151
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Longo CJ, Fitch MI. Unequal distribution of financial toxicity among people with cancer and its impact on access to care: a rapid review. Curr Opin Support Palliat Care 2021; 15:157-161. [PMID: 34232132 DOI: 10.1097/spc.0000000000000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Research demonstrates that patients and their families often carry a good portion of the economic burden during and following cancer treatment, frequently resulting in implications for access to care. This rapid review summarizes how this knowledge has evolved in recent years. RECENT FINDINGS The number of articles on patient financial burden is increasing, suggesting awareness about the growing impact of economic burden on patients. This is particularly evident when discussing out-of-pocket costs, and lost work for patients/caregivers. However, there is an increasing focus on 'foregone care' and 'financial distress'. Additionally, emerging literature is examining policies and approaches to screen and/or mitigate these patient financial risks, thereby improving access to care. There is also increasing focus on populations that shoulder a disproportionate financial burden, including ethnic minorities (blacks, Asians, Latinos) as well as those with lower socioeconomic status. Additionally, there is evidence that this burden also affects the middle class. SUMMARY As healthcare budgets become stretched, especially during a pandemic, supportive programs benefiting the less fortunate often shrink, which impacts access to care. The emerging research on strategies with government or institutions to mitigate these burdens and access issues are both welcome and needed.
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Affiliation(s)
- Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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152
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Influencing factors of treatment and prognosis perceptions among advanced cancer patients: a cross-sectional study. Support Care Cancer 2021; 30:1209-1220. [PMID: 34455482 DOI: 10.1007/s00520-021-06516-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/21/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The present study aimed to investigate the status and significantly influencing factors of treatment and prognosis perceptions among advanced cancer patients based on patient-reported outcome. METHODS A cross-sectional study was conducted at two tertiary A general hospitals. From June to September 2019, 300 patients were invited and 292 of them participated in this study. Except for 9 invalid questionnaires, 283 pen-paper questionnaires including sociodemographic and clinical characteristics, Chinese Version of Prognosis and Treatment Perception Questionnaire, Herth Hope Index, and Hospital Anxiety and Depression Scale were well completed. Descriptive analysis, Pearson's correlation test, logistic regression analysis, and multiple linear regression analysis were applied for analysis. RESULTS One hundred seventy-five (61.8%) advanced cancer patients reported inaccurate treatment perception. Prognosis perception scored 87.9 ± 13.72 indicating a middle level of prognosis perception. Fourteen (4.9%), 138 (48.8%), and 131 (46.3%) patients presented low, middle, and high prognosis perception levels, respectively. In patients, without spouse and religion beliefs, received chemoradiotherapy, diagnosed as cancer equal to or less than 1 year, and higher hope level were inaccurate treatment perception's risk factors. Younger age, longer diagnosis time, higher educational level, less support for medical expenses payment, receiving chemoradiotherapy, and lower hope level but more anxiety and depression symptoms were positive predictors of prognosis perception. CONCLUSIONS A majority of advanced cancer patients in this study reported inaccurate treatment and middle level of prognosis perception influencing by objective and subjective factors. Clinical interventions could be developed referring these impacting factors originating from patient-reported outcome.
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153
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Creff G, Jegoux F, Bendiane MK, Babin E, Licaj I. Returning to work by thyroid cancer survivors 5 years after diagnosis: the VICAN survey. J Cancer Surviv 2021; 16:801-811. [PMID: 34382180 DOI: 10.1007/s11764-021-01074-y] [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: 02/21/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Return to work (RTW) following cancer diagnosis is a challenge for both the patient and society. As thyroid cancer (TC) incidence is increasing, this study aims to assess difficulties in returning to work and income changes in TC survivors 5 years post-diagnosis. METHODS This study belongs to the national VICAN survey conducted in France among TC patients diagnosed between January and June 2010. Data were collected through phone interviews, medical surveys and from the national medico-administrative register in 2012 and 2015. We used multivariate logistic regressions to investigate TC impact on employment and income changes. RESULTS Of 146 patients, 121(82.9%) were women; the mean age was 42 years (SD = 8.34), 119 (81.3%) were diagnosed at an early stage, and 142(97.6%) underwent thyroidectomy. At 5 years post-diagnosis, 116 (79.7%) of the TC survivors were professionally active, 22 (15.4%) were unemployed and 8 (4.90%) were receiving disability. Among the patients employed at the time of diagnosis (n = 122), 15 (12.3%) had not returned to work 5 years post-diagnosis. Between 2 and 5 years post-diagnosis, there was no significant improvement in rates of RTW. At 5 years post-diagnosis, 90 (61.6%) reported an income decline. All TC survivors who have not returned to work were women and declared higher fatigue. Moreover, in multivariate analyses, not returning to work was associated with weight gain (OR = 8.41 (1.21; 58.23)) and working arrangements (6.90 (1.18-38.48)), while income decline was associated with comorbidities (OR = 2.28 (1.07; 4.86)) and to be engaged in manual work (OR = 2.28 (1.07; 4.88)). CONCLUSION This study highlights that, despite a good prognostic, up to 12.3% of TC survivors had not returned to work and 61.6% reported an income decline, 5 years post-diagnosis. Weight gain, fatigue, to be a woman and working-type arrangement were associated with higher probability of not returning to work. IMPLICATIONS FOR CANCER SURVIVORS TC affects a young working population. Our study identified potentially vulnerable TC survivors and important modifiable factors which may help TC survivors to be professionally active and, therefore, increase their overall quality of life.
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Affiliation(s)
- G Creff
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France.
| | - F Jegoux
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | | | - E Babin
- Head and Neck Department, University Hospital Centre Caen, Caen, France.,Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France
| | - I Licaj
- Cancer & Cognition Platform, Ligue Contre le Cancer, Caen, France.,Clinical Research Department, Centre François Baclesse, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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154
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Thom B, Benedict C, Friedman DN, Watson SE, Zeitler MS, Chino F. Economic distress, financial toxicity, and medical cost-coping in young adult cancer survivors during the COVID-19 pandemic: Findings from an online sample. Cancer 2021; 127:4481-4491. [PMID: 34351638 PMCID: PMC8426858 DOI: 10.1002/cncr.33823] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022]
Abstract
Background Young adult (YA) cancer survivors are at risk for financial toxicity during and after cancer treatment. Financial toxicity has been associated with medical‐related cost‐coping behaviors such as skipping or delaying treatment. The coronavirus disease 2019 (COVID‐19) pandemic has resulted in dire economic consequences that may worsen financial hardship among young survivors. Methods This was a cross‐sectional survey; data collection occurred online. A convenience sample was recruited through YA cancer advocacy groups and social media. Negative economic events associated with the COVID‐19 pandemic (eg, income loss, increased debt, and decreased job security) and medical‐related cost‐coping were documented. A validated measure assessed cancer‐related financial toxicity. Results Participants (N = 212) had a mean age of 35.3 years at survey completion and a mean age of 27.4 years at diagnosis. Financial toxicity (mean, 14.0; SD, 9.33) was high. Two‐thirds of the sample experienced at least 1 negative economic event during COVID‐19, and 71% engaged in at least 1 medical cost‐coping behavior. Cost‐coping and pandemic‐related negative economic events were significantly correlated with cancer‐related financial toxicity. In multivariable analyses, pandemic‐related negative economic events and financial toxicity were associated with cost‐coping. Conclusions Acute negative economic events associated with the COVID‐19 pandemic may exacerbate cancer‐related financial toxicity and overall financial hardship among YAs and lead to cost‐coping behaviors that can compromise survivorship care and health outcomes. Multilevel, systematic interventions are needed to address the financial needs of YA survivors after the global pandemic. This study illustrates how the acute negative economic events associated with the coronavirus disease 2019 pandemic may have exacerbated existing cancer‐related financial toxicity and general financial hardship among young adult cancer survivors. These negative economic events and financial toxicity are associated with cost‐coping behaviors that can compromise survivorship care and health outcomes.
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Affiliation(s)
- Bridgette Thom
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Catherine Benedict
- Stanford Cancer Institute, Stanford University School of Medicine, Palo Alto, California
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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155
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Doherty MJ, Thom B, Gany F. Evidence of the Feasibility and Preliminary Efficacy of Oncology Financial Navigation: A Scoping Review. Cancer Epidemiol Biomarkers Prev 2021; 30:1778-1784. [PMID: 34341051 DOI: 10.1158/1055-9965.epi-20-1853] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/24/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
One in three cancer patients reports financial hardship. Cancer-related financial hardship is associated with diminished quality of life, treatment nonadherence, and early mortality. Over 80% of NCI-designated cancer centers provide some form of oncology financial navigation (OFN). Although interest in OFN has grown, there is little scientific evidence to guide care delivery. We conducted a scoping review to assess the evidence of OFN's feasibility and preliminary efficacy and determine its core components/functions. Papers were included that (i) evaluated a clinical intervention to reduce financial hardship in patients with cancer or caregivers by facilitating access to resources, (ii) were conducted in the United States, and (iii) were published since 2000. Of 681 titles, 66 met criteria for full-text review, and six met full inclusion/exclusion criteria. The FN literature consists of descriptive studies and pilot trials focused on feasibility, acceptability, and preliminary efficacy. The studies showed that OFN implementation and evaluation are feasible; however, efficacy was difficult to evaluate because the studies were limited by small sample sizes (attributed to low patient participation). Most studies were conducted in urban, academic medical centers-which are less likely to be used by the poor and patients of color, who have the highest risk of financial hardship. The studies did not attempt to address the issue of underlying poverty at the individual and community level and whether OFN could be effectively adapted for these care environments. Future OFN programs must be tested with underserved and racially diverse patient populations, and evaluation efforts should aim to understand patient-reported barriers to participation.
