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Samaha NL, Mady LJ, Armache M, Hearn M, Stemme R, Jagsi R, Gharzai LA. Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review. J Am Coll Radiol 2024; 21:1380-1397. [PMID: 38762031 DOI: 10.1016/j.jacr.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT. METHODS A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States. RESULTS Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies. DISCUSSION FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.
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Affiliation(s)
- Nadia L Samaha
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madison Hearn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rachel Stemme
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reshma Jagsi
- Chair, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois.
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Wu VS, Khlopin M, Chadha M, Smith-Graziani DJ, Jagsi R, McClelland S. Out-of-Pocket Cost Modeling of Adjuvant Antiestrogen and Radiation Therapy After Lumpectomy for Early-Stage Breast Cancer Across Medicaid and Medicare Plans. Int J Radiat Oncol Biol Phys 2024; 119:1379-1385. [PMID: 38432284 DOI: 10.1016/j.ijrobp.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The optimal adjuvant therapy (antiestrogen therapy [ET] + radiation therapy or ET alone, or in some reports radiation therapy alone) in older women with early-stage breast cancer has been highly debated. However, granular details on the role of insurance in the out-of-pocket cost for patients receiving ET with or without radiation therapy are lacking. This project disaggregates out-of-pocket costs by insurance plans to increase treatment cost transparency. METHODS AND MATERIALS Several radiation therapy schedules are accepted standards as per the National Comprehensive Cancer Network guidelines. For our financial estimate model, we used the 5-fraction and 15-fraction radiation therapy and ET prescribed over a 5-year duration. The total aggregate out-of-pocket costs were determined from the sum of treatment costs, deductibles, and copays/coinsurance based on Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D Rx plans. The model assumes a Medicare- and/or Medicaid-eligible patient ≥70 years of age with node-negative, early-stage estrogen-receptor-positive breast cancer. Patient out-of-pocket costs were estimated from publicly available insurance data from plan-specific benefit coverage materials using a 5-year time horizon. RESULTS Original Medicare beneficiaries face a total out-of-pocket treatment charge of $2738.52 for ET alone, $2221.26 for 5-fraction radiation therapy alone, $2573.92 for 15-fraction radiation therapy alone, $3361.26 for combined ET+ 5-fraction radiation therapy, and $3713.92 for combined ET + 15-fraction radiation therapy. Medigap Plan G beneficiaries have an out-of-pocket charge of $1130.00 with radiation therapy alone and face an out-of-pocket of $2270.00 for ET alone and combined ET+ radiation therapy. For Medicaid beneficiaries, all treatments approved by Medicaid are covered without limit, resulting in no out-of-pocket expense for either adjuvant treatment option. CONCLUSIONS This model (based on actual cost estimates per insurance plan rather than claims data), by estimating expenses within Medicare and Medicaid plans, provides a level of transparency to patient cost. With knowledge of the costs borne by patients themselves, treatment decisions informed by patients' individual priorities and preferences may be further enhanced.
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Affiliation(s)
- Victoria S Wu
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Martha Khlopin
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Manjeet Chadha
- Department of Radiation Oncology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Demetria J Smith-Graziani
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Shearwood McClelland
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Neurological Surgery, University Hospitals Cleveland Medical Center Case Western Reserve University, Cleveland, Ohio.
