Annual Meeting and a New Working Group. Cancer Prev Res (Phila) 2022; 15:475-479. [DOI: 10.1158/1940-6207.capr-22-0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
Abstract
Scientific advances in the late 19th century set the stage for progress in understanding and treating cancer, a disease that was previously considered almost hopeless. One hundred years later, cancer prevention is becoming an increasingly important focus for oncology research. New tools and ideas bring to the field some extremely promising molecular, organizational, social, and political approaches, which were a focus of the American Association for Cancer Research 2022 Annual Meeting and of the newly launched AACR Cancer Prevention Working Group (CPWG). We are moving toward precision prevention, better tools for early detection and for risk assessment, the use of a Precancer Atlas, unveiling of new biomarkers. Besides improving lifestyle, by avoiding risk factors such as tobacco use, excessive UV exposure, infectious agents, as well as poor dietary habits, lack of exercise, overweight, and obesity, many other factors can impact cancer risk, which is a warning to consider a multifaceted molecular but also social approach. Gender, ethnicity, geographic, and economic lines are associated with disparities in prevention, which we want to overcome. Here we summarize some challenges and priorities in cancer prevention emerging from the work of AACR and CPWG.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Affordability Working Group, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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