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Choi E, Berkman AM, Battle A, Betts AC, Salsman JM, Milam J, Andersen CR, Miller KA, Peterson SK, Lu Q, Cheung CK, Livingston JA, Hildebrandt MAT, Parsons SK, Freyer DR, Roth ME. Psychological distress and mental health care utilization among Black survivors of adolescent and young adult cancer. Cancer 2024. [PMID: 38676935 DOI: 10.1002/cncr.35348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/05/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Survivors of adolescent and young adult (AYA) cancer experience significant psychological distress and encounter barriers to accessing mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes among AYA survivors, and none have compared outcomes within a racially minoritized population. METHODS National Health Interview Survey data (2010-2018) were analyzed that identified non-Hispanic Black (hereafter, Black) survivors of AYA cancer and age- and sex-matched Black noncancer controls. Sociodemographic factors, chronic health conditions, modifiable behaviors (smoking and alcohol use), and psychological outcomes were assessed with χ2 tests. Logistic regression models, adjusted for survey weights, were used to evaluate the odds of psychological distress by cancer status after adjusting for covariates. Interactions between variables and cancer status were investigated. RESULTS The study included 334 Black survivors of AYA cancer and 3340 Black controls. Compared to controls, survivors were more likely to report moderate/severe distress (odds ratio [OR], 1.64; p < .001), use mental health care (OR, 1.53; p = .027), report an inability to afford mental health care (OR, 3.82; p < .001), and use medication for anxiety and/or depression (OR, 2.16; p = .001). Forty-one percent of survivors reported moderate/severe distress, and only 15% used mental health care. Among survivors, ages 18-39 years (vs. 40-64 years) and current smoking (vs. never smoking) were associated with the presence of moderate/severe distress. Among survivors with distress, high poverty status was associated with reduced utilization of mental health care. CONCLUSIONS A cancer diagnosis for a Black AYA is associated with greater psychological distress within an already vulnerable population.
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Affiliation(s)
- Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy M Berkman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aryce Battle
- McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Joel Milam
- Department of Epidemiology and Biostatistics, University of California, Irvine, California, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberly A Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qian Lu
- Division of Cancer Prevention and Population Sciences, Department of Health Disparities Research, The University of Texas MD Anderson Cancer Institute, Houston, Texas, USA
| | | | - J A Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wentzell K, Nagel KE. Financial stress in emerging adults with type 1 diabetes: a mini review integrating lessons from cancer research. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1328444. [PMID: 38344219 PMCID: PMC10853321 DOI: 10.3389/fcdhc.2024.1328444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
Amongst adults in the United States, those ages 18-30 have the highest unemployment rates, the lowest incomes, and are the most likely to be uninsured. Achieving financial independence is a core developmental task for this age group, but for those with type 1 diabetes (T1D), the high costs of insulin and diabetes supplies as well as an employment-based insurance model with minimal safety net can make this a formidable challenge. Cost-related non-adherence to diabetes management is particularly high in emerging adults with T1D and is associated with severe consequences, such as diabetic ketoacidosis (DKA) and even death. Objective financial burden and subjective financial distress related to illness are not unique to diabetes; in cancer care this construct is termed financial toxicity. Researchers have identified that emerging adults with cancer are particularly vulnerable to financial toxicity. Such research has helped inform models of care for cancer patients to mitigate cost-related stress. This mini review aims to briefly describe the state of the science on financial stress for emerging adults with T1D and explore parallels in cancer scholarship that can help guide future work in diabetes care to reduce health inequity, drive research forward, improve clinical care, and inform policy debates.
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Affiliation(s)
- Katherine Wentzell
- Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Boston, MA, United States
| | - Kathryn E. Nagel
- Divisions of Endocrinology and Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA, United States
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Thom B, Friedman DN, Aviki EM, Benedict C, Watson SE, Zeitler MS, Chino F. The long-term financial experiences of adolescent and young adult cancer survivors. J Cancer Surviv 2023; 17:1813-1823. [PMID: 36472761 PMCID: PMC9734817 DOI: 10.1007/s11764-022-01280-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer-related financial hardship can negatively impact financial well-being and may prevent adolescent and young adult (AYA) cancer survivors (ages 15-39) from gaining financial independence. This analysis explored the financial experiences following diagnosis with cancer among AYA survivors. METHODS We conducted a cross-sectional, anonymous survey of a national sample of AYAs recruited online. The Comprehensive Score for Financial Toxicity (COST) and InCharge Financial Distress/Financial Well-Being Scale (IFDFW) assessed financial hardship (cancer-related and general, respectively), and respondents reported related financial consequences and financial coping behaviors (both medical and non-medical). RESULTS Two hundred sixty-seven AYA survivors completed the survey (mean 8.3 years from diagnosis). Financial hardship was high: mean COST score was 13.7 (moderate-to-severe financial toxicity); mean IFDFW score was 4.3 (high financial stress). Financial consequences included post-cancer credit score decrease (44%), debt collection contact (39%), spending more than 10% of income on medical expenses (39%), and lacking money for basic necessities (23%). Financial coping behaviors included taking money from savings (55%), taking on credit card debt (45%), putting off major purchases (45%), and borrowing money (42%). In logistic regression models, general financial distress was associated with increased odds of experiencing financial consequences and engaging in both medical- and non-medical-related financial coping behaviors. DISCUSSION AYA survivors face long-term financial hardship after cancer treatment, which impacts multiple domains, including their use of healthcare and their personal finances. Interventions are needed to provide AYAs with tools to navigate financial aspects of the healthcare system; connect them with resources; and create systems-level solutions to address healthcare affordability. IMPLICATIONS FOR CANCER SURVIVORS Survivorship care providers, particularly those who interact with AYA survivors, must be attuned to the unique risk for financial hardships facing this population and make efforts to increase access available interventions.
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Affiliation(s)
- Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline M Aviki
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA
| | | | | | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Choi E, Berkman AM, Cheung CK, Betts AC, Salsman JM, Andersen CR, Ochoa-Dominguez CY, Miller K, Milam J, Shah A, Peterson SK, Lu Q, Livingston JA, Hildebrandt MAT, Parsons SK, Freyer D, Roth ME. Psychological distress and mental health care utilization among Hispanic/Latino survivors of adolescent and young adult cancer. Psychooncology 2023; 32:1918-1929. [PMID: 37955581 PMCID: PMC10872722 DOI: 10.1002/pon.6248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE Survivors of adolescent and young adult (AYA) cancer experience psychological distress and insufficient access to mental health care. Few studies have investigated racial/ethnic disparities in psychological health outcomes in this population. This study compared psychological distress, mental health care use, and inability to afford mental health care between Hispanic/Latino survivors of AYA cancer and Hispanic/Latino controls. METHODS The National Health Interview Survey data (2010-2018) were analyzed to identify Hispanic/Latino survivors of AYA cancer and Hispanic/Latino age- and sex-matched non-cancer controls. Sociodemographic, chronic health, modifiable factors, and psychological outcomes were compared using chi-square tests. Logistic regression models with survey weights were used to assess the log-odds of psychological distress in relation to covariates, along with the cancer group. Interactions were evaluated between each variable and cancer group. RESULTS The study included 370 Hispanic/Latino survivors of AYA cancer (mean time since diagnosis = 12.34 years) and 3700 Hispanic/Latino controls. Compared to controls, survivors were more likely to report moderate/severe distress (OR = 2.23, p < 0.001), use of mental health care (OR = 2.11, p < 0.001) and inability to afford mental health care (OR = 3.05, p < 0.001). Forty-one percent of survivors reported moderate/severe distress and only 16% utilized mental health care. Among survivors, having more than two chronic health conditions and public insurance (compared to private insurance) were associated with the presence of moderate/severe distress. Among survivors experiencing moderate/severe distress, lack of insurance was associated with decreased utilization of mental health care. CONCLUSIONS Having cancer as an AYA may exacerbate disparities in psychological health within the Hispanic/Latino population.
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Affiliation(s)
- Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy M Berkman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Houston, Texas, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol Yesenia Ochoa-Dominguez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California, USA
- Center for Health Equity Education and Research, University of California San Diego, La Jolla, California, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Joel Milam
- Department of Epidemiology & Biostatistics, University of California, Irvine, California, USA
| | - Ashna Shah
- School of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Qian Lu
- Department of Health Disparities Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Institute, Houston, Texas, USA
| | - J Andrew Livingston
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michelle A T Hildebrandt
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K Parsons
- Institute for Clinical Research and Health Policy Studies and the Division of Hematology/Oncology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - David Freyer
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael E Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Roth ME, Allicock M. Polypharmacy and medication fill nonadherence in a population-based sample of adolescent and young adult cancer survivors, 2008-2017. J Cancer Surviv 2023; 17:1688-1697. [PMID: 36346577 PMCID: PMC10164839 DOI: 10.1007/s11764-022-01274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE We examined the association between polypharmacy-an established risk factor for nonadherence in the elderly-and medication fill nonadherence in a large national sample of adolescent and young adult cancer survivors (AYAs) in the USA. METHODS We pooled data (2008-2017) from the Medical Expenditure Panel Survey. We defined polypharmacy as ≥ 3 unique medications prescribed, based on self-report and pharmacy data, and medication fill nonadherence as self-reported delay or inability to obtain a necessary medication. We estimated prevalence of medication fill nonadherence among AYAs (age 18-39 years with a cancer history). We used logistic regression to estimate the association between (1) polypharmacy and medication fill nonadherence in AYAs, and (2) total number of medications prescribed and medication fill nonadherence, controlling for sex, number of chronic conditions, disability, and survey year. RESULTS AYAs (n = 598) were predominantly female (76.2%), age 30-39 years (64.9%), and non-Hispanic White (72.1%). Nearly half were poor (19.0%) or near-poor/low income (21.6%). One in ten AYAs reported medication fill nonadherence (9.75%). Of these, more than 70% cited cost-related barriers as the reason. AYAs with polypharmacy had 2.49 times higher odds of medication fill nonadherence (95%CI 1.11-5.59), compared to those without polypharmacy. Odds of medication fill nonadherence increased by 16% with each additional medication prescribed (AOR 1.16, 95% CI 1.07-1.25). CONCLUSIONS Polypharmacy may be an important risk factor for medication fill nonadherence in AYAs in the USA. IMPLICATIONS FOR CANCER SURVIVORS Improving AYAs' medication adherence requires eliminating cost-related barriers, particularly for those with polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Michael E Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Leraas H, Moya-Mendez M, Donohue V, Kawano B, Olson L, Sekar A, Robles J, Wagner L, Greenup R, Haines KL, Tracy E. Using Crowdfunding Campaigns to Examine Financial Toxicity and Logistical Burdens Facing Families of Children With Wilms Tumor. J Surg Res 2023; 291:640-645. [PMID: 37542779 DOI: 10.1016/j.jss.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/10/2023] [Accepted: 07/01/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Treatment for pediatric solid tumors is often intense and multidisciplinary and can create a substantial financial burden for families. Assessing these burdens, termed the financial toxicity of treatment, can be difficult. Using Wilms tumor as an example, we evaluated crowdfunding campaigns in an attempt to better understand the impact of economic and logistic challenges associated with pediatric solid tumor care and identify features associated with successful fundraising with this method. METHODS We used a webscraping algorithm to identify crowdfunding campaigns on GoFundMe.com for pediatric patients with Wilms tumor in the United States. We conducted a cross-sectional analysis to describe the patients and families seeking crowdfunding support for cancer care. After fundraizing information was extracted using the webscraping algorithm, each fundraiser was verified and examined by two independent reviewers to assess demographic, qualitative, disease, and treatment variables. Successful fundraisers, defined as those meeting stated financial goals, were compared to unsuccessful campaigns to identify variables associated with successful crowdfunding campaigns. RESULTS We identified 603 children with Wilms tumor and an associated crowdfunding campaign. The median age was 4 y. The majority lived in two-parent households (68.5%). Patients mentioned siblings in 35.5% of fundraisers. While motivations for crowdfunding varied, hardships endured by families included loss of employment (52.2%), need for childcare for other children (9.8%), direct costs of care [co-payments, insurance, pharmaceuticals, out-of-pocket care costs, etc.] (80.9%), indirect costs associated with seeking care [transportation, parking, lodging, lost opportunity cost, etc.] (56.2%), and need for relocation to pursue complex cancer care (6.8%). Disease characteristics in this cohort were limited to self-reports by families. However, fundraisers mentioned disease characteristics, including tumor stage (47.6%), size (11.4%), positive nodal status (9.6%), metastatic disease (3.6%), pathology (11.8%), upstaging (4.6%), and disease recurrence (8.6%). No individually examined demographic, support, disease, or hardship-related factors varied significantly between successful and unsuccessful crowdfunding campaigns (all P > 0.05). However, successful campaigns requested less money ($11,783.25 successful versus $22,442.2 unsuccessful, <0.001), received more money ($16,409.5 successful vs 7427.4 unsuccessful, P < 0.001), and solicited larger donor numbers (170.3 successful versus 86.3 unsuccessful, P < 0.001). CONCLUSIONS Families whose children undergo multimodal cancer care have significant expenses and burdens and can use crowdfunding to support their costs. Careful consideration of the financial and logistic strains associated with pediatric solid tumor treatment, including thorough analysis of crowdfunding sites, may support better understanding of nonclinical burdens, supporting therapeutic relationships and patient outcomes.