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Myers SP, Aviki E, Sevilimedu V, Thom B, Gemignani ML. Financial Toxicity Among Women with Breast Cancer Varies by Age and Race. Ann Surg Oncol 2024:10.1245/s10434-024-15895-5. [PMID: 39078600 DOI: 10.1245/s10434-024-15895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Financial toxicity negatively affects clinical outcomes in breast cancer. Underrepresented demographics may be at higher risk for financial toxicity. We characterized disparities on the basis of age and other factors. PATIENTS AND METHODS Surveys completed by women with stage 0-IV breast cancer treated at Memorial Sloan Kettering Cancer Center between 06/2022 and 05/2023 were analyzed. The comprehensive score for financial toxicity (COST) scale was used to assess financial toxicity. Descriptive statistics were calculated for differences in financial toxicity/related factors, and outcomes by age and race. Associations between variables of interest and COST scores were analyzed using linear regression. RESULTS Of 8512 respondents (75% white, 9.3% Asian, 8.4% Black), most (68%) had clinical stage 0/I disease. Stratified by age, young Black women had higher financial toxicity than young white or Asian women (p < 0.001). On multivariable analysis, women age < 45 years experienced higher financial toxicity than older women (coefficient - 2.0, 95% CI - 2.8 to - 1.1, p < 0.001). Compared with white women, financial toxicity was greater among Black (coefficient - 6.8, 95% CI - 7.8 to - 5.8) and Asian women (coefficient - 3.5, 95% CI - 4.4 to - 2.5). Cost-related medication non-adherence was more frequent among Black and Asian women (p < 0.001). Asian women more often paid for treatment with savings than white and Black women (p < 0.001). Young women reported using savings for treatment-related costs more than older (45% vs. 32%); p < 0.001). CONCLUSIONS Racial minorities and young patients are disproportionately affected by financial toxicity. Further studies are planned to determine how financial toxicity evolves over time and whether referral to financial services effectively reduces toxicity.
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Affiliation(s)
- Sara P Myers
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline Aviki
- Division of Gynecologic Oncology, NYU Langone Health, Mineola, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA.
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Huang H, Yang Z, Dong Y, Wang YQ, Wang AP. Cancer cost-related subjective financial distress among breast cancer: a scoping review. Support Care Cancer 2024; 32:484. [PMID: 38958768 DOI: 10.1007/s00520-024-08698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This article provided a comprehensive scoping review, synthesizing existing literature on the financial distress faced by breast cancer patients. It examined the factors contributing to financial distress, the impact on patients, coping mechanisms employed, and potential alleviation methods. The goal was to organize existing evidence and highlight possible directions for future research. METHODS We followed the scoping review framework proposed by the Joanna Briggs Institute (JBI) to synthesize and report evidence. We searched electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, for relevant literature. We included English articles that met the following criteria: (a) the research topic was financial distress or financial toxicity, (b) the research subjects were adult breast cancer patients, and (c) the article type was quantitative, qualitative, or mixed-methods research. We then extracted and integrated relevant information for reporting. RESULTS After removing duplicates, 5459 articles were retrieved, and 43 articles were included based on the inclusion and exclusion criteria. The articles addressed four main themes related to financial distress: factors associated with financial distress, impact on breast cancer patients, coping mechanisms, and potential methods for alleviation. The impact of financial distress on patients was observed in six dimensions: financial expenses, financial resources, social-psychological reactions, support seeking, coping care, and coping lifestyle. While some studies reported potential methods for alleviation, few discussed the feasibility of these solutions. CONCLUSIONS Breast cancer patients experience significant financial distress with multidimensional impacts. Comprehensive consideration of possible confounding factors is essential when measuring financial distress. Future research should focus on exploring and validating methods to alleviate or resolve this issue.