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Affiliation(s)
- Meredith J Doherty
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center, New York City, New York
| | - Francesca Gany
- Memorial Sloan Kettering Cancer Center, New York City, New York.,Weill Cornell School of Medicine, New York City, New York
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156
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Canzona MR, Victorson DE, Murphy K, Clayman ML, Patel B, Puccinelli-Ortega N, McLean TW, Harry O, Little-Greene D, Salsman JM. A conceptual model of fertility concerns among adolescents and young adults with cancer. Psychooncology 2021; 30:1383-1392. [PMID: 33843104 PMCID: PMC8363581 DOI: 10.1002/pon.5695] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE For adolescents and young adults (AYAs), cancer-related fertility concerns (FC) are salient, disruptive, and complex. Clinical communication about FC and fertility preservation options are suboptimal, increasing patient distress. The purpose of this study is to construct a conceptual model of FC among AYAs with cancer to inform future measurement development. METHODS Concept elicitation interviews were conducted with a purposive sample of stakeholders: 36 AYAs (10 adolescents, 12 emerging adults, and 14 young adults), 36 AYA oncology health care providers, and 12 content experts in cancer-related infertility. The constant comparative method was used to identify themes and properties that illustrate AYAs' conceptualization and/or experience of FC. RESULTS Thirteen themes characterized FC among AYAs with cancer, varying by stakeholder group and domain affiliations. Themes were grouped by four domains (e.g., affective, information, coping, and logistical), which organized the conceptual model. Affective experiences were further determined to be an important component within the other three domains. AYAs' fertility and fertility preservation experiences were shaped by communication factors and timing factors including placement along the lifespan/cancer continuum. CONCLUSIONS AYA FC are characterized by uncertainty and confusion that may contribute to future decisional regret or magnify feelings of loss. Results add to previous research by examining individual, relational, and health care factors that fluctuate to inform fertility preservation perceptions and decision-making across the AYA age spectrum. Findings will be used to develop and test new self-report measures of FC among AYAs with cancer and survivors using classic and modern measurement theory approaches.
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Affiliation(s)
- Mollie R. Canzona
- Department of Communication, Wake Forest University, Winston-Salem, North Carolina, USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David E. Victorson
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Karly Murphy
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Marla L. Clayman
- General Internal Medicine and Geriatrics, Northwestern Medicine Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bonnie Patel
- Reproductive Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Nicole Puccinelli-Ortega
- Qualitative and Patient-Reported Outcomes Shared Resource, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas W. McLean
- Pediatric Hematology And Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Onengiya Harry
- Pediatrics - Rheumatology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Denisha Little-Greene
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Clinical Research in Adolescent and Young Adult Oncology, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
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157
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Biddell CB, Wheeler SB, Angove RSM, Gallagher KD, Anderson E, Kent EE, Spees LP. Racial and Ethnic Differences in the Financial Consequences of Cancer-Related Employment Disruption. Front Oncol 2021; 11:690454. [PMID: 34395255 PMCID: PMC8361325 DOI: 10.3389/fonc.2021.690454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/16/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction Cancer-related employment disruption contributes to financial toxicity and associated clinical outcomes through income loss and changes in health insurance and may not be uniformly experienced. We examined racial/ethnic differences in the financial consequences of employment disruption. Methods We surveyed a national sample of cancer patients employed at diagnosis who had received assistance from a national nonprofit about the impact of cancer diagnosis and treatment on employment. We used logistic regression models to examine racial/ethnic differences in income loss and changes in health insurance coverage. Results Of 619 cancer patients included, 63% identified as Non-Hispanic/Latinx (NH) White, 18% as NH Black, 9% as Hispanic/Latinx, 5% as other racial/ethnic identities, and 5% unreported. Over 83% reported taking a significant amount of time off from work during cancer diagnosis and treatment, leading to substantial income loss for 64% and changes in insurance coverage for 31%. NH Black respondents had a 10.2 percentage point (95% CI: 4.8 – 19.9) higher probability of experiencing substantial income loss compared to NH White respondents, and Hispanic or Latinx respondents had a 12.4 percentage point (95% CI: 0.3 – 24.5) higher probability compared to NH White respondents, controlling for clinical characteristics (i.e., cancer type, stage and age at diagnosis, and time since diagnosis). Similarly, NH Black respondents had a 9.3 percentage point (95% CI: -0.7 – 19.3) higher probability of experiencing changes in health insurance compared to NH White respondents, and Hispanic or Latinx respondents had a 10.0 percentage point (95% CI: -3.0 – 23.0) higher probability compared to NH White respondents. Discussion Compared with NH White respondents, NH Black and Hispanic/Latinx respondents more commonly reported employment-related income loss and health insurance changes. Given documented racial/ethnic differences in job types, benefit generosity, and employment protections as a result of historic marginalization, policies to reduce employment disruption and its associated financial impact must be developed with a racial equity lens.
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Affiliation(s)
- Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | - Eric Anderson
- Patient Advocate Foundation, Hampton, VA, United States
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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158
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Sadigh G, Switchenko J, Weaver KE, Elchoufi D, Meisel J, Bilen MA, Lawson D, Cella D, El-Rayes B, Carlos R. Correlates of financial toxicity in adult cancer patients and their informal caregivers. Support Care Cancer 2021; 30:217-225. [PMID: 34255179 DOI: 10.1007/s00520-021-06424-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Financial toxicity is commonly reported by cancer patients, but few studies have assessed caregiver perceptions. We aimed to validate the modified Comprehensive Score for Financial Toxicity (COST) in cancer caregivers, identify factors associated with financial toxicity in both patients and caregivers, and assess the association of caregiver financial toxicity with patient and caregiver outcomes. METHODS Using a convenience sampling method, 100 dyads of adult cancer patients and a primary caregiver visiting outpatient oncology clinics (Jan-Sep 2019) were recruited. We assessed the internal consistency and convergent and divergent validity of the modified COST. Multivariable analyses identified correlates of financial toxicity. Association of financial toxicity with care non-adherence, lifestyle-altering behaviors (e.g., home refinance/sale, retirement/saving account withdrawal), and quality of life (QOL) was investigated. RESULTS Recruited patient vs. caregiver characteristics were as follows: mean age: 60.6 vs. 56.5; 34% vs. 46.4% female; 79% vs. 81.4% white. The caregiver COST measure demonstrated high internal consistency (Cronbach α = 0.91). In patients, older age (B, 0.3 [95% CI, 0.1-0.4]) and higher annual household income (B, 14.3 [95% CI, 9.3-19.4]) correlated with lower financial toxicity (P < 0.05). In caregivers, lower patient financial toxicity (B, 0.4 [95% CI, 0.2-0.6]) and cancer stages 1-3 (compared to stage 4) (B, 4.6 [95% CI, 0.4-8.8]) correlated with lower financial toxicity (P < 0.05). Increased caregiver financial toxicity correlated with higher care non-adherence in patients, increased lifestyle-altering behaviors, and lower QOL in patients and caregivers (P < 0.05). CONCLUSION The COST measure can also be used to assess caregiver financial toxicity. Caregivers' financial toxicity was associated with negative outcomes for both dyad members.
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Affiliation(s)
- Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA, 30322, USA.
| | - Jeffrey Switchenko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Deema Elchoufi
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Jane Meisel
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - Mehmet Asim Bilen
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - David Lawson
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Bassel El-Rayes
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University School of Medicine, Atlanta, GA, USA
| | - Ruth Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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159
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Lu ZK, Xiong X, Brown J, Horras A, Yuan J, Li M. Impact of Cost-Related Medication Nonadherence on Economic Burdens, Productivity Loss, and Functional Abilities: Management of Cancer Survivors in Medicare. Front Pharmacol 2021; 12:706289. [PMID: 34267667 PMCID: PMC8276034 DOI: 10.3389/fphar.2021.706289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Cancer survivors are vulnerable to have medication nonadherence. We aimed to estimate the impact of cost-related medication nonadherence on economic burdens, productivity loss, and functional abilities among cancer survivors. Methods: A cross-sectional study was conducted using data from the National Health Interview Survey (NHIS), 2011–2018. Cost-related medication nonadherence was identified based on NHIS prompts. An ordinal logistic regression model was used to determine the impact of cost-related medication nonadherence on survivors’ economic burden. Two negative binomial regression models were implemented to estimate the impact on productivity loss. In addition, four logistic regression models were used to determine the impact on functional abilities. The weighted analysis was used to generate national estimates. Results: Among 35, 773, 286 cancer survivors, 15, 002, 192 (41.9%) respondents reported that they experienced cost-related medication nonadherence. Compared to cancer survivors without cost-related medication nonadherence, those with nonadherence were significantly associated with an increased economic burden (OR: 1.89, 95% CI: 1.70–2.11). Also, cancer survivors with cost-related medication nonadherence were significantly more likely to have an increased bed disability day (IRR: 1.46, 95% CI: 1.21–1.76). In terms of the limitations, cancer survivors with nonadherence were significantly more likely to have both activity limitation (OR: 1.42, 95% CI: 1.25–1.60) and functional limitation (OR: 2.12, 95% CI: 1.81–2.49). Conclusion: Cost-related medication nonadherence increased economic burdens, productivity loss, and limitations in functional abilities among cancer survivors. Strategies are needed to help cancer survivors with cost-related medication nonadherence to be adherent to prescriptions.