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Affiliation(s)
- Harold Leraas
- M.D., Duke University Department of Surgery, Durham, North Carolina.
| | | | | | - Brad Kawano
- Department of Surgery, University of California San Diego, San Diego, California
| | - Lindsay Olson
- Duke University School of Medicine, Durham, North Carolina
| | - Akshaya Sekar
- Campbell University School of Osteopathic Medicine, Harnett County, North Carolina
| | - Joanna Robles
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Lars Wagner
- Duke University Department of Pediatrics, Durham, North Carolina
| | - Rachel Greenup
- M.D., Duke University Department of Surgery, Durham, North Carolina; Yale University Department of Surgery, New Haven, Connecticut
| | - Krista L Haines
- M.D., Duke University Department of Surgery, Durham, North Carolina
| | - Elisabeth Tracy
- M.D., Duke University Department of Surgery, Durham, North Carolina
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Hall AG, Syrjala KL, Ketterl TG, Ganz PA, Jacobs LA, Palmer SC, Partridge A, Rajotte EJ, Mueller BA, Baker KS. Socioeconomic Factors and Adherence to Health Care Recommendations in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:701-709. [PMID: 36779982 PMCID: PMC10611968 DOI: 10.1089/jayao.2022.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Purpose: The majority of adolescent and young adult (AYA) cancer survivors do not receive recommended health care surveillance after therapy. We used cross-sectional survey data to evaluate the impact of income, education, marital status, and insurance on health care adherence among AYA survivors. Methods: Eligible survivors were 18-39 years at diagnosis with invasive malignancy, 1-5 years from therapy completion. Online surveys assessed sociodemographic factors and self-report of completion of recommended health care services. Diagnosis and treatment data were abstracted from medical records. Multivariable logistic regression calculated odds ratios (ORs) and 95% confidence intervals (CIs) for adherence in relation to socioeconomic status and support. Results: Of 344 participants, 36% were adherent to at least 80% of recommendations. Adherence varied by cancer type: 34% for breast cancer, 52% for leukemia/lymphoma, 23% for other tumors. Adherence rates were similar among White, Asian, and Hispanic/Latinx patients. Lower adherence was associated with lower education (OR: 0.43; 95% CI: 0.23-0.80 for <4-year college degree) and lower annual income (OR: 0.51; 95% CI: 0.28-0.95 for $41,000-$80,000; OR: 0.40; 95% CI: 0.19-0.86 for ≤$40,000). Adherence decreased with decreasing income levels among those who were 1 to less than 3 years after diagnosis (OR: 0.25; 95% CI: 0.07-0.93 for $81,000-$120,000; OR: 0.24; 95% CI: 0.07-0.84 for $41,000-$80,000; OR: 0.13; 95% CI: 0.03-0.60 for ≤$40,000). Conclusion: Risk of nonadherence to health care guidelines was associated with lower income and lower education among AYA cancer survivors. Identification of these risks and related barriers to adherence in AYA survivors will inform interventions designed to meet needs of these high-risk groups, particularly during the first years after diagnosis. Trial Registration: NCT02192333.
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Affiliation(s)
- Anurekha G Hall
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tyler G Ketterl
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Linda A Jacobs
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven C Palmer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily Jo Rajotte
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Beth A Mueller
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Betts AC, Murphy CC, Shay LA, Balasubramanian BA, Markham C, Allicock M. Polypharmacy and prescription medication use in a population-based sample of adolescent and young adult cancer survivors. J Cancer Surviv 2023; 17:1149-1160. [PMID: 34997910 PMCID: PMC10614319 DOI: 10.1007/s11764-021-01161-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined prescription medication use and identified correlates of polypharmacy-taking multiple medications-in adolescent and young adult cancer survivors (AYAs), who experience early-onset chronic conditions. METHODS Our cross-sectional study pooled data (2008-2017) from the national Medical Expenditure Panel Survey. We estimated prevalence of polypharmacy (≥ 5 unique prescription medications over an approximate 1-year period) in AYAs (age 18-39 years with a history of cancer) and age- and sex-matched controls, overall and by sociodemographics, clinical factors, and health indicators. We compared survivors' and controls' medication use across therapeutic classes. To identify correlates of polypharmacy among AYAs, we included factors with p < 0.20 in bivariable analysis in a multivariable logistic regression model. RESULTS AYAs (n = 601) had a higher prevalence of polypharmacy than controls (n = 2,402), overall (31.5% vs. 15.9%, p < .01) and by all sociodemographics, clinical factors, and health indicators. A majority of AYAs with multiple chronic conditions (58.8%, 95% CI 47.3-70.4) or disability (61.3%, 95% CI 52.6-70.0) had polypharmacy. Patterns of AYAs' medication use across therapeutic classes were consistent with their chronic conditions. Nearly one-third used opioid/narcotic analgesics (32.2% vs. 13.7% of controls, p < 0.01). Among AYAs, multiple chronic conditions (aOR 4.68, 95% CI 2.23-9.83) and disability (aOR 3.70, 95% CI 2.23-6.14) were correlated with polypharmacy. CONCLUSIONS Chronic conditions and disabilities, including aftereffects of cancer treatment, may drive polypharmacy in AYAs. Future research should examine adverse outcomes of polypharmacy and opioid/narcotic use in AYAs. IMPLICATIONS FOR CANCER SURVIVORS AYAs with chronic conditions or disabilities should be monitored for polypharmacy.
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Affiliation(s)
- Andrea C Betts
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston (UTHealth), 2777 N. Stemmons Fwy., Ste. 8400, Dallas, TX, 75207, USA.
| | - Caitlin C Murphy
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - L Aubree Shay
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, San Antonio, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Houston, TX, USA
| | - Marlyn Allicock
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston (UTHealth), 2777 N. Stemmons Fwy., Ste. 8400, Dallas, TX, 75207, USA
- Center for Health Promotion and Prevention Research, UTHealth School of Public Health, Dallas, TX, USA
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Antón M, Cabañes N, Fernández-Meléndez S, Fernández-Nieto M, Jiménez-Ferrera G, Letrán A, Méndez-Brea P, Montoro J, Moreno F, Mur-Gimeno P, Rodríguez-Vázquez V, Rosado A, Sánchez-Guerrero I, Vega-Chicote JM, Vidal C. Shared Decision-Making in Allergen Immunotherapy (AIT) Options Using a Questionnaire for Respiratory Allergic Patients: A Delphi Consensus Study. Patient Prefer Adherence 2023; 17:1771-1782. [PMID: 37520065 PMCID: PMC10378527 DOI: 10.2147/ppa.s409466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach. Patients and Methods A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on "agreement" on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions). Conclusion This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.
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Affiliation(s)
- Mónica Antón
- Allergy Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Nieves Cabañes
- Allergy Department, Hospital Universitario de Toledo, Toledo, Spain
| | | | - Mar Fernández-Nieto
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Letrán
- Allergy Unit, Centro médico Asisa Doctor Lobatón, Cádiz, Spain
| | - Paula Méndez-Brea
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Javier Montoro
- Allergy Department, Hospital de Llíria, Valencia, Spain
- Department of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | | | - Pilar Mur-Gimeno
- Allergy Department, Hospital de Santa Bárbara, Puertollano, Ciudad Real, Spain
| | - Virginia Rodríguez-Vázquez
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Rosado
- Allergy Department, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | | | - Carmen Vidal
- Allergy Department, Complejo Hospitalario Clínico Universitario de Santiago, Santiago de Compostela, Spain
- Department of Medicine, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
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10
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Shi JJ, McGinnis GJ, Peterson SK, Taku N, Chen YS, Yu RK, Wu CF, Mendoza TR, Shete SS, Ma H, Volk RJ, Giordano SH, Shih YCT, Nguyen DK, Kaiser KW, Smith GL. Pilot study of a Spanish language measure of financial toxicity in underserved Hispanic cancer patients with low English proficiency. Front Psychol 2023; 14:1188783. [PMID: 37492449 PMCID: PMC10364629 DOI: 10.3389/fpsyg.2023.1188783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Background Financial toxicity (FT) reflects multi-dimensional personal economic hardships borne by cancer patients. It is unknown whether measures of FT-to date derived largely from English-speakers-adequately capture economic experiences and financial hardships of medically underserved low English proficiency US Hispanic cancer patients. We piloted a Spanish language FT instrument in this population. Methods We piloted a Spanish version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure using qualitative cognitive interviews and surveys in un-/under-insured or medically underserved, low English proficiency, Spanish-speaking Hispanics (UN-Spanish, n = 23) receiving ambulatory oncology care at a public healthcare safety net hospital in the Houston metropolitan area. Exploratory analyses compared ENRICh FT scores amongst the UN-Spanish group to: (1) un-/under-insured English-speaking Hispanics (UN-English, n = 23) from the same public facility and (2) insured English-speaking Hispanics (INS-English, n = 31) from an academic comprehensive cancer center. Multivariable logistic models compared the outcome of severe FT (score > 6). Results UN-Spanish Hispanic participants reported high acceptability of the instrument (only 0% responded that the instrument was "very difficult to answer" and 4% that it was "very difficult to understand the questions"; 8% responded that it was "very difficult to remember resources used" and 8% that it was "very difficult to remember the burdens experienced"; and 4% responded that it was "very uncomfortable to respond"). Internal consistency of the FT measure was high (Cronbach's α = 0.906). In qualitative responses, UN-Spanish Hispanics frequently identified a total lack of credit, savings, or income and food insecurity as aspects contributing to FT. UN-Spanish and UN-English Hispanic patients were younger, had lower education and income, resided in socioeconomically deprived neighborhoods and had more advanced cancer vs. INS-English Hispanics. There was a higher likelihood of severe FT in UN-Spanish (OR = 2.73, 95% CI 0.77-9.70; p = 0.12) and UN-English (OR = 4.13, 95% CI 1.13-15.12; p = 0.03) vs. INS-English Hispanics. A higher likelihood of severely depleted FT coping resources occurred in UN-Spanish (OR = 4.00, 95% CI 1.07-14.92; p = 0.04) and UN-English (OR = 5.73, 95% CI 1.49-22.1; p = 0.01) vs. INS-English. The likelihood of FT did not differ between UN-Spanish and UN-English in both models (p = 0.59 and p = 0.62 respectively). Conclusion In medically underserved, uninsured Hispanic patients with cancer, comprehensive Spanish-language FT assessment in low English proficiency participants was feasible, acceptable, and internally consistent. Future studies employing tailored FT assessment and intervention should encompass the key privations and hardships in this population.