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Affiliation(s)
- Hao Huang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Zhen Yang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Yu Dong
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Yu Qi Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Ai Ping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
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Hirata Y, To C, Lyu H, Smith GL, Samuel JP, Tran Cao HS, Badgwell BD, Katz MHG, Ikoma N. Prevalence of and Factors Associated with Financial Toxicity After Pancreatectomy and Gastrectomy. Ann Surg Oncol 2024; 31:4361-4370. [PMID: 38536586 DOI: 10.1245/s10434-024-15236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/12/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Financial toxicity (FT) refers to the adverse impact of cancer treatment costs on patients' experiences, potentially leading to poor adherence to treatment and outcomes. However, the prevalence of FT among patients undergoing major upper gastrointestinal cancer operations, as well as factors associated with FT, remain unclear. METHODS We conducted a cross-sectional study by sending the Comprehensive Score for financial Toxicity (COST) survey and Surgery-Q (a survey specifically developed for this study) to patients who underwent gastrectomy or pancreatectomy for malignant disease at our institution in 2019-2021. RESULTS We sent the surveys to 627 patients and received responses from 101 (16%) patients. The FT prevalence (COST score <26) was 48 (48%). Patients likely to experience FT were younger than 50 years of age, of non-White race, earned an annual income <$75,000, and had credit scores <740 (all p < 0.05). Additionally, longer hospital stay (p = 0.041), extended time off work for surgery (p = 0.011), and extended time off work for caregivers (p = 0.005) were associated with FT. Procedure type was not associated with FT; however, patients who underwent minimally invasive surgery (MIS) had a lower FT probability (p = 0.042). In a multivariable analysis, age <50 years (p = 0.031) and credit score <740 (p < 0.001) were associated with high FT risk, while MIS was associated with low FT risk (p = 0.024). CONCLUSIONS Patients with upper gastrointestinal cancer have a major risk of FT. In addition to predicting the FT risk before surgery, facilitating quicker functional recovery with the appropriate use of MIS is considered important to reducing the FT risk.
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Affiliation(s)
- Yuki Hirata
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Connie To
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lyu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joyce P Samuel
- Division of Pediatric Nephrology and Hypertension, The University of Texas Health Science Center-Houston, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Lam AB, Nipp RD, Hasler JS, Hu BY, Zahner GJ, Robbins S, Wheeler SB, Tagai EK, Miller SM, Peppercorn JM. National survey of patient perspectives on cost discussions among recipients of copay assistance. Oncologist 2024:oyae148. [PMID: 38864681 DOI: 10.1093/oncolo/oyae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Individuals with cancer and other medical conditions often experience financial concerns from high costs-of-care and may utilize copay assistance programs (CAP). We sought to describe CAP recipients' experiences/preferences for cost discussions with clinicians. METHODS We conducted a national, cross-sectional electronic-survey from 10/2022 to 11/2022 of CAP recipients with cancer or autoimmune conditions to assess patient perspectives on cost discussions. We used multivariable logistic regression models to explore associations of patient perspectives on cost discussions with patient characteristics and patient-reported outcomes (eg, financial toxicity, depression/anxiety, and health literacy). RESULTS Among 1,566 participants, 71% had cancer and 29% had autoimmune conditions. Although 62% of respondents desired cost discussions, only 32% reported discussions took place. Additionally, 52% of respondents wanted their doctor to consider out-of-pocket costs when deciding the best treatment, and 61% of respondents felt doctors should ensure patients can afford treatment prescribed. Participants with depression symptoms were more likely to want doctors to consider out-of-pocket costs (OR = 1.54, P = .005) and to believe doctors should ensure patients can afford treatment (OR = 1.60, P = .005). Those with severe financial toxicity were more likely to desire cost discussions (OR = 1.65, P < .001) and want doctors to consider out-of-pocket costs (OR = 1.52, P = .001). Participants with marginal/inadequate health literacy were more likely to desire cost discussions (OR = 1.37, P = .01) and believe doctors should ensure patients can afford treatment (OR = 1.30, P = .036). CONCLUSIONS In this large sample of CAP recipients with cancer and autoimmune conditions, most reported a desire for cost discussions, but under one-third reported such discussions took place.