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Affiliation(s)
- Z Kevin Lu
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Xiaomo Xiong
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Jacob Brown
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Ashley Horras
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, United States
| | - Jing Yuan
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN, United States
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160
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Smith GL, Shih YCT, Frank SJ. Financial Toxicity in Head and Neck Cancer Patients Treated With Proton Therapy. Int J Part Ther 2021; 8:366-373. [PMID: 34285962 PMCID: PMC8270089 DOI: 10.14338/ijpt-20-00054.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/29/2020] [Indexed: 11/21/2022] Open
Abstract
Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy-dimensions of "financial toxicity"-need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.
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Affiliation(s)
- Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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161
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Huang D, Frank SJ, Verma V, Thaker NG, Brooks ED, Palmer MB, Harrison RF, Deshmukh AA, Ning MS. Cost-Effectiveness Models of Proton Therapy for Head and Neck: Evaluating Quality and Methods to Date. Int J Part Ther 2021; 8:339-353. [PMID: 34285960 PMCID: PMC8270103 DOI: 10.14338/ijpt-20-00058.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/28/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Proton beam therapy (PBT) is associated with less toxicity relative to conventional photon radiotherapy for head-and-neck cancer (HNC). Upfront delivery costs are greater, but PBT can provide superior long-term value by minimizing treatment-related complications. Cost-effectiveness models (CEMs) estimate the relative value of novel technologies (such as PBT) as compared with the established standard of care. However, the uncertainties of CEMs can limit interpretation and applicability. This review serves to (1) assess the methodology and quality of pertinent CEMs in the existing literature, (2) evaluate their suitability for guiding clinical and economic strategies, and (3) discuss areas for improvement among future analyses. MATERIALS AND METHODS PubMed was queried for CEMs specific to PBT for HNC. General characteristics, modeling information, and methodological approaches were extracted for each identified study. Reporting quality was assessed via the Consolidated Health Economic Evaluation Reporting Standards 24-item checklist, whereas methodologic quality was evaluated via the Philips checklist. The Cooper evidence hierarchy scale was employed to analyze parameter inputs referenced within each model. RESULTS At the time of study, only 4 formal CEMs specific to PBT for HNC had been published (2005, 2013, 2018, 2020). The parameter inputs among these various Markov cohort models generally referenced older literature, excluding many clinically relevant complications and applying numerous hypothetical assumptions for toxicity states, incorporating inputs from theoretical complication-probability models because of limited availability of direct clinical evidence. Case numbers among study cohorts were low, and the structural design of some models inadequately reflected the natural history of HNC. Furthermore, cost inputs were incomplete and referenced historic figures. CONCLUSION Contemporary CEMs are needed to incorporate modern estimates for toxicity risks and costs associated with PBT delivery, to provide a more accurate estimate of value, and to improve their clinical applicability with respect to PBT for HNC.
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Affiliation(s)
- Danmeng Huang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Steven J. Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Eric D. Brooks
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | | | - Ross F. Harrison
- Department of Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish A. Deshmukh
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - Matthew S. Ning
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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162
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Yu HH, Yu ZF, Li H, Zhao H, Sun JM, Liu YY. The COmprehensive Score for financial Toxicity in China: Validation and Responsiveness. J Pain Symptom Manage 2021; 61:1297-1304.e1. [PMID: 33412268 DOI: 10.1016/j.jpainsymman.2020.12.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 12/29/2022]
Abstract
CONTEXT Financial toxicity is a priority concern faced by cancer patients and oncology providers. A validated instrument is important to measure this toxicity and improve health-related quality of life of patients. OBJECTIVES To assess the validity and responsiveness of the Chinese version of the COmprehensive Score for financial Toxicity (COST) and to measure financial toxicity using the COST instrument in Chinese health care systems. METHODS A longitudinal observational study was performed at three cancer centers from March 2017 to October 2018 for eligible patients. Construct validity was assessed by exploratory and confirmatory factor analysis. The convergent and discriminant validity was tested by examining the correlation coefficient. Responsiveness was tested using the standardized response mean and effect size. Associations between the financial toxicity and variables were assessed by multivariable linear analysis. RESULTS There were 440 participants at baseline and 268 participants at 6-month follow up. A two-factor solution better represented the Chinese version of COST structure with good internal consistency and test-retest reliability. Convergent validity showed mild to moderate correlations between the domains of COST and the similar domains of Self-Perceived Burden Scale and Quality of Life Discriminant validity showed a low correlation between the COST and the subjective support of Social Support Rate Scale. Sensitivity to change at the sixth month showed effect sizes with global COST scores of 0.3. Multivariable analysis showed that age, household income, and health insurance were significantly associated with financial toxicity. CONCLUSIONS The Chinese version of COST is a valid and clinically responsive instrument. The identified baseline variables can be used to provide evidence for a financial toxicity intervention study.
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Affiliation(s)
- Hui-Hui Yu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Zhi-Fu Yu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Hui Li
- Department of Nursing, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China
| | - Hai Zhao
- Department of Breast surgery, Fushun Cancer Hospital, Fourth People's Hospital of Fushun, Fushun, P.R. China
| | - Jian-Min Sun
- Department of Cancer Prevention and Treatment, Anshan Cancer Hospital, Anshan, P.R. China
| | - Yun-Yong Liu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, P.R. China.
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163
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Maldonado JA, Fu S, Chen YS, Acquati C, Yabroff KR, Banegas MP, Chang S, Conti RM, Checka CM, Peterson SK, Advani P, Ku K, Jagsi R, Giordano SH, Volk RJ, Shih YCT, Smith GL. Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery. JCO Oncol Pract 2021; 17:e1856-e1865. [PMID: 34043452 DOI: 10.1200/op.20.01009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes. METHODS A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients' distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models. RESULTS Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship (P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001). CONCLUSION Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.
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Affiliation(s)
- J Alberto Maldonado
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.,Departement of Radiation Oncology, University of Texas Medical Branch, Galveston, TX
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX
| | | | | | - Shine Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University School of Business, Boston, MA
| | - Cristina M Checka
- Department of Breast Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pragati Advani
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Kimberly Ku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ya-Chen T Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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164
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Esselen KM, Stack-Dunnbier H, Gompers A, Hacker MR. Crowdsourcing to measure financial toxicity in gynecologic oncology. Gynecol Oncol 2021; 161:595-600. [PMID: 33551197 PMCID: PMC10029746 DOI: 10.1016/j.ygyno.2021.01.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To utilize a novel crowdsourcing method to measure financial toxicity and its effects among a national cohort of gynecologic cancer patients. METHODS Crowdsourcing methods were used to administer an online survey to women in the United States with gynecologic cancers. We used the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity and the EQ-5D-3L to measure quality of life (QOL). Based on prior work, we defined high financial toxicity as a COST score ≤ 23. We assessed correlation of COST scores with QOL. We used log-binomial regression to examine associations between high financial toxicity and cost-coping strategies. RESULTS Among the final study sample of 334 respondents, 87% were white, median age at diagnosis was 55 (interquartile range 47-63), 52% had stage III or IV disease and 90% had private insurance or Medicare. Median COST score was 24 (interquartile range 15-32) and 49% of respondents reported high financial toxicity. Greater financial toxicity was correlated with worse QOL (p < 0.001). Participants reporting high financial toxicity were more likely to use cost-coping strategies, including spending less on basic goods (RR: 3.3; 95% CI: 2.1-5.1), borrowing money or applying for financial assistance (RR: 4.0; 95% CI: 2.4-6.9), and delaying or avoiding care (RR: 5.6; 95% CI: 2.6-12.1). CONCLUSIONS Crowdsourcing is an effective tool to measure financial toxicity. Nearly half of respondents reported high financial toxicity, which was significantly associated with worse QOL, utilization of cost-coping strategies and delays or avoidance of care.
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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.
| | - Hannah Stack-Dunnbier
- 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
| | - 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
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165
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Koenig JL, Sandhu N, Sborov K, Sabolch A, Usoz M, Li G, Gephart MH, Chang S, Hiniker S, Soltys SG, Pollom EL. Financial Toxicity in Patients with Brain and Spine Metastases. World Neurosurg 2021; 151:e630-e651. [PMID: 33940276 DOI: 10.1016/j.wneu.2021.04.103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Financial toxicity associated with cancer treatment has a deleterious impact on patient outcomes but has not been well characterized among patients with metastatic cancers. We characterize the extent of financial toxicity among this population and identify factors associated with financial toxicity. METHODS We prospectively surveyed adult patients with brain and spine metastases who received radiosurgery at a large academic medical center between January 2018 and December 2019. Financial toxicity was measured with the Personal Financial Wellness (PFW) scale. RESULTS In total, 93 patients were included, with a median survival of 17.7 months. Most patients had private insurance (47%) or Medicare with supplementary insurance (42%), whereas 11% of patients were uninsured or insured by Medicaid/Medicare/Veterans Affairs. Of patients, 60% were primary income earners, of whom 52% had dependents. The median PFW score was 7.0 (interquartile range, 5.1-9.1), with financial toxicity reported in 23 patients (25%). After adjusting for age and education level, private insurance (odds ratio [OR], 0.28; P = 0.080) was associated with a lower likelihood of financial toxicity. Having ≥1 emergency department visit (OR, 3.87; P = 0.024) and a cancer-related change in employment status (OR, 3.63; P = 0.036) were associated with greater likelihood of reporting financial toxicity. CONCLUSIONS Most patients with cancer with brain and spine metastases with a poor prognosis treated at a tertiary center are primary income earners and experience financial toxicity. Further studies are warranted to assess the longitudinal impact of financial toxicity in patients with metastatic cancer, particularly those with ≥1 emergency department visit and a cancer-related change in employment status.