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Affiliation(s)
- Julia J. Shi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gwendolyn J. McGinnis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert K. Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tito R. Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanjay S. Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hilary Ma
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diem-Khanh Nguyen
- University of California Riverside School of Medicine, Riverside, CA, United States
| | - Kelsey W. Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L. Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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11
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Erickson JM, Kamke-Jordan A, Lancaster IJ, Palou-Torres A, Esch M, Gonzalez A, Charlson J, Bingen K. Medication self-management behaviors of adolescents and young adults with cancer. Support Care Cancer 2023; 31:390. [PMID: 37300714 DOI: 10.1007/s00520-023-07863-8] [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: 02/11/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer are challenged to manage complex medication regimens during treatment. The aims of the study are to (1) describe the medication self-management behaviors of AYAs with cancer and (2) examine the barriers and facilitators to AYAs' optimal use of medications, including their self-efficacy to manage medications. METHODS This cross-sectional study enrolled 30 AYAs (18-29 years) with cancer who were receiving chemotherapy. Participants electronically completed a demographic form, a health literacy screen, and the PROMIS Self-efficacy for Medication Management instrument. They completed a semi-structured interview to answer questions about their medication self-management behaviors. RESULTS Participants (53% female, mean age = 21.9 y) had a variety of AYA cancer diagnoses. Over half (63%) had limited health literacy. Most AYAs had accurate knowledge about their medications and average self-efficacy for managing medications. These AYAs were managing an average of 6 scheduled and 3 unscheduled medications. Oral chemotherapy was prescribed for 13 AYAs; other medications were for prevention of complications and symptom management. Many AYAs relied on a parent for obtaining and paying for medications, used multiple reminders to take medications, and used a variety of strategies to store and organize medications. CONCLUSION AYAs with cancer were knowledgeable and confident about managing complex medication regimens but needed support and reminders. Providers should review medication-taking strategies with AYAs and ensure a support person is available.
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Affiliation(s)
- Jeanne M Erickson
- University of Wisconsin-Milwaukee College of Nursing, Milwaukee, WI, USA.
| | | | | | - Akasha Palou-Torres
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Marloe Esch
- Froedtert & the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alyssa Gonzalez
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pail O, Knight TG. Financial toxicity in patients with leukemia undergoing hematopoietic stem cell transplantation: A systematic review. Best Pract Res Clin Haematol 2023; 36:101469. [PMID: 37353293 DOI: 10.1016/j.beha.2023.101469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
Financial toxicity (FT) is a term used to describe the objective financial burden of cancer care including the associated coping behaviors used by patients and their caregivers. FT has been shown to result in both direct financial burdens and in clinically relevant outcomes, such as non-adherence with care, diminished quality of life, and even decreased overall survival. Much of the data has been described in solid tumors, with limited investigations in the malignant hematology population. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) face a unique financial burden driven by lengthy hospitalizations and acute and chronic morbidity that have downstream implications on their income and costs. In this review, we discuss the prevalence of FT in patients with leukemia who are eligible for HSCT. We review the impact of FT on financial and clinical outcomes and the role of various interventions that have been studied within this population.
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Affiliation(s)
- Orrin Pail
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Greater financial toxicity correlates with increased psychological distress and lower quality of life among Turkish cancer patients. Support Care Cancer 2023; 31:137. [PMID: 36700998 DOI: 10.1007/s00520-023-07586-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aims to investigate the factors that influence financial toxicity and its effects on both quality of life and psychological distress in Turkish cancer patients. METHODS Data from 400 cancer patients receiving chemotherapy at a public university in Turkey was analyzed. The Comprehensive Score for Financial Toxicity (COST), Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and Functional Assessment of Cancer Therapy-General (FACT-G) were used to measure financial toxicity, psychological distress, and health quality of life, respectively. RESULTS Patients' median COST score was 22 (SD = 10.1; range: 1-44) and was consistent with mild financial toxicity. Financial toxicity was associated with lower education level (p < 0.001), lower monthly income (p < 0.001), being a woman (p = 0.021), living in another city (p = 0.012), and previous cancer surgery (p = 0.02). A negative and statistically significant correlation was found between financial toxicity and quality of life (r = - 0.139; p = 0.005) and psychological distress (r = - 0.398; p < 0.001). CONCLUSION This investigation demonstrated that financial toxicity was a significant determinant of quality of life and psychological distress.
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14
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Cho SK, Lee M, Brown LS, Nijhawan RI, Chong BF. Non-adherence of surgical treatment in patients with non-melanoma skin cancer: a retrospective cohort pilot study. Arch Dermatol Res 2023; 315:101-105. [PMID: 34741652 DOI: 10.1007/s00403-021-02296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 01/07/2023]
Abstract
There is limited data on non-adherence for surgical treatment in non-melanoma skin cancer (NMSC) patients. The objective of this single-center, retrospective cohort study is to compare rates of non-adherence of surgical treatment options, determine factors associated with non-adherence, and identify barriers for non-adherence. All adult patients with NMSC (> 18 years) seen between 2015 and 2017 recommended surgical treatment (surgical excision and electrodessication and curettage (ED&C) or Mohs surgery) were eligible. Non-adherence was defined as not completing recommended treatment and reasons for non-adherence were collected. Out of 427 patients that met inclusion criteria, patients recommended surgical excision and ED&C had a lower non-adherence rate of 3.4% compared to those recommended Mohs (11.4%) (p = 0.006). Factors associated with non-adherence included self-pay patients (19.07% adherent vs. 43.24% non-adherent, p = 0.004). Multivariate logistic regression analysis confirmed that Mohs patients were more likely to be non-adherent (odds ratio (OR) = 3.839, 95% confidence interval (CI) (1.435-10.270), p = 0.007) compared to surgical excision and ED&C patients. Males were more likely to be non-adherent (OR = 2.474, 95% CI (1.105-5.542), p = 0.028) to females, and self-pay patients were more likely to be non-adherent than those with other payers (OR = 3.050, 95% CI (1.437-6.475), p = 0.004). Of the 37 patients who were non-adherent, the most common reasons were loss to follow-up (46%), social reasons (41%), medical reasons (38%), and financial reasons (22%). There was a significant difference in non-adherence rates between surgical treatments for NMSCs in our cohort. Our study suggests the need for future interventional studies that implement strategies and patient education to decrease non-adherence rates.
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Affiliation(s)
- Sung Kyung Cho
- Department of Dermatology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Michelle Lee
- Department of Dermatology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - L Steven Brown
- Department of Health Systems Research, Parkland Health and Hospital System, Dallas, TX, USA
| | - Rajiv I Nijhawan
- Department of Dermatology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center and Parkland Health and Hospital System, 5323 Harry Hines Blvd., Dallas, TX, 75390-9069, USA.
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15
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Wang STL, Parkinson A, Butler D, Law HD, Fanning V, Desborough J. Real price of health-experiences of out-of-pocket costs in Australia: protocol for a systematic review. BMJ Open 2022; 12:e065932. [PMID: 36600422 PMCID: PMC9772657 DOI: 10.1136/bmjopen-2022-065932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Australians have substantial out-of-pocket (OOP) health costs compared with other developed nations, even with universal health insurance coverage. This can significantly affect access to care and subsequent well-being, especially for priority populations including those on lower incomes or with multimorbidity and chronic illness. While it is known that high OOP healthcare costs may contribute to poorer health outcomes, it is not clear exactly how these expenses are experienced by people with chronic illnesses. Understanding this may provide critical insights into the burden of OOP costs among this population group and may highlight policy gaps. METHOD AND ANALYSIS A systematic review of qualitative studies will be conducted using Pubmed, CINAHL Complete (EBSCO), Cochrane Library, PsycINFO (Ovid) and EconLit from date of inception to June 2022. Primary outcomes will include people's experiences of OOP costs such as their preferences, priorities, trade-offs and other decision-making considerations. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and methodological appraisal of included studies will be assessed using the Critical Appraisal Skills Programme. A narrative synthesis will be conducted for all included studies. ETHICS AND DISSEMINATION Ethics approval was not required given this is a systematic review that does not include human recruitment or participation. The study's findings will be disseminated through conferences and symposia and shared with consumers, policymakers and service providers, and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337538.