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Affiliation(s)
- Anh B Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | - Ryan David Nipp
- Section of Hematology and Oncology, Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, United States
| | - Jill S Hasler
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Bonnie Y Hu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Greg J Zahner
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarina Robbins
- HealthWell Foundation, Germantown, MD 20874, United States
| | - Stephanie B Wheeler
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Erin K Tagai
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Jeffrey M Peppercorn
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
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Harris JP, Ku E, Harada G, Hsu S, Chiao E, Rao P, Healy E, Nagasaka M, Humphreys J, Hoyt MA. Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy. Am J Hosp Palliat Care 2024; 41:592-600. [PMID: 37406195 PMCID: PMC10772523 DOI: 10.1177/10499091231187999] [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: 07/07/2023] Open
Abstract
Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Eric Ku
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Garrett Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Sophie Hsu
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Elaine Chiao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Pranathi Rao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Erin Healy
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Misako Nagasaka
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Orange, CA, USA
| | - Jessica Humphreys
- Department of Geriatrics and Extended Care, Division of Palliative Care, Tibor Rubin VA Medical Center, Long Beach, CA, USA
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Michael A Hoyt
- Department of Population Health & Disease Prevention, University of California Irvine, Irvine, CA, USA
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Berkman AM, Choi E, Cheung CK, Salsman JM, Peterson SK, Andersen CR, Lu Q, Livingston JA, Hildebrandt MA, Parsons SK, Roth ME. Socioeconomic Status and Chronic Health Conditions in Asian Survivors of Adolescent and Young Adult Cancers. J Adolesc Young Adult Oncol 2024; 13:262-270. [PMID: 37594775 PMCID: PMC11265642 DOI: 10.1089/jayao.2023.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Purpose: While there are known disparities in socioeconomic status (SES) and health outcomes among racially and ethnically minoritized adolescent and young adult (AYA; ages 15-39 years at diagnosis) cancer survivors compared with White survivors, outcomes in the Asian survivor population are understudied. To better understand the association of an AYA cancer diagnosis with SES and health outcomes within a minoritized population, the current study makes comparisons between individuals of the same race or ethnicity with and without a history of AYA cancer. Methods: Non-Hispanic, Asian AYA cancer survivors and non-Hispanic, Asian age- and sex-matched controls were identified from self-reported data in the National Health Interview Survey (2009-2020). Prevalence of chronic health conditions and socioeconomic factors were compared between groups using chi-square tests. Odds of chronic conditions by SES factors were determined within and between survivors and controls using logistic regression methods. Results: One hundred and thirty-one survivors and 1310 controls were included. Survivors were less likely to be married compared with controls; however, there were no differences in other SES factors examined. Survivors had higher odds of at least one chronic condition diagnosis (odds ratio = 4.17, p < 0.001) compared with controls. Of the chronic conditions assessed, survivors had higher odds of arthritis, pulmonary disease, and hypertension compared with controls. Conclusions: Asian AYA cancer survivors are at increased risk of chronic health conditions compared with Asian individuals without a cancer history. Culturally adapted targeted interventions are needed to improve health outcomes for this population.
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Affiliation(s)
- Amy M. Berkman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eunju Choi
- Department of Nursing, The University of Texas MD Anderson Cancer Center, 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
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clark R. Andersen
- Department of Biostatistics, 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
| | - Michael E. Roth
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Wu VS, Shen X, de Moor J, Chino F, Klein J. Financial Toxicity in Radiation Oncology: Impact for Our Patients and for Practicing Radiation Oncologists. Adv Radiat Oncol 2024; 9:101419. [PMID: 38379894 PMCID: PMC10876607 DOI: 10.1016/j.adro.2023.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/16/2023] [Indexed: 02/22/2024] Open
Abstract
With rising costs of diagnosis, treatment, and survivorship, financial burdens on patients with cancer and negative effects from high costs, called financial toxicity (FT), are growing. Research suggests that FT may be experienced by more than half of working-age cancer survivors and a similar proportion may incur debt or avoid recommended prescription medications due to treatment costs. As FT can lead to worse physical, psychological, financial, and survival outcomes, there is a discrete need to identify research gaps around this issue that constrain the development and implementation of effective screening and innovative care delivery interventions. Prior research, including within a radiation oncology-specific context, has sought to identify the scope of FT among patients with cancer, develop assessment tools to evaluate patient risk, quantify financial sacrifices, and qualify care compromises that occur when cancer care is unaffordable. FT is a multifactorial problem and potential solutions should be pursued at all levels of the health care system (patient-provider, institutional, and systemic) with specific regard for patients' individual/local contexts. Solutions may include selecting alternative treatment schedules, discussing financial concerns with patients, providing financial navigation services, low-cost transportation options, and system-wide health policy shifts. This review summarizes existing FT research, describes tools developed to measure FT, and suggests areas for intervention and study to help improve FT and outcomes for radiation oncology patients.