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Affiliation(s)
- Julie L Koenig
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA
| | - Katherine Sborov
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA; Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Aaron Sabolch
- Department of Radiation Oncology, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Melissa Usoz
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford Cancer Institute, Stanford, California, USA
| | | | - Steven Chang
- Department of Neurosurgery, Stanford Cancer Institute, Stanford, California, USA
| | - Susan Hiniker
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California, USA.
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166
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Esselen KM, Gompers A, Hacker MR, Bouberhan S, Shea M, Summerlin SS, Rucker LR, Huh WK, Pisu M, Liang MI. Evaluating meaningful levels of financial toxicity in gynecologic cancers. Int J Gynecol Cancer 2021; 31:801-806. [PMID: 33858954 DOI: 10.1136/ijgc-2021-002475] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Comprehensive Score for Financial Toxicity (COST) is a validated instrument measuring the economic burden experienced by patients with cancer. We evaluated the frequency of financial toxicity at different COST levels and stratified risk factors and associations with cost-coping strategies by financial toxicity severity. METHODS We analyzed previously collected survey data of gynecologic oncology patients from two tertiary care institutions. Both surveys included the COST tool and questions assessing economic and behavioral cost-coping strategies. We adapted a proposed grading scale to define three groups: no/mild, moderate, and severe financial toxicity and used χ2, Fisher's exact test, and Wilcoxon rank sum test to compare groups. We used Poisson regression to calculate crude and adjusted risk ratios for cost-coping strategies, comparing patients with moderate or severe to no/mild financial toxicity. RESULTS Among 308 patients, 14.9% had severe, 32.1% had moderate, and 52.9% had no/mild financial toxicity. Younger age, non-white race, lower education, unemployment, lower income, use of systemic therapy, and shorter time since diagnosis were associated with worse financial toxicity (all p<0.05). Respondents with moderate or severe financial toxicity were significantly more likely to use economic cost-coping strategies such as changing spending habits (adjusted risk ratio (aRR) 2.7, 95% CI 1.8 to 4.0 moderate; aRR 3.6, 95% CI 2.4 to 5.4 severe) and borrowing money (aRR 5.5, 95% CI 1.8 to 16.5 moderate; aRR 12.7, 95% CI 4.3 to 37.1 severe). Those with severe financial toxicity also had a significantly higher risk of behavioral cost-coping through medication non-compliance (aRR 4.6, 95% CI 1.2 to 18.1). CONCLUSIONS Among a geographically diverse cohort of gynecologic oncology patients, nearly half reported financial toxicity (COST <26), which was associated with economic cost-coping strategies. In those 14.9% of patients reporting severe financial toxicity (COST <14) there was also an increased risk of medication non-compliance, which may lead to worse health outcomes in this group.
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Affiliation(s)
- Katharine McKinley Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA .,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Bouberhan
- Department of Hematology/Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meghan Shea
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah S Summerlin
- School of Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Lindsay R Rucker
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
| | - Warner K Huh
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
| | - Maria Pisu
- Department of Internal Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Margaret I Liang
- Department of Obstetrics and Gynecology, The University of Alabama, Birmingham, Alabama, USA
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167
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McDermott CL, Curtis JR, Sun Q, Fedorenko C, Kreizenbeck K, Ramsey SD. Polypharmacy, chemotherapy receipt, and medication-related out-of-pocket costs at end of life among commercially insured adults with advanced cancer. J Oncol Pharm Pract 2021; 28:836-841. [PMID: 33823685 DOI: 10.1177/10781552211006180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Polypharmacy raises the risk of drug-drug interactions and adverse events among patients with cancer. Most polypharmacy research has focused on adults age 65 or older enrolled in Medicare insurance. To better inform pharmacy practice and cancer care delivery, data are needed on polypharmacy among commercially insured patients with cancer and those younger than 65. METHODS We performed a retrospective analysis of insurance enrollment and claims files linked to the Puget Sound Cancer Surveillance System for adults age 18 and older who were commercially insured, diagnosed with stage IV cancer, survived 30+ days after diagnosis, and did not enroll in hospice. We describe the prevalence of polypharmacy, chemotherapy use, and medication-related out-of-pocket (OOP) costs in the last month of life. RESULTS Of 606 patients, 390 (64%) experienced polypharmacy (i.e. 5+ medications) in the last 30 days of life. Almost half (n = 297, 49%) received chemotherapy or targeted agents; chemotherapy was associated with significantly higher odds of polypharmacy (odds ratio (OR) 2.93, 95% confidence interval (CI) 2.04-4.20). The most commonly prescribed medications at end of life were opioids, benzodiazepines and anti-emetics. Among 484 patients (80%) incurring medication-related costs in the last month of life, median total OOP cost was $82 (interquartile range $30-$200). Seven patients (1%) had total costs above $5,000. The median chemotherapy-related OOP cost was $446 (IQR $150-$1896); 32 patients (7%) had chemotherapy-related OOP costs between $1,000 and $5,000. CONCLUSION Most patients with advanced cancer experienced polypharmacy at end of life, although most medications observed herein are commonly used for supportive care. Patients receiving chemotherapy had higher medication-related OOP costs, and chemotherapy was significantly associated with polypharmacy at end of life. Evaluation of polypharmacy at end of life may represent an important opportunity to improve quality of life and reduce costs for patients and families.
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Affiliation(s)
- Cara L McDermott
- Cambia Palliative Care Center of Excellence, Department of Medicine, University of Washington, Seattle, WA, USA.,Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Qin Sun
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Fedorenko
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Scott D Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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168
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Lueckmann SL, Kowalski C, Schumann N. Finanzielle Toxizität einer Krebserkrankung. DER ONKOLOGE 2021. [DOI: 10.1007/s00761-021-00931-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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169
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Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: a systematic review of qualitative studies. J Cancer Surviv 2021; 16:314-328. [DOI: 10.1007/s11764-021-01025-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
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170
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Estrogen Disrupting Pesticides in Nebraska Groundwater: Trends between Pesticide-contaminated Water and Estrogen-related Cancers in An Ecological Observational Study. WATER 2021. [DOI: 10.3390/w13060790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Estrogen disrupting pesticides (EDP) are pesticides that modify estrogen activities in estrogen-producing vertebrates. A substantial amount of these pesticides has been detected in human tissues, and they function directly to disrupt estrogen synthesis or effector cells. This study examines EDP’s ecological distribution across Nebraska counties and its association with estrogen-related cancers (ERC). To determine the ecological distribution of selected EDP, county-level choropleth maps were created. Moreover, EDP was tested in separate linear models with different ERC to determine the association between ERC and EDP across Nebraska counties. Exposure data for this county-level study was obtained from the quality assessed agrichemical contaminant Nebraska groundwater database between 1 January 1974 and 31 December 2012. Acetochlor, atrazine, and its metabolites, deethylatrazine (DEA), and de-isopropyl atrazine (DIA) were the most frequently detected EDP in Nebraska groundwater. Moreover, Nebraska county-level potential confounder for ERC such as physically unhealthy days, % adult smoking, % obese adult, % uninsured, and % binge drinking were obtained from County Health Rankings 2010. ERC, which is the outcome variable (breast cancer, uterine cancer, and prostate cancer), were obtained from the Nebraska State profile of the National Cancer Institute. This was expressed as county-level age-standardized incidence cancer rates between 1 January 2013 and 31 December 2017. Data characteristics were determined using percentages, mean, median, 25th and 75th percentile, minimum and maximum values. The relationship between county-level cancer rates and % wells positive for pesticides after adjusting for the county level potential confounders were analyzed in a linear regression model. Water supply wells positive for atrazine and DEA were observed to cluster in the South and South East counties of Nebraska. Furthermore, breast cancer and prostate cancer incidence rates were higher in the southeast of Nebraska with more atrazine and DEA. However, breast cancer and prostate cancer were not significantly associated in a linear regression model with any of the observed EDP. In contrast, uterine cancer was statistically associated with % water supply wells positive for acetochlor (β = 4.01, p = 0.04). While consistent associations were not observed between ERC and EDP from the GIS and the linear regression model, this study’s results can drive future conversation concerning the potential estrogenic effects of acetochlor, atrazine, and its metabolites on the incidence of breast, uterine and prostate cancer in the State of Nebraska.