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Affiliation(s)
- Shelley Ting-Li Wang
- School of Medicine and Psychology, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Anne Parkinson
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Danielle Butler
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Hsei Di Law
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Vanessa Fanning
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Doherty M, Jacoby J, Gany F. " I wish I knew about these programs before!" A brief report exploring barriers to financial assistance reported by gynecological oncology patients. J Psychosoc Oncol 2022; 41:493-501. [PMID: 36514954 PMCID: PMC10322634 DOI: 10.1080/07347332.2022.2149374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite widespread reports of cancer-related financial hardship, hospital financial assistance programs are underutilized. APPROACH Rapid qualitative research. SAMPLE Gynecologic oncology patients with recurrent or metastatic disease, under 65 years old, and Comprehensive Score for Financial Toxicity of 26 or under. METHODS Semi-structured interviews to elicit (1) financial assistance awareness/knowledge, (2) barriers to accessing assistance, and (3) suggestions for improving access. We analyzed the transcripts using thematic analysis: open coding, consensus building/codebook, and identification of salient themes. FINDINGS We interviewed 25 patients and identified four barriers and three suggestions for improving access. Barriers: lack of awareness, perceptions of ineligibility, fear of negative consequences, and being overwhelmed. Suggestions: simplifying financial processes, providing individualized assistance, and being more proactive by intervening earlier. CONCLUSION Increase access by reducing stigma, misconceptions, and more proactively engaging at-risk patients. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Patients may be too afraid or overwhelmed to ask for help. A more proactive, psychosocial approach is needed.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Jacoby
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesca Gany
- Center for Immigrant Health and Cancer Disparities, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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17
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Meng X, An Z, Xu Y, Du J, Tan L, Yu H, Yu L. Living experiences of people with advance cancer with low socioeconomic status: A systematic review of qualitative evidence. Palliat Med 2022; 37:444-459. [PMID: 36411513 DOI: 10.1177/02692163221137106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The number of patients with advanced cancer is rapidly increasing, and the subgroup of this population with low socioeconomic status has suffered more disease burden than others. However, there is no recent qualitative synthesis of primary research studies into advanced cancer patients with low socioeconomic status. OBJECTIVE To synthesise qualitative research findings into advanced cancer patients' experiences with low socioeconomic status, and then to help provide targeted and effective strategies to improve their quality of life. DESIGN A systematic review and meta-synthesis of qualitative evidence (PROSPERO: CRD42021250423). DATA SOURCES PubMed, Web of Science Core Collection (ISI Web of Science), Cochrane Library, Embase, OVID LWW, CINAHL Complete (EBSCO), PsycINFO (EBSCO) and MEDLINE (ISI Web of Science), China National Knowledge Infrastructure (CNKI), WangFang, and Vip databases were systematically searched from their original dates to July 2022. Qualitative data were appraised using the Joanna Briggs Institute (JBI) qualitative assessment. FINDINGS The findings were synthesised into the following three analytical themes: (1) multi-dimensional disease distresses; (2) barriers in coping with disease distresses; and (3) strategies for dealing with disease distresses. CONCLUSIONS Patients with advanced cancer with low socioeconomic status experienced complicated and interactional distresses, unique life barriers, and a wide range of adaptation strategies. These findings will provide a comprehensive perspective to promote individual-centred health care systems and services to help these vulnerable people deal with the challenges of disease and improve their quality of life.
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Affiliation(s)
- Xianmei Meng
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Zifen An
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Yuying Xu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Jiayi Du
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Lanhui Tan
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Huidan Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
| | - Liping Yu
- Center for Nurturing Care Research, School of Nursing, Wuhan University, No. 115 Donghu Road, Wuhan, Hubei, China
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Espinoza Suarez NR, LaVecchia CM, Morrow AS, Fischer KM, Kamath C, Boehmer KR, Brito JP. ABLE to support patient financial capacity: A qualitative analysis of cost conversations in clinical encounters. PATIENT EDUCATION AND COUNSELING 2022; 105:3249-3258. [PMID: 35918230 DOI: 10.1016/j.pec.2022.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore how costs of care are discussed in real clinical encounters and what humanistic elements support them. METHODS A qualitative thematic analysis of 41 purposively selected transcripts of video-recorded clinical encounters from trials run between 2007 and 2015. Videos were obtained from a corpus of 220 randomly selected videos from 8 practice-based randomized trials and 1 pre-post prospective study comparing care with and without shared decision making (SDM) tools. RESULTS Our qualitative analysis identified two major themes: the first, Space Needed for Cost Conversations, describes patients' needs regarding their financial capacity. The second, Caring Responses, describes humanistic elements that patients and clinicians can bring to clinical encounters to include good quality cost conversations. CONCLUSION Our findings suggest that strengthening patient-clinician human connections, focusing on imbalances between patient resources and burdens, and providing space to allow potentially unexpected cost discussions to emerge may best support high quality cost conversations and tailored care plans. PRACTICE IMPLICATIONS We recommend clinicians consider 4 aspects of communication, represented by the mnemonic ABLE: Ask questions, Be kind and acknowledge emotions, Listen for indirect signals and (discuss with) Every patient. Future research should evaluate the practicality of these recommendations, along with system-level improvements to support implementation of our recommendations.
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Affiliation(s)
- Nataly R Espinoza Suarez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Centre for Sustainable Health Research, Laval University, Quebec, QC, Canada
| | | | - Allison S Morrow
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Karen M Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, MN, USA
| | - Celia Kamath
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Juan P Brito
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, MN, USA.
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Mann K, Waters AR, Park ER, Perez GK, Vaca Lopez PL, Kaddas HK, Warner EL, Ray N, Tsukamoto T, Allen K, Haaland B, Fair DB, Lewis MA, Kirchhoff AC. HIAYA CHAT study protocol: a randomized controlled trial of a health insurance education intervention for newly diagnosed adolescent and young adult cancer patients. Trials 2022; 23:682. [PMID: 35986416 PMCID: PMC9388989 DOI: 10.1186/s13063-022-06590-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND For adolescent and young adult (AYA) cancer patients aged 18 to 39 years, health insurance literacy is crucial for an effective use of the health care system. AYAs often face high out-of-pocket costs or have unmet health care needs due to costs. Improving health insurance literacy could help AYAs obtain appropriate and affordable health care. This protocol illustrates a randomized controlled trial testing a virtual health insurance education intervention among AYA patients. METHODS This is a two-arm multisite randomized controlled trial. A total of 80 AYAs diagnosed with cancer in the Mountain West region will be allocated to either usual navigation care or tailored health insurance education intervention with a patient navigator that includes usual care. All participants will complete a baseline and follow-up survey 5 months apart. The primary outcomes are feasibility (number enrolled and number of sessions completed) and acceptability (5-point scale on survey measuring satisfaction of the intervention). The secondary outcomes are preliminary efficacy measured by the Health Insurance Literacy Measure and the COmprehensive Score for financial Toxicity. DISCUSSION This trial makes a timely contribution to test the feasibility and acceptability of a virtual AYA-centered health insurance education program. TRIAL REGISTRATION ClinicalTrials.gov NCT04448678. Registered on June 26, 2020.
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Affiliation(s)
- Karely Mann
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Austin R. Waters
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC USA
| | - Elyse R. Park
- Health Promotion & Resiliency Intervention Research Program, Mongan Institute, Boston, MA USA
- Departments of Psychiatry & Medicine, Mass General Hospital/Harvard Medical School, Boston, MA USA
| | - Giselle K. Perez
- Health Promotion & Resiliency Intervention Research Program, Mongan Institute, Boston, MA USA
- Departments of Psychiatry & Medicine, Mass General Hospital/Harvard Medical School, Boston, MA USA
| | - Perla L. Vaca Lopez
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Heydon K. Kaddas
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Echo L. Warner
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- College of Nursing, University of Utah, Salt Lake City, UT USA
| | - Nicole Ray
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
| | - Tomoko Tsukamoto
- Adolescent and Young Adult Cancer Care Program, Intermountain Healthcare, Salt Lake City, UT USA
| | - Karlie Allen
- AYA Patient Navigation Program, Huntsman Cancer Hospital, Salt Lake City, UT USA
| | - Ben Haaland
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT USA
| | - Douglas B. Fair
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT USA
- Primary Children’s Hospital, Intermountain Healthcare, Salt Lake City, UT USA
| | - Mark A. Lewis
- Adolescent and Young Adult Cancer Care Program, Intermountain Healthcare, Salt Lake City, UT USA
| | - Anne C. Kirchhoff
- Cancer Control & Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah, Salt Lake City, UT USA
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20
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Williams CP, Davidoff A, Halpern MT, Mollica M, Castro K, Allaire B, de Moor JS. Cost-Related Medication Nonadherence and Patient Cost Responsibility for Rural and Urban Cancer Survivors. JCO Oncol Pract 2022; 18:e1234-e1246. [PMID: 35947881 PMCID: PMC9377697 DOI: 10.1200/op.21.00875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/13/2022] [Accepted: 06/24/2022] [Indexed: 08/03/2023] Open
Abstract
PURPOSE The relationship between out-of-pocket spending and cost-related medication nonadherence among older rural- and urban-dwelling cancer survivors is not well understood. METHODS This retrospective cohort study used the Surveillance, Epidemiology, and End Results Program, Medicare claims, and the Consumer Assessment of Healthcare Providers and Systems survey linked data resource linked data (2007-2015) to investigate the relationship between cancer survivors' cost responsibility in the year before and after report of delaying or not filling a prescription medication because of cost in the past 6 months (cost-related medication nonadherence). Secondary exposures and outcomes included Medicare spending and utilization. Generalized linear models assessed bidirectional relationships between cost-related medication nonadherence, spending, and utilization. Effects of residence were assessed via interaction terms. RESULTS Of 6,591 older cancer survivors, 13% reported cost-related medication nonadherence. Survivors were a median 8 years (interquartile range, 4.5-12.5 years) from their cancer diagnosis, 15% were dually Medicare/Medicaid-eligible, and prostate (40%) and breast (32%) cancer survivors were most prevalent. With every $500 USD increase in patient cost responsibility, risk of cost-related medication nonadherence increased by 3% (risk ratio, 1.03; 95% CI, 1.02 to 1.04). After report of cost-related medication nonadherence, patient cost responsibility was 22% higher (95% CI, 1.11 to 1.32) compared with those not reporting nonadherence, amounting to $523 USD (95% CI, $430 USD to $630 USD). Medicare spending and utilization were also higher before and after report of cost-related nonadherence versus none. For survivors residing in rural (18%) and urban (82%) areas, residence did not modify adherence or cost outcomes. CONCLUSION A bidirectional relationship exists between patient cost responsibility and cost-related medication nonadherence. Interventions reducing urban- and rural-dwelling survivor health care costs and cost-related adherence barriers are needed.
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Affiliation(s)
- Courtney P. Williams
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Amy Davidoff
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michael T. Halpern
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Michelle Mollica
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Kathleen Castro
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Janet S. de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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21
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Corrigan KL, Fu S, Chen YS, Kaiser K, Roth M, Peterson SK, Shih YCT, Jagsi R, Giordano SH, Volk RJ, Robin Yabroff K, Banegas MP, Acquati C, Conti RM, Ma HY, Ku K, Nancy You Y, Smith GL. Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery. Cancer 2022; 128:2455-2462. [PMID: 35417565 PMCID: PMC9177670 DOI: 10.1002/cncr.34220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Young adults and other working-age adults with cancer are at risk for cancer-related financial toxicity (FT), including material hardships, depletion of coping resources, and psychological burden. This study compares FT domains in young adults (18-39 years old) (YAs), other working-age adults (40-64 years old), and older adults (≥65 years old) receiving cancer care. METHODS A total of 311 adults were surveyed using the multi-domain Economic Strain and Resilience in Cancer instrument measuring FT (0-10 score indicating least to greatest FT; score ≥5 severe FT). Participants were receiving ambulatory care from March-September 2019. Associations of age with overall FT and material hardship, coping resource depletion, and psychological burden FT domains were tested using Kruskal-Wallis and χ2 tests and multivariable generalized linear models with gamma distribution. RESULTS YAs (median age, 31.5 years) comprised 9.6% of the sample; other working-age adults comprised 56.9%. Overall, material, coping, and psychological FT scores were worse in younger age adults versus older adults (P < .001 in all multivariable models). Compared with older adults, younger age adults demonstrated worse material hardship (median scores, 3.70 vs 4.80 vs 1.30 for YAs, other working-age, and older adults, respectively; P < .001), coping resource depletion (4.50 vs 3.40 vs 0.80; P < .001), and psychological burden (6.50 vs 7.00 vs 1.00; P < .001). Fifty percent of YAs had severe overall FT versus 40.7% of other working-age adults and 9.6% of older adults (P < .001). CONCLUSIONS Younger age adults with cancer bore disproportionate FT. Interventions to address unmet needs are critical components for addressing FT in this population.