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Affiliation(s)
- Victoria S. Wu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Medical Center, Kansas City, Kansas
| | - Janet de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Klein
- Department of Radiation Oncology, Maimonides Medical Center and State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
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10
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Gunn AH, Warraich HJ, Mentz RJ. Costs of care and financial hardship among patients with heart failure. Am Heart J 2024; 269:94-107. [PMID: 38065330 DOI: 10.1016/j.ahj.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024]
Abstract
With the implementation of new therapies, more patients are living with heart failure (HF) as a chronic condition. Alongside these advances, out-of-pocket (OOP) medical costs have increased, and patients experience significant financial burden. Despite increasing interest in understanding and mitigating financial burdens, there is a relative paucity of data specific to HF. Here, we explore financial hardship in HF from the patient perspective, including estimated OOP costs for guideline-directed medical therapy for HF with reduced ejection fraction, hospitalizations, and total direct medical costs, as well as the consequences of high OOP costs. Studies estimate that high OOP costs are common in HF, and a large proportion are related to prescription drugs. Subsequently, the effects on patients can lead to worsening adherence, delayed care, and poor outcomes, leading to a financial toxicity spiral. Further, we summarize patients' cost preferences and outline future research that is needed to develop evidence-based solutions to reduce costs in HF.
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Affiliation(s)
- Alexander H Gunn
- Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Haider J Warraich
- Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
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11
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Kinzer H, Lee CN, Cooksey K, Myckatyn T, Olsen MA, Foraker R, Johnson AR, Politi MC. Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice. Womens Health Issues 2024; 34:107-114. [PMID: 38413293 DOI: 10.1016/j.whi.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/21/2024] [Accepted: 01/31/2024] [Indexed: 02/29/2024]
Affiliation(s)
- Hannah Kinzer
- Washington University in St Louis, School of Medicine, St. Louis, Missouri.
| | - Clara N Lee
- University of North Carolina-Chapel Hill, School of Medicine, Chapel Hill, North Carolina
| | - Krista Cooksey
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Terence Myckatyn
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Margaret A Olsen
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Randi Foraker
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Anna Rose Johnson
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
| | - Mary C Politi
- Washington University in St Louis, School of Medicine, St. Louis, Missouri
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12
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Salazar MM, Khera N, Chino F, Johnston E. Financial hardship for patients with cancer and caregivers at end of life in the USA: narrative review. BMJ Support Palliat Care 2024; 14:25-35. [PMID: 38123962 DOI: 10.1136/spcare-2023-004556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients and their families face financial hardship during cancer treatment, which may intensify at end of life (EOL) due to increased symptoms and care needs. We undertook a narrative literature review to describe the current understanding of the causes, impacts and factors associated with financial hardship at EOL. We identify gaps in research, policy and clinical practice and propose steps to mitigate financial hardship for patients and caregivers at EOL. METHODS We conducted a Medline search to identify US studies since 2000 that examined EOL financial hardship for patients with cancer and their caregivers. RESULTS Twenty-seven adult and four paediatric studies met review criteria. Adults with cancer and their caregivers face significant financial hardship at EOL and in bereavement, especially due to employment changes and informal caregiving time costs. Financial hardship may be higher for younger caregivers and for patients who are uninsured, low income, rural, with high symptom burdens or with certain cancer types. The few paediatric studies showed high financial hardship and employment impact lasting well beyond a child's death. CONCLUSIONS There is limited literature examining financial hardship at EOL in the USA, especially in paediatrics. Priorities for future research include longitudinal studies in diverse populations of patients with cancer and informal caregivers using standardised financial hardship measures. Policies to address financial hardship at EOL, especially with hospice care, should include insurance coverage for family caregiving and medical leave policies. There is need for increased financial hardship screening at EOL and in bereavement and a need for financial navigation interventions.