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171
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Sidey-Gibbons C, Pfob A, Asaad M, Boukovalas S, Lin YL, Selber JC, Butler CE, Offodile AC. Development of Machine Learning Algorithms for the Prediction of Financial Toxicity in Localized Breast Cancer Following Surgical Treatment. JCO Clin Cancer Inform 2021; 5:338-347. [PMID: 33764816 PMCID: PMC8140797 DOI: 10.1200/cci.20.00088] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/16/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Financial burden caused by cancer treatment is associated with material loss, distress, and poorer outcomes. Financial resources exist to support patients but identification of need is difficult. We sought to develop and test a tool to accurately predict an individual's risk of financial toxicity based on clinical, demographic, and patient-reported data prior to initiation of breast cancer treatment. PATIENTS AND METHODS We surveyed 611 patients undergoing breast cancer therapy at MD Anderson Cancer Center. We collected data using the validated COmprehensive Score for financial Toxicity (COST) patient-reported outcome measure alongside other financial indicators (credit score, income, and insurance status). We also collected clinical and perioperative data. We trained and tested an ensemble of machine learning (ML) algorithms (neural network, regularized linear model, support vector machines, and a classification tree) to predict financial toxicity. Data were randomly partitioned into training and test samples (2:1 ratio). Predictive performance was assessed using area-under-the-receiver-operating-characteristics-curve (AUROC), accuracy, sensitivity, and specificity. RESULTS In our test sample (N = 203), 48 of 203 women (23.6%) reported significant financial burden. The algorithm ensemble performed well to predict financial burden with an AUROC of 0.85, accuracy of 0.82, sensitivity of 0.85, and specificity of 0.81. Key clinical predictors of financial burden from the linear model were neoadjuvant therapy (βregularized, .11) and autologous, rather than implant-based, reconstruction (βregularized, .06). Notably, radiation and clinical tumor stage had no effect on financial burden. CONCLUSION ML models accurately predicted financial toxicity related to breast cancer treatment. These predictions may inform decision making and care planning to avoid financial distress during cancer treatment or enable targeted financial support. Further research is warranted to validate this tool and assess applicability for other types of cancer.
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Affiliation(s)
- Chris Sidey-Gibbons
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - André Pfob
- Department of Obstetrics and Gynecology, Heidelberg University, Heidelberg, Germany
| | - Malke Asaad
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stefanos Boukovalas
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu-Li Lin
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jesse Creed Selber
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles E. Butler
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anaeze Chidiebele Offodile
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX
- Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, TX
- Baker Institute for Public Policy, Rice University, Houston, TX
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172
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McLouth LE, Nightingale CL, Levine BJ, Burris JL, McDougall JA, Lycan TW, Gabbard J, Ruiz J, Farris M, Blackstock AW, Grant SC, Petty WJ, Weaver KE. Unmet Care Needs and Financial Hardship in Patients With Metastatic Non-Small-Cell Lung Cancer on Immunotherapy or Chemoimmunotherapy in Clinical Practice. JCO Oncol Pract 2021; 17:e1110-e1119. [PMID: 33539182 DOI: 10.1200/op.20.00723] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Immunotherapy or chemoimmunotherapy is now standard treatment for most patients with metastatic non-small-cell lung cancer (mNSCLC), yet patient supportive care needs (SCNs) on immunotherapy are not well defined. This study characterized the SCNs and financial hardship of patients with mNSCLC treated with immunotherapy or chemoimmunotherapy and examined the relationship between patient and caregiver cancer-related employment reductions and patient financial hardship. METHODS Patients with mNSCLC on immunotherapy or chemoimmunotherapy from a single academic medical center completed the SCNs Survey-34, items indexing material, psychological, and behavioral financial hardship, and the Comprehensive Score for Financial Toxicity. Univariate and bivariate analyses examined care needs, financial hardship, and impact of cancer-related employment reductions on patient financial hardship. RESULTS Sixty patients (40% male; 75% White, mean age = 62.5 years, 57% on immunotherapy alone) participated. Fifty-five percent reported unmet needs in physical or daily living and psychological domains. Financial hardship was common (33% material, 63% psychological, and 57% behavioral). Fifty-two percent reported hardship in at least two domains. Forty percent reported a caregiver cancer-related employment reduction. Caregiver employment reduction was related to patient financial hardship (68% of those reporting caregiver employment reduction reported at least two domains of hardship v 40% of those without reduction, P = .03) and patient financial distress (mean Comprehensive Score for Financial Toxicity = 19.6 among those with caregiver employment reduction v 26.8 without, P = .01). CONCLUSION Patients with mNSCLC treated with immunotherapy or chemoimmunotherapy report multiple unmet care needs and financial hardship. Psychological, functional, financial, and caregiver concerns merit assessment and intervention in this population.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Jean A McDougall
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - Thomas W Lycan
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jennifer Gabbard
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Jimmy Ruiz
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC.,W. G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC
| | - Michael Farris
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Arthur W Blackstock
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stefan C Grant
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - W Jeffrey Petty
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC.,Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
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173
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Sittenfeld SMC, Greenberg Z, Al-Hilli Z, Abraham J, Moore HCF, Grobmyer S, Monteleone E, Tullio K, Shah C. Reducing time to treatment and patient costs with breast cancer: the impact of patient visits. Breast J 2021; 27:237-241. [PMID: 33533542 DOI: 10.1111/tbj.14174] [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: 08/26/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of processes aimed at reducing time to treatment initiation (TTI) on minimizing the days spent to complete pretreatment visits and the associated costs for patients with nonmetastatic breast cancer. METHODS System-wide initiatives were implemented in 2014 to minimize TTI, by incorporating multiple strategies (eg, creation of teams, patient liaisons, process mapping) and enhanced communication to increase coordinated visits. Average number of days spent to complete visits, TTI, and associated patient costs including driving expenses, parking, food, childcare, and lost wages were calculated and compared between the years 2015 and 2018. RESULTS In 2015, the median TTI was 43.5 days and the average number of separate days spent to attend multidisciplinary visits prior to first treatment was 1.86. These were reduced to 29 days and 1.52 visits, respectively, in 2018 (p < 0.0001 for both). When evaluating treatment visits by surgical procedure, the average number of visits was reduced regardless of surgical procedure. The average number of visits was highest for patients undergoing mastectomy with reconstruction (2.34 in 2015, reduced to 1.65 in 2018, p < 0.0001). A single visit to complete treatment planning was associated with patient costs of $249 as compared with multiple trips costing $491 for 2 visits and up to $1,226 for 5 visits. CONCLUSIONS In breast cancer patients, implementing processes to reduce time to treatment was associated with fewer visits required prior to treatment initiation, resulting in lower patient costs.
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Affiliation(s)
- Sarah M C Sittenfeld
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zachary Greenberg
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Section of Breast Surgery, Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jame Abraham
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Halle C F Moore
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephen Grobmyer
- Section of Breast Surgery, Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Emily Monteleone
- Department of Cancer Center Administration, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine Tullio
- Department of Cancer Center Administration, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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174
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Emergency Healthcare Providers' Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031158. [PMID: 33525577 PMCID: PMC7908551 DOI: 10.3390/ijerph18031158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to explore and compare knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). Using a cross-sectional study design and convenience sampling, 96 nurses and 68 EMTs were recruited from 12 emergency medical centers. A survey on knowledge about and attitudes toward ADs was performed using both online and offline methods between November and December 2019. Emergency healthcare providers were conceptually knowledgeable regarding ADs and LST, although approximately half or fewer had knowledge about ADs (such as the legal process for preparation, family or healthcare providers’ role, and the healthcare proxy). The knowledge levels of nurses and EMTs were moderate. Nurses had significantly greater knowledge relative to EMTs about ADs and LST. Positive attitudes of emergency healthcare providers were also moderately low, with nurses having less positive views than EMTs. Significant differences regarding ADs were found, with younger emergency healthcare providers having fewer career years, no personal end-of-life experiences, and less need for ADs having less knowledge. Emergency healthcare providers’ knowledge about and attitudes toward ADs were moderately low, with EMTs demonstrating a greater knowledge deficit and nurses exhibiting lower positive attitudes. Younger and novice providers had lower knowledge, but younger providers had more positive attitudes, implying that professional education and training should begin early in their careers to enhance their confidence for emergency delivery of advanced care planning.
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175
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Kondo A, Oki T, Otaki A, Abuliezi R, Eckhardt AL. Factors related to perceived control and health-related quality of life of patients after acute coronary syndrome during admission and after discharge. Jpn J Nurs Sci 2021; 18:e12404. [PMID: 33448141 PMCID: PMC8248406 DOI: 10.1111/jjns.12404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/26/2022]
Abstract
Aim To explore the relationship between demographic factors, acute coronary syndrome‐related factors, perceived control and health‐related quality of life during admission, 3 months and 6 months after discharge, in patients with acute coronary syndrome. Methods Participants were recruited for this longitudinal study after admission for acute coronary syndrome in three university hospitals in the Tokyo metropolitan area, Japan. Self‐administered questionnaires included demographic data, perceived control, health‐related quality of life, acute coronary syndrome symptoms, fatigue, depression and anxiety. Results Participants (N = 137) had an average age of 62.8 (SD 11.6) years and 80.3% were male. As a result of Path analysis, higher perceived control (β = 0.258, p = .001), lower anxiety (β = −0.226, p = .009) and lower fatigue (β = −0.231, p = .010), were significantly related to better health‐related quality of life (General health). Only annual income was significantly related to perceived control (β = 0.187, p = .029). Eighty‐two (59.9%) participants at 3 months and 54 (39.4%) participants at 6 months completed the questionnaires. Perceived control (F = 7.074, p = .001) and General health (χ2 = 10.22, p = .006) significantly increased over the 6 months. Perceived control during admission was significantly related with health‐related quality of life at 3 months. Perceived control at 3 months was significantly related with health‐related quality of life at 6 months. Conclusion Perceived control was an important factor for health‐related quality of life of the Japanese patients with acute coronary syndrome. It is necessary to investigate whether nursing interventions to enhance perceived control lead to improvement of health‐related quality of life.