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Affiliation(s)
- Kelsey L. Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, 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
| | - Kelsey Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Roth
- Department of Pediatrics, 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
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
- Center for Bioethics and Social Sciences in Medicine, 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
| | | | - Mathew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX
- Department of Health Disparities Research, 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
| | - Hilary Y. Ma
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Ku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y. Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Waters AR, Bybee S, Warner EL, Kaddas HK, Kent EE, Kirchhoff AC. Financial Burden and Mental Health Among LGBTQIA+ Adolescent and Young Adult Cancer Survivors During the COVID-19 Pandemic. Front Oncol 2022; 12:832635. [PMID: 35785163 PMCID: PMC9245943 DOI: 10.3389/fonc.2022.832635] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background In the United States, the cost of cancer treatment can lead to severe financial burden for cancer survivors. The economic impacts of the COVID-19 pandemic compound cancer survivors' financial challenges. Financial burden may be particularly challenging for lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (LGBTQIA+) survivors. LGBTQIA+ survivors who are adolescent and young adults (AYA) may face elevated financial burden due to multiple, intersecting identities. Methods An explanatory sequential mixed methods design was applied, beginning with a survey of AYA cancer survivors in the Mountain West region of the United States. Survey measures included demographics, COVID-19 impacts, the COmprehensive Score for financial Toxicity (COST), Perceived Stress Scale-4 (PSS-4), and PROMIS anxiety and depression scales. Two-way t-tests were used to analyze differences in outcomes between LGBTQIA+ and non-LGBTQIA+ AYAs. All LGBTQIA+ survey participants were invited to complete an interview, and those who agreed participated in descriptive interviews about financial burden due to cancer, COVID-19, and LGBTQIA+ identity. Interviews were audio recorded, transcribed, and analyzed using Dedoose. Results Survey participants (N=325) were LGBTQIA+ (n=29, 8.9%), primarily female (n= 197, 60.6%), non-Hispanic White (n= 267, 82.2%), and received treatment during COVID-19 (n= 174, 54.0%). LGBTQIA+ interview participants (n=9, 100%) identified as a sexual minority and (n=2, 22.2%) identified as a gender minority. Most were non-Hispanic White (n=6, 66.7%) and had received treatment during COVID-19 (n=7, 77.8%). Statistical analyses revealed that LGBTQIA+ AYAs reported significantly worse COST scores than non-LGBTQIA+ AYAs (p=0.002). LGBTQIA+ AYAs also reported significantly higher PSS-4 (p=0.001), PROMIS anxiety (p=0.002) and depression scores (p<0.001) than non-LGBTQIA+ AYAs, reflecting worse mental health outcomes. High costs of cancer treatment and employment disruptions due to COVID-19 contributed to substantial financial stress, which exacerbated existing mental health challenges and introduced new ones. Conclusions LGBTQIA+ AYA survivors reported substantial financial burden and psychological distress exacerbated by cancer, the COVID-19 pandemic, and LGBTQIA+ stigma. Given their multiple intersecting identities and potential for marginalization, LGBTQIA+ AYA survivors deserve prioritization in research to reduce financial burden and poor mental health.
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Affiliation(s)
- Austin R. Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- Department of Health Policy & Management, Gilling’s School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Echo L. Warner
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Heydon K. Kaddas
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Erin E. Kent
- Department of Health Policy & Management, Gilling’s School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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23
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Doherty M, Finik J, Blinder V. Work Status Reduction and Cost-Related Nonadherence during Cancer Treatment. HEALTH & SOCIAL WORK 2022; 47:123-130. [PMID: 35253845 PMCID: PMC9226655 DOI: 10.1093/hsw/hlac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/21/2020] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Many cancer patients experience a reduction in work status during cancer treatment. Authors analyzed cross-sectional survey data from U.S. cancer patients and survivors to examine the relationship between reduced work status and cost-related nonadherence, defined as skipping or forgoing medical treatments or medications due to cost. Of 381 respondents who were working at the time of diagnosis, 143 reported a reduction in work status during treatment. Age, racial identity, level of education, and treatment type were associated with reductions in work status. Respondents who reduced work status had higher odds of engaging in cost-related nonadherence than those with stable employment. Authors conclude that reduced work status is associated with nonadherence that can undermine treatment benefit and lead to disease progression. This association is troubling given that African American respondents were more likely to report reduced work status during treatment, potentially exacerbating existing cancer health disparities. To reduce treatment nonadherence, social workers should assess for potential employment problems and be prepared to intervene through counseling, community resource referrals, and direct financial assistance. Social workers should be aware of how structural racism is reproduced through inequitable labor policies and practices that have direct implications for health and access to care.
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Hastert TA, Ruterbusch JJ, Abrams J, Nair M, Wenzlaff AS, Beebe-Dimmer JL, Pandolfi SS, Schwartz AG. Financial Hardship by Age at Diagnosis Including in Young Adulthood among African American Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2022; 31:876-884. [PMID: 35064060 PMCID: PMC9377160 DOI: 10.1158/1055-9965.epi-21-0739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/08/2021] [Accepted: 01/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Financial hardship is most common among cancer survivors with the fewest financial resources at diagnosis; however, little is known about the financial outcomes of young adult (YA) survivors (ages 20-39 at diagnosis), despite their having fewer financial reserves than older adults. METHODS We utilized data from 3,888 participants in the population-based Detroit Research on Cancer Survivors cohort. Participants self-reported several forms of material and behavioral financial hardship (MFH and BFH, respectively). Psychological financial hardship (PFH) was measured using the Comprehensive Score for financial Toxicity (COST) score. Modified Poisson models estimated prevalence ratios (PR) and 95% confidence intervals (CI) for financial hardship by age at diagnosis controlling for demographic, socioeconomic, and cancer-related factors. RESULTS MFH prevalence was inversely associated with age such that 72% of YA survivors reported MFH, 62% ages 40 to 54, 49% ages 55 to 64, and 33% ages 65 to 79 (PRadjusted YA vs. 65+: 1.75; 95% CI, 1.49-2.04; Ptrend < 0.001). BFH was also more common among YA survivors (26%) than those ages 65 to 79 (20%; PRadjusted: 1.50; 95% CI, 1.08-2.08; Ptrend = 0.019). Age was positively associated with financial wellbeing. COST scores ranged from 20.7 (95% CI, 19.0-22.4) among YA survivors to 27.2 (95% CI, 26.1-28.2) among adults 65 to 79 years old (Ptrend < 0.001). CONCLUSIONS In this population of African American cancer survivors, MFH and BFH were more common, and PFH was more severe, in YA survivors compared with those diagnosed as older adults. IMPACT Young adulthood at diagnosis should be considered a risk factor for cancer-related financial hardship and addressed in work designed to reduce the adverse financial impacts of cancer.
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Affiliation(s)
- Theresa A. Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Julie J. Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Judith Abrams
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Angie S. Wenzlaff
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Jennifer L. Beebe-Dimmer
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Stephanie S. Pandolfi
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI
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25
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Salsman JM, Kircher SM. Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches. JCO Oncol Pract 2022; 18:173-176. [PMID: 34807736 PMCID: PMC8932498 DOI: 10.1200/op.21.00663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine and the Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Sheetal M. Kircher
- Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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An Z, Meng X, Fang P, Yu H, Yu L. Living experiences of patients with advanced cancer with low socioeconomic status: protocol for a systematic review of qualitative evidence. BMJ Open 2022; 12:e054606. [PMID: 35105586 PMCID: PMC8808456 DOI: 10.1136/bmjopen-2021-054606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The number of patients with advanced cancer is rapidly increasing, and the disease burden among those with low socioeconomic status (SES) has accordingly become a global concern. Low SES can adversely impact patients with advanced cancer. The purpose of this systematic review is to shed light on the life experiences of patients with advanced cancer with low SES to help provide targeted and effective strategies to improve their quality of life. METHODS AND ANALYSIS We will include the following English databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PubMed, MEDLINE, Embase, Web of Science, Joanna Briggs Institute (JBI) Database of Systematic Reviews, PsycINFO and OpenGrey, and the following Chinese databases: China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals and Wanfang Data Knowledge Service Platform. A comprehensive search of qualitative studies on the experiences of patients with advanced cancer with low SES will be conducted from the above databases, with no age limit. Quality assessments of the studies will be independently performed by two reviewers using the JBI Critical Assessment Checklist, and any disagreements will be resolved through a discussion with a third reviewer. Relevant data will be extracted using the JBI standardised data extraction tools. The JBI meta-aggregation tool will be used to compare, analyse and summarise the original results. The reliability and credibility of the overall quality of the studies included will be evaluated using the JBI ConQual approach. ETHICS AND DISSEMINATION This study is based on existing public literature and therefore does not require a formal ethics review. The results of the study may be presented in peer-reviewed international journals and presented at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42021250423.
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Affiliation(s)
- Zifen An
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Xianmei Meng
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Pei Fang
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Huidan Yu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
| | - Liping Yu
- School of Nursing, Wuhan University, Wuhan, Hubei, China
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Zhou H, Wang X, Yu D, Du R, Wang H, Zhu J, Zhang H, Chen C, Wang T. Adherence to Oral Targeted Anti-Lung Cancer Therapy: A Qualitative Interview Study. Patient Prefer Adherence 2022; 16:995-1004. [PMID: 35431541 PMCID: PMC9012231 DOI: 10.2147/ppa.s341966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Oral targeted antineoplastic drugs (OTADs) are becoming more and more acceptable for lung cancer treatment due to their advantages such as the convenience of administration and milder side effects. However, medication adherence represents a major issue for prolonged OTAD treatment. In this study, the factors associated with treatment adherence to OTAD were explored through the Adherence Influencing Factor Framework suggested by WHO. Based on these results, we further examined the potential factors related to social psychological cognition in OTAD adherence in patients with lung cancer. METHODS This qualitative study was conducted in public hospitals in Henan, China. Data were collected through semi-structured interviews with selected lung cancer patients. Face-to-face interviews were audio-recorded and transcribed for thematic analysis. RESULTS Of the 21 patients interviewed, 17 were males and 4 were females. The analysis of the data led to four themes, ie, patient-related factors (medication-taking introspection, family structure, weigh the pros and cons of OTAD treatment), medication-related factors (medication experience, adverse reactions, information access), physician/nurse-related factors (shared decision making, doctor's reaction, nurse's inquiry) and society-related factors (fear, stigma). CONCLUSION Family structure, weigh the pros and cons of OTAD treatment, information access, shared decision making, nurse's inquiry are potential factors affecting OTAD adherence in lung cancer patients. Providing drug information support to patients, inviting patients to join in shared decision-making and strengthening doctor-patient-nurse cooperation are important for improving medication adherence. Further research should be conducted to help healthcare providers to promote the medication adherence of lung cancer patients to OTAD treatment.