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Affiliation(s)
- Marisa Martinez Salazar
- School of Medicine, Mayo Clinic School of Medicine-Scottsdale Campus, Scottsdale, Arizona, USA
| | - Nandita Khera
- Mayo Clinic School of Medicine, Phoenix, Arizona, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emily Johnston
- Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
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13
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Villalona S, Castillo BS, Chavez Perez C, Ferreira A, Nivar I, Cisneros J, Guerra CE. Interventions to Mitigate Financial Toxicity in Adult Patients with Cancer in the United States: A Scoping Review. Curr Oncol 2024; 31:918-932. [PMID: 38392062 PMCID: PMC10888212 DOI: 10.3390/curroncol31020068] [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: 12/12/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Financial toxicity adversely affects quality of life and treatment outcomes for patients with cancer. This scoping review examined interventions aimed at mitigating financial toxicity in adult patients with cancer and their effectiveness. We utilized five bibliographical databases to identify studies that met our inclusion criteria. The review included studies conducted among adult patients with cancer in the United States and published in English between January 2011 to March 2023. The review identified eight studies that met the inclusion criteria. Each of the studies discussed the implementation of interventions at the patient/provider and/or health system level. Collectively, the findings from this scoping review highlight both the limited number of published studies that are aimed at mitigating financial toxicity and the need to create and assess interventions that directly impact financial toxicity in demographically diverse populations of adult patients with cancer.
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Affiliation(s)
- Seiichi Villalona
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Brenda S. Castillo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Carlos Chavez Perez
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Alana Ferreira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Isoris Nivar
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Juan Cisneros
- Institute for Systems Biology, Seattle, WA 98109, USA;
| | - Carmen E. Guerra
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
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14
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Deboever N, Eisenberg MA, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rajaram R. Perspectives, risk factors, and coping mechanisms in patients with self-reported financial burden following lung cancer surgery. J Thorac Cardiovasc Surg 2024; 167:478-487.e2. [PMID: 37356476 DOI: 10.1016/j.jtcvs.2023.05.044] [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] [Received: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE We evaluated self-reported financial burden (FB) after lung cancer surgery and sought to assess patient perspectives, risk factors, and coping mechanisms within this population. METHODS Patients with lung cancer resected at our institution between January 1, 2016, and December 31, 2021, were surveyed. Descriptive and multivariable analyses were performed to evaluate the association between clinical and financial characteristics with patient-reported major ("significant" or "catastrophic") FB. RESULTS Of 1477 patients contacted, 31.3% (n = 463) completed the survey. Major FB was reported by 62 (13.4%) patients. multivariable analyses demonstrated increasing age (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), credit score >740 (OR, 0.29; 95% CI, 0.14-0.60), and employer-based insurance (OR, 0.24; 95% CI, 0.07-0.80) were protective factors. In contrast, an out of pocket cost greater than expected (OR, 3.63; 95% CI, 1.67-7.88), decrease in work hours (OR, 4.42; 95% CI, 1.59-12.25), or cessation of work (OR, 5.13; 95% CI, 2.06-12.78), chronic obstructive pulmonary disease diagnosis (OR, 5.39, 95% CI, 1.87-15.50), and hospital readmission (OR, 4.87; 95% CI, 1.11-21.42) were risk factors for FB. To pay for care, some patients reported "often" or "always" decreasing food (n = 102 [23.4%]) or leisure spending (n = 179 [40.7%]). Additionally, use of savings (n = 246 [62.9%]), borrowing funds (n = 72 [16.6%]), and skipping clinic visits (n = 36 [8.3%]) at least once were also reported. Coping mechanisms occurred more often in patients with major FB compared with those without (P < .001). CONCLUSIONS Patients with resected lung cancer may experience major FB related to treatment with several identifiable risk factors. Targeted interventions are needed to limit the adoption of detrimental coping mechanisms and potentially affect survivorship.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Michael A Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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15
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Baglien BD, Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion. Semin Plast Surg 2024; 38:39-47. [PMID: 38495060 PMCID: PMC10942833 DOI: 10.1055/s-0043-1778040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, "other") were significantly more likely to prefer a cost-of-care discussion ( p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.