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Affiliation(s)
- Akiko Kondo
- International Nursing Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomi Oki
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Amane Otaki
- School of Nursing and Rehabilitation Sciences, Showa University, Tokyo, Japan
| | - Renaguli Abuliezi
- International Nursing Development, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ann L Eckhardt
- School of Nursing, Illinois Wesleyan University, Bloomington, Illinois, USA
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176
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McLouth LE, Nightingale CL, Dressler EV, Snavely AC, Hudson MF, Unger JM, Kazak AE, Lee SJC, Edward J, Carlos R, Kamen CS, Neuman HB, Weaver KE. Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program. Cancer Epidemiol Biomarkers Prev 2020; 30:669-675. [PMID: 33355237 DOI: 10.1158/1055-9965.epi-20-1157] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/12/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer-related financial hardship is associated with poor care outcomes and reduced quality of life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. METHODS The NCI Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served). RESULTS Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new patients with cancer enrolled in Medicaid (adjOR = 2.81, P = 0.02) and with less than 30% racial/ethnic minority cancer patient composition (adjOR = 3.91, P < 0.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition (adjOR = 2.37, P < 0.01) were more likely to have a dedicated financial navigator or counselor for patients with cancer. CONCLUSIONS Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator. IMPACT The effectiveness of financial screening and navigation for mitigating financial hardship could be tested within NCORP, along with specific interventions to address cancer care inequities.See related commentary by Yabroff et al., p. 593.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky, Markey Cancer Center, Center for Health Equity Transformation, Lexington, Kentucky.
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health, Greenville, South Carolina
| | - Joseph M Unger
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, SWOG Statistics and Data Management Center, Seattle, Washington
| | - Anne E Kazak
- Centers for Healthcare Delivery Service, Nemours Children's Health System, Wilmington, Delaware
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas-Southwestern Medical Center, Dallas, Texas
| | - Jean Edward
- College of Nursing, University of Kentucky, Markey Cancer Center, UK Healthcare, Lexington, Kentucky
| | - Ruth Carlos
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Heather B Neuman
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Silver ER, Truong HQ, Ostvar S, Hur C, Tatonetti NP. Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding. JAMA Netw Open 2020; 3:e2026946. [PMID: 33270122 PMCID: PMC7716189 DOI: 10.1001/jamanetworkopen.2020.26946] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/25/2020] [Indexed: 01/16/2023] Open
Abstract
Importance Financial toxicity resulting from cancer care poses a substantial public health concern, leading some patients to turn to online crowdfunding. However, the practice may exacerbate existing socioeconomic cancer disparities by privileging those with access to interpersonal wealth and digital media literacy. Objective To test the hypotheses that higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with amount raised from cancer crowdfunding. Design, Setting, and Participants This cross-sectional analysis examined US cancer crowdfunding campaigns conducted between 2010 and 2019 and data from the American Community Survey (2013-2017). Data analysis was performed from December 2019 to March 2020. Exposures Neighborhood deprivation index of campaign location and campaign text features indicating the beneficiary's worth. Main Outcomes and Measures Amount of money raised. Results This study analyzed 144 061 US cancer crowdfunding campaigns. Campaigns in counties with higher neighborhood deprivation raised less (-26.07%; 95% CI, -27.46% to -24.65%; P < .001) than those in counties with less neighborhood deprivation. Campaigns raised more funds when legitimizing details were provided, including clinical details about the cancer type (9.58%; 95% CI, 8.00% to 11.18%; P < .001) and treatment type (6.58%; 95% CI, 5.44% to 7.79%; P < .001) and financial details, such as insurance status (1.39%; 95% CI, 0.20% to 2.63%; P = .02) and out-of-pocket costs (7.36%; 95% CI, 6.18% to 8.55%; P < .001). Campaigns raised more money when beneficiaries were described as warm (13.80%; 95% CI, 12.30% to 15.26%; P < .001), brave (15.40%; 95% CI, 14.11% to 16.65%; P < .001), or self-reliant (5.23%; 95% CI, 3.77% to 6.72%; P < .001). Conclusions and Relevance These findings suggest that cancer crowdfunding success ay disproportionately benefit those in high-socioeconomic status areas and those with the internet literacy necessary to portray beneficiaries as worthy. By rewarding those with existing socioeconomic advantage, cancer crowdfunding may perpetuate socioeconomic disparities in cancer care access. The findings also underscore the widespread nature of financial toxicity resulting from cancer care.
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Affiliation(s)
- Elisabeth R. Silver
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Han Q. Truong
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sassan Ostvar
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York
| | - Nicholas P. Tatonetti
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York
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178
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Jones SMW, Henrikson NB, Panattoni L, Syrjala KL, Shankaran V. A theoretical model of financial burden after cancer diagnosis. Future Oncol 2020; 16:3095-3105. [PMID: 32976048 PMCID: PMC7787147 DOI: 10.2217/fon-2020-0547] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Current models of financial burden after cancer do not adequately define types of financial burden, moderators or causes. We propose a new theoretical model to address these gaps. This model delineates the components of financial burden as material and psychological as well as healthcare-specific (affording treatment) versus general (affording necessities). Psychological financial burden is further divided into worry about future costs and rumination about past and current financial burden. The model hypothesizes costs and employment changes as causes, and moderators include precancer socioeconomic status and post-diagnosis factors. The model outlines outcomes affected by financial burden, including depression and mortality. Theoretically derived measures of financial burden, interventions and policy changes to address the causes of financial burden in cancer are needed.
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Affiliation(s)
- Salene MW Jones
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, King County, Washington 98101, USA
| | - Laura Panattoni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Karen L Syrjala
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
| | - Veena Shankaran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, King County, Washington 98109, USA
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Xu RH, Wong ELY, Su Y, Zhang H, Zhang W, Dong D. Quantifying the Effect of Financial Burden on Health-Related Quality of Life among Patients with Non-Hodgkin's Lymphomas. Cancers (Basel) 2020; 12:cancers12113325. [PMID: 33187112 PMCID: PMC7698092 DOI: 10.3390/cancers12113325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Financial burdens result from the growing out-of-pocket costs associated with cancer care to help patients regain physical and psychological health-related quality of life (HRQoL) are dramatically intensified. The aim of our study was to assess the association of HRQoL with financial burden using both subjective and objective methods among patients with non-Hodgkin’s lymphoma (NHL) in China. A majority of the patients reported suffering moderate to high financial burdens. A significant relationship between increased financial burden and reduced HRQoL was identified. Patients tended to report a poorer HRQoL when using objective method than using subjective method to estimate financial burden. Medical professionals should involve patients and their families into the clinical decision making and provide them cost-effective plans. Abstract Objective: This study aimed to assess the association of health-related quality of life (HRQoL) with financial burden among patients with non-Hodgkin’s lymphoma (NHL) in China. Methods: The data used for the analyses came from a nationwide survey to investigate the health status of patients with lymphomas in China. The EQ-5D and EORTC QLQ-C30 were used to assess the patients’ HRQoL. The financial burden was calculated using both subjective and objective methods. The chi-squared test, Kruskal–Wallis one-way analysis of variance, ordinal least squared model, and Tobit regression model were used to estimate the relationship between financial burden and HRQoL. Results: Data from 1549 patients who reported living with 11 subtypes of NHL were elicited for our analysis. Approximately 60% of respondents reported suffering moderate to high financial burdens. A significant relationship between increased financial burden and reduced HRQoL scores, including the EQ-Index, physical, emotional, and social functioning, was identified. Compared with using an objective method to measure financial burden, patients with NHL indicated a poorer HRQoL when using a subjective method to measure financial burden. Conclusion: Medical professionals should select highly cost-effective treatments and ensure that patients understand the potential financial consequences of those treatments.
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Affiliation(s)
- Richard Huan Xu
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (R.H.X.); (E.L.-y.W.)
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza Lai-yi Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (R.H.X.); (E.L.-y.W.)
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Su
- Department of Health Affairs, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210000, China;
| | - Hongyu Zhang
- Department of Hematology, Peking University Shenzhen Hospital, Shenzhen 518000, China;
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Beijing 100730, China;
| | - Dong Dong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (R.H.X.); (E.L.-y.W.)
- Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518000, China
- Correspondence: ; Tel.: +852-2252-8461; Fax: +852-2606-3500
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180
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Longo CJ, Fitch MI, Banfield L, Hanly P, Yabroff KR, Sharp L. Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 2020; 28:4645-4665. [PMID: 32653957 DOI: 10.1007/s00520-020-05620-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Financial toxicity related to cancer diagnosis and treatment is a common issue in developed countries. We seek to systematically summarize the extent of the issue in very high development index countries with publicly funded healthcare. METHODS We identified articles published Jan 1, 2005, to March 7, 2019, describing financial burden/toxicity experienced by cancer patients and/or informal caregivers using OVID Medline Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. Only English language peer-reviewed full papers describing studies conducted in very high development index countries with predominantly publicly funded healthcare were eligible (excluded the USA). All stages of the review were evaluated in teams of two researchers excepting the final data extraction (CJL only). RESULTS The searches identified 7117 unique articles, 32 of which were eligible. Studies were undertaken in Canada, Australia, Ireland, UK, Germany, Denmark, Malaysia, Finland, France, South Korea, and the Netherlands. Eighteen studies reported patient/caregiver out-of-pocket costs (range US$17-US$506/month), 18 studies reported patient/caregiver lost income (range 17.6-67.3%), 14 studies reported patient/caregiver travel and accommodation costs (range US$8-US$393/month), and 6 studies reported financial stress (range 41-48%), strain (range 7-39%), or financial burden/distress/toxicity among patients/caregivers (range 22-27%). The majority of studies focused on patients, with some including caregivers. Financial toxicity was greater in those with early disease and/or more severe cancers. CONCLUSIONS Despite government-funded universal public healthcare, financial toxicity is an issue for cancer patients and their families. Although levels of toxicity vary between countries, the findings suggest financial protection appears to be inadequate in many countries.
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Affiliation(s)
- Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Paul Hanly
- National College of Ireland, Dublin, Ireland
| | - K Robin Yabroff
- Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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181
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Chan R, Cooper B, Paul S, Conley Y, Kober K, Koczwara B, Chan A, Tan CJ, Gordon L, Thomy L, Levine J, Miaskowski C. Distinct financial distress profiles in patients with breast cancer prior to and for 12 months following surgery. BMJ Support Palliat Care 2020; 12:347-354. [PMID: 32913003 DOI: 10.1136/bmjspcare-2020-002461] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Study purposes were to identify subgroups of patients with breast cancer with distinct self-reported financial distress (FD) profiles and determine which demographic, clinical and symptom characteristics, as well as quality of life (QOL) outcomes were associated with subgroup membership. METHODS Patients (n=391) who were assessed for changes in FD a total of 10 times from prior to through 12 months after breast cancer surgery. Latent profile analysis was used to identify subgroups of patients with distinct FD profiles. RESULTS Three distinct FD profiles (ie, None (14.6%), Low (52.7%), High (32.7%)) were identified. Compared with None and/or Low subgroups, patients in the High subgroup were more likely to report a lower annual household income and performance status; had a higher body mass index, axillary lymph node dissection and more advanced stage disease; had a longer time from cancer diagnosis to surgery; and had received neoadjuvant or adjuvant chemotherapy. In addition, patients in the High subgroup reported higher fatigue, sleep disturbance, state/trait anxiety, depressive symptom scores, and lower attentional function and QOL scores. CONCLUSION This study provides new insights on risk factors for and evidence of a higher symptom burden associated with FD. Findings from this study provide clinicians with information on how to identify high-risk patients and to recommend appropriate interventions for both symptom management and FD. Additional research on the mechanisms that underlie the relationships among FD and common physical and psychological symptoms may inform future interventions.
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Affiliation(s)
- Raymond Chan
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce Cooper
- School of Nursing, UCSF, San Francisco, California, USA
| | - Steven Paul
- School of Nursing, UCSF, San Francisco, California, USA
| | - Yvette Conley
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kord Kober
- School of Nursing, UCSF, San Francisco, California, USA
| | - Bogda Koczwara
- Flinders University, Adelaide, South Australia, Australia
| | - Alexandre Chan
- University of California Irvine, Irvine, California, USA.,Department of Pharmacy, University of California Irvine, Irvine, CA, United States
| | | | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lebogang Thomy
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jon Levine
- School of Medicine, UCSF, San Francisco, California, USA
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Kim J, Choi J, Shin MS, Kim M, Seo E, An M, Shim JL, Heo S. Do advance directive attitudes and perceived susceptibility and end-of-life life-sustaining treatment preferences between patients with heart failure and cancer differ? PLoS One 2020; 15:e0238567. [PMID: 32898165 PMCID: PMC7478644 DOI: 10.1371/journal.pone.0238567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022] Open
Abstract
There is limited evidence on the relationships of preference for end-of-life life-sustaining treatments [LSTs] and diagnostic contexts like heart failure [HF] or cancer, and patient attitudes toward and perceived susceptibility to use advance directives [ADs]. Thus, this study aimed to compare attitudes and perceived susceptibility between HF patients and community-dwelling patients with cancer, and examine the associations of these variables with their preference for each LST (cardiopulmonary resuscitation [CPR], ventilation support, hemodialysis, and hospice care). Secondary data were obtained from 36 outpatients with HF (mean age, 65.44 years; male, 69.4%) and 107 cancer patients (mean age, 67.39 years; male, 32.7%). More patients with HF preferred CPR than cancer patients (41.7% and 15.9%, χ2 = 8.88, P = 0.003). Attitudes and perceived susceptibility were similar between the two diagnostic cohorts. HF patients and those with more positive attitudes had greater odds of preferring CPR (odds ratio [OR] = 3.02, confidence interval [CI] = 1.19, 7.70) and hospice care (OR = 1.14, CI = 1.06, 1.23), respectively. HF diagnosis and AD attitudes increased the preference for CPR and hospice care, respectively. This suggests that it is important to gain positive attitudes toward ADs and consider diagnostic context to facilitate informed decision-making for LSTs.
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Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - Jiin Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Medical Center, College of Medicine, Gachon University, Incheon, South Korea
| | - Miyeong Kim
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - EunJu Seo
- Department of Nursing, National Cancer Center, Seoul, South Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Jae Lan Shim
- Department of Nursing, College of Medicine, Dongguk University, Gyeongju, South Korea
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia, United States of America
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183
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Ziakas PD, Mylonakis E. Medicare Part D Spending on Drugs Prescribed by Oncologists: Temporal Trends and Regional Variation. JCO Oncol Pract 2020; 17:e433-e439. [PMID: 32813601 DOI: 10.1200/op.20.00165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Drug cost is a significant factor in the ever-increasing expenditures for cancer health care. METHODS We used Medicare Part D administrative data to explore prescribing patterns and attributed drug costs of oncologists from 2013 to 2017. We highlighted regional variation in spending and potential associations. We used the location quotient (LQ) to measure the relative concentration of oncologists compared with the national average by hospital referral regions. Costs were reported in 2017 US dollars (inflation adjusted) for cross-year comparisons. RESULTS Oncology's share in Part D spending showed an uninterrupted increasing trend. In 2017, oncologists prescribed medicines with $12.8 billion in Part D costs (8.3% of all Part D payments), which exceeded 2013 costs by $7.3 billion, when their claim payments were $5.5 billion (5.0% of all Part D payments). Oncology contributed a higher annual growth in Part D drug costs compared with all other providers (15.1% and 3.1%, respectively, for 2017). The top 3 drugs increased cost by approximately $3.5 billion from 2013 to 2017. Across hospital referral regions, the oncologists' Part D share varied (median in 2017, 7.7%; interquartile range, 6.2%-9.3%) and was higher across regions where oncologists had an LQ significantly > 1 (mostly in areas with centers that excel in cancer care) and lower for an LQ significantly < 1 (median, 9.7% v 6.2%, respectively; P < .001). CONCLUSION Oncology increased its share in Part D drug spending, disproportionately to all other providers, with regional differences partially moderated by the oncology workforce and quality of cancer care.
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184
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Lim M, Shulman DS, Roberts H, Li A, Clymer J, Bona K, Al-Sayegh H, Ma C, DuBois SG. Off-label prescribing of targeted anticancer therapy at a large pediatric cancer center. Cancer Med 2020; 9:6658-6666. [PMID: 32750219 PMCID: PMC7520353 DOI: 10.1002/cam4.3349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/25/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Off‐label drug prescribing is common in pediatric clinical medicine, though the extent and impact of this practice in pediatric oncology has not yet been characterized. Methods We completed a retrospective single‐institution cohort study evaluating prevalence, characteristics, and clinical outcomes of off‐label prescribing of 108 FDA‐approved targeted anticancer drugs in patients < 30 years old treated for cancer from 2007 to 2017. Dosing strategies were adjusted for body size and compared to FDA‐approved adult dosing regimen. A composite toxicity endpoint was defined as a patient having unplanned clinic visits, emergency department visits, or unplanned hospital admissions that were at least possibly related to the off‐label treatment. Results The overall prevalence of off‐label use of targeted therapies was 9.2% (n = 374 patients). The prevalence increased significantly over the study period (P < .0001). Patients treated off‐label were more likely to have neuro‐oncology diagnoses compared to patients not treated off‐label (46% vs 29%; P < .0001). Of the 108 potential agents, 38 (35%) were used by at least one patient. The median starting dose was below the FDA‐approved normalized dose for 44.4% of agents. Fifteen percent of patients had a complete response while receiving off‐label therapy, 38% experienced toxicity as defined, and 13% discontinued off‐label therapy due to toxicity. Conclusions In this real‐world evaluation of prescribing at a large pediatric cancer center, off‐label prescribing of FDA‐approved targeted therapies was common, increasing in prevalence, encompassed a broad sample of targeted agents, and was tolerable. Clinicians commonly start dosing below the equivalent FDA‐approved dose.