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Affiliation(s)
- Huiyue Zhou
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Xin Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Dan Yu
- Department of Gengral Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Ruofei Du
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Huaisong Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China
| | - Jizhe Zhu
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Haoning Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
- Changying Chen, Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China, Email
| | - Tao Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China
- Cancer Centre, Telethon Kids Institute, Perth, WA, 6872, Australia
- Medical School, University of Western Australia, Perth, WA, 6872, Australia
- Department of Oncology, People’s hospital of Hebi, Hebi, Henan, 458010, People’s Republic of China
- Correspondence: Tao Wang, Nursing and Health School, Zhengzhou University, Zhengzhou, Henan, 450001, People’s Republic of China, Email
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Alefan Q, Cheekireddy VM, Blackburn D. Cost-Related Nonadherence Can be Explained by A General Non-Adherence Framework. J Am Pharm Assoc (2003) 2022; 62:658-673. [DOI: 10.1016/j.japh.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/24/2022]
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Fiala MA. Disparities in health care affordability among childhood cancer survivors persist following the Affordable Care Act. Pediatr Blood Cancer 2021; 68:e29370. [PMID: 34626446 DOI: 10.1002/pbc.29370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) included many provisions that may have improved access to care for childhood cancer survivors (CCS). In this study, we sought to compare health insurance coverage and the affordability of health care among adult childhood CCS before and after the implementation of the ACA. PROCEDURE Using data from the National Health Interview Survey (NHIS), two cohorts of CCS age 21-65 years old and matched (1:3) controls without a history of cancer were identified. A difference-in-differences analysis was used to compare insurance coverage and health care affordability pre- (2011-2013) and post-ACA (2015-2017). RESULTS There were 309 CCS identified in the pre-ACA cohort and 324 in the post-ACA cohort. The two cohorts were similar in demographic composition. Prior to the ACA, CCS were 39% more likely to be uninsured than their peers (p = .046). Post, there was no difference in the odds of being uninsured between CCS and their peers. Following implementation of the ACA, the proportion of CCS who reported having difficulty with the affordability of health care decreased (p = .013) as did the proportion reporting skipping needed care due to cost (p < .001). However, 13% of CCS still reported being uninsured, 36% reported difficulty paying for health care, and 13% reported foregoing needed care due to cost. Relative to their peers, CCS saw improvement in foregoing needed care due to cost, but disparities still remain. CONCLUSIONS Although improvements were observed, health care affordability, and medical nonadherence remains a problem for CCS. IMPLICATIONS FOR CANCER SURVIVORS Additional efforts are needed to improve health care affordability among CCS.
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Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, Missouri, USA.,School of Social Work, Saint Louis University, St Louis, Missouri, USA
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Li M, Bounthavong M. Cancer history, insurance coverage, and cost-related medication nonadherence in Medicare beneficiaries, 2013-2018. J Manag Care Spec Pharm 2021; 27:1750-1756. [PMID: 34818087 PMCID: PMC10391237 DOI: 10.18553/jmcp.2021.27.12.1750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Cancer survivors are at risk of financial hardships and cost-related medication nonadherence, particularly among those without adequate insurance coverage. OBJECTIVE: To examine the association between cancer history and cost-related medication nonadherence, as well as the association between insurance coverage and nonadherence among Medicare beneficiaries. METHODS: We used the 2013-2018 Medicare Current Beneficiary Survey Public Use File, a survey on the health, health service utilization, access to care, and satisfaction among a nationally representative sample of Medicare beneficiaries. Cost-related medication nonadherence was defined as often or sometimes reporting any of the following: (1) took smaller dose of medication, (2) skipped doses to make medication last, (3) delayed medication because of cost, and (4) not get medication because of cost. Logistic regression was used to estimate the odds ratio of cost-related nonadherence associated with cancer history, adjusting for survey year and sociodemographic characteristics of the respondents, including age, sex, race and ethnicity, highest grade completed, income level, marital status, and number of chronic conditions. We also included Medicare Part D, an interaction between Part D and the low-income subsidy, and Medicare Advantage in the model to examine the effect of insurance coverage on cost-related nonadherence. RESULTS: From 2013 to 2018, there were 12,492 cancer survivors and 53,262 respondents without a history of cancer in our sample, and 16.5% reported cost-related medication nonadherence. After adjusting for characteristics of the respondents, cancer survivors were more likely than those without a history of cancer to report cost-related medication nonadherence (adjusted OR = 1.10; 95% CI = 1.02-1.19). Having unsubsidized Part D-Part D without the low-income subsidy-was associated with a greater likelihood of reporting cost-related medication nonadherence (adjusted OR = 1.63, 95% CI = 1.49-1.78), while having subsidized Part D was not (adjusted OR = 0.96; 95% CI = 0.85-1.08). Finally, being on Medicare Advantage was associated with lower likelihood of reporting cost-related nonadherence compared with traditional fee-for-service Medicare (adjusted OR = 0.86; 95% CI = 0.80-0.92). CONCLUSIONS: Expanding the low-income subsidy and capping out-of-pocket drug expenditure can be effective policy options to reduce cost-sharing burden and cost-related nonadherence. DISCLOSURES: For this study, Li was partially supported by a research grant from the National Cancer Institute (R01CA225647). The sponsor had no role in the design or implementation of the study, analysis or interpretation of the data, or drafting or approval the manuscript. The authors report no conflicts of interest.
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Affiliation(s)
- Meng Li
- Department of Health Service Research, University of Texas MD Anderson Cancer Center, Houston
| | - Mark Bounthavong
- University of California San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences, La Jolla
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Lestuzzi C, Mascarin M, Coassin E, Canale ML, Turazza F. Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How? Front Cardiovasc Med 2021; 8:671001. [PMID: 34760934 PMCID: PMC8572927 DOI: 10.3389/fcvm.2021.671001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/27/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Radiotherapy may cause valvular (VHD), pericardial, coronary artery disease (CAD), left ventricular dysfunction (LVD), arrhythmias. The risk of radiation induced heart disease (RIHD) increases over time. The current guidelines suggest a screening for RIHD every 5 years in the long-term survivors who had been treated by chest RT. Methods: We reviewed the clinical and instrumental data of 106 patients diagnosed with RIHD. In one group (Group A: 69 patients) RIHD was diagnosed in an asymptomatic phase through a screening with ECG, echocardiogram and stress test. A second group (37 patients) was seen when RIHD was symptomatic. We compared the characteristics of the two groups at the time of RT, of RIHD detection and at last follow-up. Results: Overall, 64 patients (60%) had CAD (associated to other RIHD in 18); 39 (36.7%) had LVD (isolated in 20); 24 (22.6%) had VHD (isolated in 10 cases). The interval between the last negative test and the diagnosis of moderate or severe RIHD was <5 years in 26 patients, and <4 years in 18. In group A, 63% of the patients with CAD had silent ischemia. The two groups did not differ with regard to type of tumor, cardiovascular risk factors, use of anthracycline-based chemotherapy, age at RT treatment, radiation dose and interval between RT and toxicity detection. The mean time from RT and RIHD was 16 years in group A and 15 in group B. Interventional therapy at RIHD diagnosis was more frequent in group B (54 vs. 30%, p < 0.05). At last follow-up, 27 patients had died (12 of cancer, 9 of cardiac causes, 6 of other causes); mean ejection fraction was 60% in group A and 50% in group B (p < 0.01). Patients with ejection fraction ≤ 50% were 14.5% in group A and 40% in group B (p < 0.01). Conclusions: Clinically relevant RIHD become evident at a mean interval of 16 years after RT. The most frequent clinical manifestations are CAD and LVD. RIHD diagnosis in asymptomatic patients may preserve their cardiac function with timely interventions. We suggest -after 10 years from radiotherapy- a screening every 2–3 years.
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Affiliation(s)
- Chiara Lestuzzi
- Azienda Sanitaria Friuli Occidentale (ASFO) Department of Cardiology, Cardiology and Cardio-Oncology Rehabilitation Service, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Maurizio Mascarin
- Adolescents and Young Adults (AYA) Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Coassin
- Adolescents and Young Adults (AYA) Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Maria Laura Canale
- Cardiology Department, Azienda Usl Toscana Nord-Ovest, Ospedale Versilia, Camaiore, Italy
| | - Fabio Turazza
- Cardiology Unit, Istituto Nazionale Tumori (INT), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Milan, Italy
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Abstract
BACKGROUND A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. OBJECTIVE The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. METHODS We used Rodgers' evolutionary method and articles published between January 2013 and December 2020. RESULTS We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. CONCLUSIONS Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. IMPLICATIONS FOR PRACTICE Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.
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Ürek D, Uğurluoğlu Ö. Predictors of financial toxicity and its associations with health-related quality of life and treatment non-adherence in Turkish cancer patients. Support Care Cancer 2021; 30:865-874. [PMID: 34392415 DOI: 10.1007/s00520-021-06491-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aims to determine the financial toxicity (FT) level in cancer patients, identify the risk factors associated with this level, and reveal the effect of this level on patient outcomes (health-related quality of life (HRQoL) and treatment non-adherence). METHODS The data of 316 cancer patients, who were receiving inpatient treatment in an oncology hospital affiliated to a public university in Ankara, Turkey, were ≥ 18 years old, and were receiving chemotherapy for at least 3 months, were evaluated. The data were collected through a face-to-face interview. FT was measured with the COmprehensive Score for financial Toxicity (COST) Measure (v2), HRQoL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G) Scale (v4), and treatment adherence was measured using a questionnaire created by conducting a literature review. RESULTS Patients were found to experience FT above the moderate level (mean ± SD, 21.85 ± 12.02; median value, 24.0). Younger age, being married, low education level, low monthly household income, and receiving social/economic support for treatment were revealed to be the determinants of high FT. Moreover, as the FT score decreased (as the FT level felt increased), the HRQoL was observed to decrease, and treatment non-adherence increased. CONCLUSION The results indicate that FT problem is also valid for cancer patients in Turkey despite the system of general health insurance. The FT was found to result from socio-economic characteristics rather than the disease and treatment-related characteristics. The significant associations revealed between FT and patient outcomes emphasize the importance of reducing the FT in cancer patients.
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Affiliation(s)
- Duygu Ürek
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe Campus, 06800, Ankara, Turkey.
| | - Özgür Uğurluoğlu
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe Campus, 06800, Ankara, Turkey
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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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35
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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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Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, Esnaola NF, Nasir K. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC: CARDIOONCOLOGY 2021; 3:236-246. [PMID: 34396329 PMCID: PMC8352280 DOI: 10.1016/j.jaccao.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Background Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.