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Affiliation(s)
- Mir Lim
- Boston University School of Medicine, Boston, MA, USA.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - David S Shulman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Holly Roberts
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Anran Li
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Jessica Clymer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Kira Bona
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Hasan Al-Sayegh
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Clement Ma
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Steven G DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
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185
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Wang Y, Zhou L, Lu J, Jiang B, Liu C, Guo J. USP4 function and multifaceted roles in cancer: a possible and potential therapeutic target. Cancer Cell Int 2020; 20:298. [PMID: 32669974 PMCID: PMC7350758 DOI: 10.1186/s12935-020-01391-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
Cancer remains one of the major culprits causing disease-related deaths and leads to a high morbidity and similar mortality. Insidious onset, difficult early detection and a lack of broad-spectrum and effective multi-cancer therapeutic targets have limited the prolongation of cancer patients’ survival for decades. Therefore, a versatile therapeutic target which is involved in various cancer-related signaling pathways and different cancers may be more effective for cancer targeted therapy. USP4, one of the DUBs members which participates in deubiquitination, an inverse process of ubiquitination, can regulate various classical cancer-related signaling pathways, and thereby plays a vital role in some pathological and physiological processes including tumor initiation and progression. Recently, USP4 has been found to exert versatile influences on cells proliferation, migration and invasion, also apoptosis of various tumors. Moreover, USP4 can also act as a prognostic biomarker in several cancers. This review will give a comprehensive introduction of USP4 about its regulatory mechanisms, related signaling pathways, pathophysiological functions and the roles in various cancers which may help us better understand its biological functions and improve future studies to construct suitable USP4-targeted cancer therapy system.
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Affiliation(s)
- Yizhi Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Li Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Jun Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Bolun Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Chengxi Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Junchao Guo
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
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186
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Patient and Family Caregiver Considerations When Selecting Early Breast Cancer Treatment: Implications for Clinical Pathway Development. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 13:683-697. [DOI: 10.1007/s40271-020-00426-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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187
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Calidad de Vida: a systematic review of quality of life in Latino cancer survivors in the USA. Qual Life Res 2020; 29:2615-2630. [PMID: 32430782 DOI: 10.1007/s11136-020-02527-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Hispanics/Latinos. Thus, understanding health-related quality of life (HRQOL) needs among this diverse racial/ethnic group is critical. Using Ferrell's multidimensional framework for measuring QOL, we synthesized evidence on HRQOL needs among Hispanic/Latino cancer survivors. METHODS We searched MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO, for English language articles published between 1995 and January 2020, reporting HRQOL among Hispanic/Latino cancer survivors in the USA. RESULTS Of the 648 articles reviewed, 176 met inclusion criteria, with 100 of these studies focusing exclusively on breast cancer patients and no studies examining end-of-life HRQOL issues. Compared with other racial/ethnic groups, Hispanics/Latinos reported lower HRQOL and a higher symptom burden across multiple HRQOL domains. Over 80% of studies examining racial/ethnic differences in psychological well-being (n = 45) reported worse outcomes among Hispanics/Latinos compared with other racial/ethnic groups. Hispanic/Latino cancer survivors were also more likely to report suboptimal physical well-being in 60% of studies assessing racial/ethnic differences (n = 27), and Hispanics/Latinos also reported lower social well-being relative to non-Hispanics/Latinos in 78% of studies reporting these outcomes (n = 32). In contrast, reports of spiritual well-being and spirituality-based coping were higher among Hispanics/Latinos cancer survivors in 50% of studies examining racial/ethnic differences (n = 15). DISCUSSION Findings from this review point to the need for more systematic and tailored interventions to address HRQOL needs among this growing cancer survivor population. Future HRQOL research on Hispanics/Latinos should evaluate variations in HRQOL needs across cancer types and Hispanic/Latino subgroups and assess HRQOL needs during metastatic and end-of-life disease phases.
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188
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Sittenfeld SMC, Moore HCF, Greenberg Z, Al‐Hilli Z, Abraham J, Grobmyer SR, Monteleone E, Tullio K, Shah C. The power of one: Evaluating the impact of a single multi‐disciplinary treatment visit on time to treatment. Breast J 2020; 26:2015-2017. [DOI: 10.1111/tbj.13875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Sarah M. C. Sittenfeld
- Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OhioUSA
| | - Halle C. F. Moore
- Department of Hematology Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OhioUSA
| | - Zachary Greenberg
- Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OhioUSA
| | - Zahraa Al‐Hilli
- Section of Breast Surgery Department of Surgery Cleveland Clinic Cleveland Ohio USA
| | - Jame Abraham
- Department of Hematology Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OhioUSA
| | | | - Emily Monteleone
- Department of Cancer Center Administration Taussig Cancer Institute Cleveland Clinic Cleveland Ohio USA
| | - Katherine Tullio
- Department of Cancer Center Administration Taussig Cancer Institute Cleveland Clinic Cleveland Ohio USA
| | - Chirag Shah
- Department of Radiation Oncology Taussig Cancer Institute Cleveland Clinic Cleveland OhioUSA
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189
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Shen SH, Woroniecka K, Barbour AB, Fecci PE, Sanchez-Perez L, Sampson JH. CAR T cells and checkpoint inhibition for the treatment of glioblastoma. Expert Opin Biol Ther 2020; 20:579-591. [PMID: 32027536 DOI: 10.1080/14712598.2020.1727436] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Glioblastoma (GBM) is a highly aggressive brain tumor and is one of the most lethal human cancers. Chimeric antigen receptor (CAR) T cell therapy has markedly improved survival in previously incurable disease; however, this vanguard treatment still faces challenges in GBM. Likewise, checkpoint blockade therapies have not enjoyed the same victories against GBM. As it becomes increasingly evident that a mono-therapeutic approach is unlikely to provide anti-tumor efficacy, there evolves a critical need for combined treatment strategies.Areas covered: This review highlights the clinical successes observed with CAR T cell therapy as well the current efforts to overcome its perceived limitations. The review also explores employed combinations of CAR T cell approaches with immune checkpoint blockade strategies, which aim to potentiate immunotherapeutic benefits while restricting the impact of tumor heterogeneity and T cell exhaustion.Expert opinion: Barriers such as tumor heterogeneity and T cell exhaustion have exposed the weaknesses of various mono-immunotherapeutic approaches to GBM, including CAR T cell and checkpoint blockade strategies. Combining these potentially complementary strategies, however, may proffer a rational means of mitigating these barriers and advancing therapeutic successes against GBM and other solid tumors.
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Affiliation(s)
- Steven H Shen
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Karolina Woroniecka
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Andrew B Barbour
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Peter E Fecci
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Luis Sanchez-Perez
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - John H Sampson
- Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.,The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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190
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Dottino JA, Rauh-Hain JA. Financial toxicity: An adverse effect worthy of a black box warning? Gynecol Oncol 2020; 156:263-264. [PMID: 32046838 PMCID: PMC7346986 DOI: 10.1016/j.ygyno.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/02/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joseph A Dottino
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Alejandro Rauh-Hain
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
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191
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Meernik C, Kirchhoff AC, Anderson C, Edwards TP, Deal AM, Baggett CD, Kushi LH, Chao CR, Nichols HB. Material and psychological financial hardship related to employment disruption among female adolescent and young adult cancer survivors. Cancer 2020; 127:137-148. [PMID: 33043464 PMCID: PMC7736150 DOI: 10.1002/cncr.33190] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The importance of addressing adverse financial effects of cancer among adolescents and young adults (AYAs) is paramount as survival improves. In the current study, the authors examined whether cancer-related employment disruption was associated with financial hardship among female AYA cancer survivors in North Carolina and California. METHODS AYA cancer survivors identified through the North Carolina Central Cancer Registry and the Kaiser Permanente Northern/Southern California tumor registries responded to an online survey. Disrupted employment was defined as reducing hours, taking temporary leave, or stopping work completely because of cancer. Financial hardship was defined as material conditions or psychological distress related to cancer. Descriptive statistics and chi-square tests were used to characterize the invited sample and survey respondents. Marginal structural binomial regression models were used to estimate prevalence differences (PDs) and 95% confidence intervals (95% CIs). RESULTS Among 1328 women employed at the time of their diagnosis, women were a median age of 34 years at the time of diagnosis and 7 years from diagnosis at the time of the survey and approximately 32% experienced employment disruption. A substantial percentage reported financial hardship related to material conditions (27%) or psychological distress (50%). In adjusted analyses, women with disrupted employment had a 17% higher burden of material conditions (95% CI, 10%-23%) and an 8% higher burden of psychological distress (95% CI, 1%-16%) compared with those without disruption. CONCLUSIONS Financial hardship related to employment disruption among female AYA cancer survivors can be substantial. Interventions to promote job maintenance and transition back to the workforce after treatment, as well as improved workplace accommodations and benefits, present an opportunity to improve cancer survivorship.
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Affiliation(s)
- Clare Meernik
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | - Anne C Kirchhoff
- University of Utah Health, Huntsman Cancer Institute
- Huntsman Cancer Institute, Department of Pediatrics, University of Utah
| | | | - Teresa P Edwards
- University of North Carolina at Chapel Hill, H.W. Odum Institute for Research in Social Science
| | - Allison M Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center
| | | | | | | | - Hazel B Nichols
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
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