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Affiliation(s)
- Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
| | - Fouad Chouairi
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Rohan Khera
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Gowtham R Grandhi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anshul Saxena
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida, USA
| | - Haider J Warraich
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas, USA
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Farzan Sasangohar
- Center for Outcomes Research, Houston Methodist, Houston, Texas, USA.,Department of Industrial and Systems Engineering, Texas A&M College of Engineering, Texas A&M University, College Station, Texas, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Nestor F Esnaola
- Cancer Center, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Surgical Oncology, Fox Chase Cancer Center-Temple Health, Philadelphia, Pennsylvania, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.,Center for Outcomes Research, Houston Methodist, Houston, Texas, USA
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Hsu CD, Nichols HB, Lund JL. Polypharmacy and medication use by cancer history in a nationally representative group of adults in the USA, 2003-2014. J Cancer Surviv 2021; 16:659-666. [PMID: 34032998 DOI: 10.1007/s11764-021-01059-x] [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: 03/10/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study examines polypharmacy and prescription drug use patterns in cancer survivors, a growing population at risk for cancer sequelae and side effects from treatment, which can arise months or even years following diagnosis. Survivors may experience greater medication burden than the general population, increasing concerns for polypharmacy and subsequent risks of drug interactions and non-adherence. METHODS Using the National Health and Nutrition Examination Survey (NHANES) data from 2003 to 2014, we examined the association between a cancer history and presence of polypharmacy (5+ medications). We estimated prevalence ratios and prevalence differences for polypharmacy comparing those with and without a cancer history using binomial regression models and propensity score (PS) weighting to account for baseline differences between groups. RESULTS We identified 32,238 adults aged 20 years or older; 1899 had cancer (excluding non-melanoma skin) at least 1 year before the survey. Overall, polypharmacy prevalence was 13% and 35% in those with and without a cancer history, respectively. After PS weighting, the polypharmacy prevalence was 1.26 times higher among those with versus without a cancer history (weighted prevalence ratio, 1.26; 95% CI, 1.18, 1.35). In sub-group analyses, the weighted prevalence ratio was largest for those 20-39 years old at survey (2.78; 95% CI, 1.71, 4.53), and the weighted prevalence difference was largest for those 40-64 years old at survey (9.35%; 95% CI, 5.70%, 13.01%). CONCLUSIONS/IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors of all ages take more medications than those without cancer history and may benefit from discussions with providers about age-tailored medication use management.
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Affiliation(s)
- Christine D Hsu
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Hazel B Nichols
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Pandrangi VC, Farrell NF, Mace JC, Detwiller KY, Smith TL, Geltzeiler M. Perceived Financial Insecurity Impacts Healthcare Decision-Making Among Patients With Sinusitis. Laryngoscope 2021; 131:2403-2412. [PMID: 33851727 DOI: 10.1002/lary.29561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/16/2021] [Accepted: 04/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS The economic burden of sinusitis is significant, and socioeconomic factors can impact patient decision-making. The purpose of this study was to examine the impact of perceived financial insecurity on healthcare decision-making and treatment compliance among sinusitis patients. STUDY DESIGN Cross-sectional study using the 2018 National Health Interview Survey. METHODS Survey responses to nine questions regarding financial stressors and nine questions regarding cost-saving healthcare actions were recorded, which included seeking lower cost medication, medication noncompliance, and avoiding care visits due to costs. RESULTS There was a total weighted sample size of 28.9 million patients who self-reported a diagnosis of sinusitis (12% of the U.S. population). Sinusitis patients who reported cost-saving actions had an increased severity of perceived financial insecurity than those without cost-saving actions (P < .001). Sinusitis patients with perceived financial insecurity had the highest odds of at least one cost-saving action (odds ratio [OR] = 5.94, 95% CI = 5.911-5.970, P < .001), followed by lack of health insurance (OR = 5.13, 95% CI = 5.107-5.159, P < .001), and poor self-reported health status (OR = 2.81, 95% CI = 2.792-2.822, P < .001). Increasing the number of financial stressors increased the odds of at least one cost-saving action (P < .001). Across all financial stressors, the most commonly performed cost-saving action was asking for lower cost medication. CONCLUSIONS Perceived financial insecurity is associated with cost-saving healthcare actions among sinusitis patients, including treatment noncompliance. Interventions to assess financial insecurity among sinusitis patients may facilitate shared decision-making for optimal, individualized treatment plans that may lead to improved outcomes and quality of life. LEVEL OF EVIDENCE NA. Laryngoscope, 2021.
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Affiliation(s)
- Vivek C Pandrangi
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nyssa Fox Farrell
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, USA
| | - Jess C Mace
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Kara Y Detwiller
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
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Lu AD, Zheng Z, Han X, Qi R, Zhao J, Yabroff KR, Nathan PC. Medical Financial Hardship in Survivors of Adolescent and Young Adult Cancer in the United States. J Natl Cancer Inst 2021; 113:997-1004. [PMID: 33839786 DOI: 10.1093/jnci/djab013] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/27/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States. METHODS We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress], and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately. RESULTS A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P < .001) and behavioral (28.4% vs 21.2%, P < .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P < .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior. CONCLUSIONS Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors' health, and multifaceted interventions are necessary to address underlying causes.
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Affiliation(s)
- Amy D Lu
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Ruowen Qi
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
| | - Paul C Nathan
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
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40
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Abdel-Rahman O, North S. Patterns of cost-related medication underuse among Canadian adults with cancer: a cross-sectional study using survey data. CMAJ Open 2021; 9:E474-E481. [PMID: 33958383 PMCID: PMC8157980 DOI: 10.9778/cmajo.20200186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cost-related medication underuse (CRMU) has been reported within the general population in Canada. In this study, we assessed patterns of CRMU among Canadian adults with cancer. METHODS This is a cross-sectional study using survey data. We accessed data sets from the 2015/16 Canadian Community Health Survey (CCHS) and reviewed the records of adults (≥ 18 yr) with a history of cancer who were prescribed medication in the previous 12 months. We collected information about sociodemographic features, health behaviours and CRMU, and conducted a multivariable logistic regression analysis for factors associated with CRMU. RESULTS A total of 8581 participants were eligible for the current study. In the weighted multivariable logistic regression analysis, the following factors were associated with CRMU: younger age (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.79-3.63), female sex (male sex v. female sex OR 0.62, 95% CI 0.44-0.88), Indigenous racial background (Indigenous v. White OR 2.37, 95% CI 1.49- 3.77), unmarried status (OR 1.59, 95% CI 1.09-2.30), poor self-perceived health (excellent v. poor self-perceived health OR 0.36, 95% CI 0.17-0.77), lower annual income (< $20 000 v. income ≥ $80 000 OR 3.08, 95% CI 1.75-5.41) and lack of insurance for prescription medications (OR 2.49, 95% CI 1.77-3.50). INTERPRETATION The toll of CRMU among adults seems to be unequally carried by women, racial minorities, and younger (< 65 yr) and uninsured patients with cancer. Discussion about a national pharmacare program for people without private insurance is needed.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta.
| | - Scott North
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alta
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41
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Belsky JA, Holmes C, Stanek J, Yeager ND, Audino AN. Evaluating Perspectives of a Smartphone Medication Application in the Adolescent and Young Adult Oncology Population: A Qualitative Study. J Adolesc Young Adult Oncol 2020; 10:282-287. [PMID: 32960135 DOI: 10.1089/jayao.2020.0113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Medication adherence research involving adolescent and young adult (AYA) oncology patients has consisted of small, retrospective studies demonstrating poor adherence rates. Technology plays an active role in attempt to improve medication adherence. There is a growing body of literature investigating the role of smartphone applications (apps). We hypothesized a medication phone app, MedActionPlan Pro (MPP), leads to perceived improvement in medication adherence. Methods: Thirty AYA oncology patients actively receiving treatment (AYA defined as 15-30 years) at Nationwide Children's Hospital were enrolled. Participants downloaded the MPP app on their smartphone for 3 months, during which time participants were provided text messages and alerts to encourage medication adherence. Post-app use, participants completed semi-structured interviews. Interviews were audio-recorded, transcribed, and independently coded to determine consensus thematic content. Results: Thirty AYA oncology participants (16 male), median age 17.5 (range: 15-30 years), participated in the study, with 22 participants (55% male) with a median age of 18 years (range: 15-30 years) participated in the final qualitative survey interview. Participants reported positive views about app utilization and perceived improved medication adherence. Additional themes included perceived decreased forgetfulness, improved organization, and identified customization for medications within the app was most important to AYAs. Conclusion: AYA oncology patients reported improvement in perceived medication adherence utilizing MPP and identified several features they thought would lead to improved medication adherence. These findings, integrated with previous literature, support the further need to investigate the utility of medication adherence apps that fit the unique needs of AYA oncology patients.
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Affiliation(s)
- Jennifer A Belsky
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Caitlin Holmes
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nicholas D Yeager
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Anthony N Audino
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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Khera R, Valero-Elizondo J, Nasir K. Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. J Am Heart Assoc 2020; 9:e017793. [PMID: 32924728 PMCID: PMC7792407 DOI: 10.1161/jaha.120.017793] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
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Cuglievan B, Berkman A, Dibaj S, Wang J, Andersen CR, Livingston JA, Gill J, Bleyer A, Roth M. Impact of Lagtime, Health Insurance Type, and Income Status at Diagnosis on the Long-Term Survival of Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2020; 10:164-174. [PMID: 32678703 DOI: 10.1089/jayao.2020.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: Delays in diagnosis can affect the short-term survival outcomes of adolescent and young adult (AYA) cancer patients. We sought to determine the extent to which delayed diagnosis, health insurance type, and income status are associated with the long-term survival of AYA cancer patients. Methods: We reviewed an institutional cohort of 268 patients age 15-29 years who were diagnosed with the most common neoplasms of the AYA population between 2001 and 2003. We grouped patients by the time of onset of cancer symptomatology to verified diagnosis (lagtime to diagnosis; short or long), health insurance type at diagnosis (public or private), zip-code-based median household income (≤U.S. $50,000 or >U.S. $50,000), and demographic variables. Overall survival (OS) and late OS (LOS; the time from the 5-year anniversary of cancer diagnosis to death from any cause) were the outcomes of interest. Results: OS and LOS did not differ between those with short or long lagtimes to diagnosis for all cancer and for specific cancer types. Among patients with long lagtimes, those with private insurance had significantly better LOS than those with public insurance (p = 0.03). Compared with those who had public insurance, patients who had private insurance at diagnosis had significantly better LOS (p = 0.008). Patients with household incomes >U.S. $50,000 had better LOS than those with household incomes ≤U.S. $50,000 (p = 0.02). Patients with public insurance and household incomes ≤U.S. $50,000 had the poorest LOS. Conclusions: AYA cancer patients with either public health insurance or a low household income at diagnosis are at risk of an inferior LOS.
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Affiliation(s)
- Branko Cuglievan
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Berkman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Seyedeh Dibaj
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jian Wang
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R Andersen
- Divisions of Biostatistics and The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John A Livingston
- Divisions of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan Gill
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Michael Roth
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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44
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Vandermorris A, Sampson L, Korenblum C. Promoting adherence in adolescents and young adults with cancer to optimize outcomes: A developmentally oriented narrative review. Pediatr Blood Cancer 2020; 67:e28128. [PMID: 31886630 DOI: 10.1002/pbc.28128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 01/03/2023]
Abstract
Adherence is a critical consideration in ongoing efforts to improve outcomes among adolescents and young adults (AYAs) with cancer. In this narrative review, we embed existing conceptualizations of adherence within a developmental context to provide a novel vantage point from which to examine this important issue. Applying this developmentally oriented framework, we summarize the most current literature on strategies to enhance adherence in the AYA population. A developmentally informed approach to working with AYAs can elucidate unique strengths and vulnerabilities of this population and offer a new perspective on opportunities to respond to biopsychosocial barriers to adherence in a strengths-based, collaborative manner.
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Affiliation(s)
- Ashley Vandermorris
- Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
| | - Lorna Sampson
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Chana Korenblum
- Princess Margaret Cancer Centre, University Health Network, Division of Adolescent Medicine, Department of Paediatrics, SickKids Hospital and University of Toronto, Toronto, Canada
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45
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Oates GR, Juarez LD, Hansen B, Kiefe CI, Shikany JM. Social Risk Factors for Medication Nonadherence: Findings from the CARDIA Study. Am J Health Behav 2020; 44:232-243. [PMID: 32019655 DOI: 10.5993/ajhb.44.2.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Nonadherence to medications has been documented, but the combined effect of social risk factors on medication nonadherence has not been investigated. Methods: We conducted a cross-sectional analysis of data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based prospective cohort. The sample (N = 1506) included subjects who at Year 20 (2005-06) were taking prescription medications and completed a 4-item Medication Adherence Scale. Social risk factors were education of high school or less, annual household income <$25,000, high financial strain, high chronic stress, low social support, and high social strain. Results: In a fully adjusted logistic regression model, income <$25,000 (OR = 2.37 [95% CI 1.12-4.98], p < .05) and high chronic stress (OR = 2.07 [95% CI 1.09-3.94], p < .05) were significantly associated with medication nonadherence. Individuals with ≥3 social risk factors had >3 times higher odds of nonadherence than counterparts with no social risk factors (OR = 3.26 [95% CI 1.72-6.19], p < .001). Conclusion: Low income and chronic stress are associated with medication nonadherence, and the odds of nonadherence increase with the accumulation of social risk factors. Findings may be used to develop risk prediction tools to identify individuals who can benefit from adherence-promoting interventions.
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Affiliation(s)
- Gabriela R. Oates
- Assistant Professor of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL.,
| | - Lucia D. Juarez
- Scientist III, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara Hansen
- Scientist I, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Catarina I. Kiefe
- Professor and Chair, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - James M. Shikany
- Professor of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
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46
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Tangka FKL, Subramanian S, Jones M, Edwards P, Flanigan T, Kaganova Y, Smith KW, Thomas CC, Hawkins NA, Rodriguez J, Fairley T, Guy GP. Insurance Coverage, Employment Status, and Financial Well-Being of Young Women Diagnosed with Breast Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:616-624. [PMID: 32132129 PMCID: PMC7909848 DOI: 10.1158/1055-9965.epi-19-0352] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic cost of breast cancer is a major personal and public health problem in the United States. This study aims to evaluate the insurance, employment, and financial experiences of young female breast cancer survivors and to assess factors associated with financial decline. METHODS We recruited 830 women under 40 years of age diagnosed with breast cancer between January 2013 and December 2014. The study population was identified through California, Florida, Georgia, and North Carolina population-based cancer registries. The cross-sectional survey was fielded in 2017 and included questions on demographics, insurance, employment, out-of-pocket costs, and financial well-being. We present descriptive statistics and multivariate analysis to assess factors associated with financial decline. RESULTS Although 92.5% of the respondents were continuously insured over the past 12 months, 9.5% paid a "higher price than expected" for coverage. Common concerns among the 73.4% of respondents who were employed at diagnosis included increased paid (55.1%) or unpaid (47.3%) time off, suffering job performance (23.2%), and staying at (30.2%) or avoiding changing (23.5%) jobs for health insurance purposes. Overall, 47.0% experienced financial decline due to treatment-related costs. Patients with some college education, multiple comorbidities, late stage diagnoses, and self-funded insurance were most vulnerable. CONCLUSIONS The breast cancer diagnosis created financial hardship for half the respondents and led to myriad challenges in maintaining employment. Employment decisions were heavily influenced by the need to maintain health insurance coverage. IMPACT This study finds that a breast cancer diagnosis in young women can result in employment disruption and financial decline.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | | | | | | | | | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A Hawkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juan Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Temeika Fairley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kaddas HK, Pannier ST, Mann K, Waters AR, Salmon S, Tsukamoto T, Warner EL, Fowler B, Lewis MA, Fair DB, Kirchhoff AC. Age-Related Differences in Financial Toxicity and Unmet Resource Needs Among Adolescent and Young Adult Cancer Patients. J Adolesc Young Adult Oncol 2020; 9:105-110. [PMID: 31524556 PMCID: PMC7047093 DOI: 10.1089/jayao.2019.0051] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Financial toxicity may differ by age at diagnosis between adolescents and young adults (AYAs) with cancer. We surveyed 52 AYA cancer patients about unmet needs and financial toxicity using the COmprehensive Score for financial Toxicity (COST). We compared outcomes by age at diagnosis (15-25-year olds [n = 25, 48%] vs. 26-39-year olds [n = 27, 52%]). AYAs diagnosed ages 26-39 reported that cancer negatively affected their finances more than 15-25-year olds (77.8% vs. 37.5%, p = 0.0005). Lower mean COST scores among those diagnosed ages 26-39 indicated greater financial toxicity compared to those 15-25 years (18.22 vs. 24.84, p = 0.02). Financial burden appears to be greater for older AYAs with cancer.
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Affiliation(s)
- Heydon K. Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Samantha T. Pannier
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karely Mann
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Austin R. Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Sara Salmon
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Brynn Fowler
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Douglas B. Fair
- Intermountain Healthcare, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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48
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Khera R, Valero-Elizondo J, Das SR, Virani SS, Kash BA, de Lemos JA, Krumholz HM, Nasir K. Cost-Related Medication Nonadherence in Adults With Atherosclerotic Cardiovascular Disease in the United States, 2013 to 2017. Circulation 2019; 140:2067-2075. [DOI: 10.1161/circulationaha.119.041974] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background:
Medication nonadherence is associated with worse outcomes in patients with atherosclerotic cardiovascular disease (ASCVD), a group who requires long-term therapy for secondary prevention. It is important to understand to what extent drug costs, which are potentially actionable factors, contribute to medication nonadherence.
Methods:
In a nationally representative survey of US adults in the National Health Interview Survey (2013–2017), we identified individuals ≥18 years with a reported history of ASCVD. Participants were considered to have experienced cost-related nonadherence (CRN) if in the preceding 12 months they reported skipping doses to save money, taking less medication to save money, or delaying filling a prescription to save money. We used survey analysis to obtain national estimates.
Results:
Of the 14 279 surveyed individuals with ASCVD, a weighted 12.6% (or 2.2 million [95% CI, 2.1–2.4]) experienced CRN, including 8.6% or 1.5 million missing doses, 8.8% or 1.6 million taking lower than prescribed doses, and 10.5% or 1.9 million intentionally delaying a medication fill to save costs. Age <65 years, female sex, low family income, lack of health insurance, and high comorbidity burden were independently associated with CRN, with >1 in 5 reporting CRN in these subgroups. Survey respondents with CRN compared with those without CRN had 10.8-fold higher odds of requesting low-cost medications and 8.9-fold higher odds of using alternative, nonprescription, therapies.
Conclusions:
One in 8 patients with ASCVD reports nonadherence to medications because of cost. The removal of financial barriers to accessing medications, particularly among vulnerable patient groups, may help improve adherence to essential therapy to reduce ASCVD morbidity and mortality.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., S.R.D., J.A.d.L.)
| | - Javier Valero-Elizondo
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (J.V.-E., H.M.K.)
| | - Sandeep R. Das
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., S.R.D., J.A.d.L.)
| | - Salim S. Virani
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Bita A. Kash
- Center for Outcomes Research, Houston Methodist Research Institute, TX (B.A.K.)
- School of Public Health, Texas A&M University, College Station (B.A.K.)
| | - James A. de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., S.R.D., J.A.d.L.)
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (J.V.-E., H.M.K.)
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.)
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart & Vascular Center & Center for Outcomes Research Houston Methodist, Houston, TX (K.N.)
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Salsman JM, Bingen K, Barr RD, Freyer DR. Understanding, measuring, and addressing the financial impact of cancer on adolescents and young adults. Pediatr Blood Cancer 2019; 66:e27660. [PMID: 30756484 PMCID: PMC6777708 DOI: 10.1002/pbc.27660] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 01/06/2023]
Abstract
The financial impact of cancer treatment among adolescents and young adults (AYAs, 15-39 years) is deep and long lasting. Compared with other age groups, because of their life stage, AYAs are particularly vulnerable to the adverse economic effects of cancer treatment, also known as financial toxicity. Clinical manifestations of cancer-related financial toxicity include interrupted work and income loss, accumulated debt, treatment nonadherence, avoidance of medical care, and social isolation. Effective clinical interventions should include efforts to increase financial self-efficacy as well as direct support. Measures that are valid, reliable, multidimensional, and age-appropriate are needed to study and address financial toxicity in the AYA population.
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Affiliation(s)
- John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina,Wake Forest Baptist Comprehensive Cancer Center,Winston-Salem, North Carolina
| | - Kristin Bingen
- Division of Hematology/Oncology/Blood and MarrowTransplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee,Wisconsin
| | - Ronald D. Barr
- Division of Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, Canada
| | - David R. Freyer
- Children’s CenterforCancerand Blood Diseases,Children’s Hospital LosAngeles, Los Angeles,California,USC Norris Comprehensive Cancer Center, Los Angeles, California,Departments of Pediatrics and Medicine, Keck School of Medicine, University of Southern California, LosAngeles, California
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50
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How I treat chronic myeloid leukemia in children and adolescents. Blood 2019; 133:2374-2384. [PMID: 30917954 DOI: 10.1182/blood.2018882233] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/21/2019] [Indexed: 12/15/2022] Open
Abstract
Evidence-based recommendations have been established for treatment of chronic myeloid leukemia (CML) in adults treated with tyrosine kinase inhibitors (TKIs), but the rarity of this leukemia in children and adolescents makes it challenging to develop similar recommendations in pediatrics. In addition to imatinib, which was approved for pediatric CML in 2003, the second-generation TKIs dasatinib and nilotinib were recently approved for use in children, expanding the therapeutic options and pushing allogeneic stem cell transplantation to a third-line treatment of most pediatric cases. Yet, without sufficient data on efficacy and safety specific to pediatric patients, the selection of a TKI continues to rely on clinical experience in adults. Here, we present 4 case scenarios highlighting common yet challenging issues encountered in the treatment of pediatric CML (suboptimal response, poor treatment adherence, growth retardation, and presentation in advanced phases). Limited experience with very young children, the transition of teenagers to adult medicine, and the goal of achieving treatment-free remission for this rare leukemia are additional significant obstacles that require further clinical investigation through international collaboration.
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