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Affiliation(s)
- Brigit D. Baglien
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nishant Ganesh Kumar
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nicholas L. Berlin
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeyiza O. Momoh
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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16
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Wu VS, Khlopin M, Jagsi R, McClelland S. Out-of-Pocket Cost Modeling of Adjuvant Radiation Therapy Duration in Standard-of-Care Early Stage Breast Cancer Treatment Across Medicaid and Medicare Plans. Pract Radiat Oncol 2024; 14:24-27. [PMID: 37748680 DOI: 10.1016/j.prro.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE For early stage breast cancer (BC), the choice of radiation therapy duration (1 vs 3 weeks) is highly debated. Cost and financial toxicity are major concerns that patients with BC face. Nonetheless, there remain limited discussions providing granular details of the role of insurance in the aggregate cost of 1 week versus 3 weeks of radiation therapy for patients. This project aims to disaggregate costs by plan to increase transparency of out-of-pocket (OOP) cost estimates in radiation therapy. METHODS AND MATERIALS Treatment procedures were determined through the National Comprehensive Cancer Network guidelines. OOP treatment costs, deductibles, and copays/coinsurance were calculated by using Medicaid, Original Medicare, Medigap Plan G, and Medicare Part D prescription plans. The medicare.gov, medicaid.oh.gov, aarpmedicareplans.com, and the physician fee schedule from cms.gov were used to determine costs by treatment. Price estimates reflect actual costs per insurance plan rather than costs estimated from claims data. All procedures were considered to be performed in an Ohio hospital setting. One-week radiation therapy was defined as 5 fractions without boost, and 3-week radiation therapy was defined as 15 fractions without boost. RESULTS Medicare beneficiaries with Original Medicare coverage face an OOP treatment charge of $649.24 for 1 week of radiation therapy and $1006.20 for 3 weeks of radiation therapy. Assuming the deductible is met postlumpectomy, Medigap Plan G beneficiaries are faced with no additional charges for both lengths of radiation therapy. Similarly for Medicaid beneficiaries (assuming treatment is approved by Medicaid), all expenses are covered without limit, resulting in no OOP expense. CONCLUSIONS Considerations of 1 and 3 weeks of radiation therapy for postlumpectomy early-stage BC are often dependent on cancer characteristics and patient preferences. This model (based on actual cost estimates per insurance plan rather than claims data) compares OOP costs across Medicaid and Medicare plans, which more holistically informs providers and patients in radiation therapy duration decision making.
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Affiliation(s)
- Victoria S Wu
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Martha Khlopin
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Shearwood McClelland
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio; Department of Neurological Surgery, University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio.
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17
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Abujaradeh H, Mazanec SR, Sereika SM, Connolly MC, Bender CM, Gordon BB, Rosenzweig M. Economic Hardship and Associated Factors of Women With Early-Stage Breast Cancer Prior to Chemotherapy Initiation. Clin Breast Cancer 2024; 24:36-44. [PMID: 37852896 PMCID: PMC10841408 DOI: 10.1016/j.clbc.2023.09.009] [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: 01/19/2023] [Revised: 07/07/2023] [Accepted: 09/11/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Economic hardship (EH) can negatively influence cancer outcomes. Little is known about the factors that are associated with higher levels of EH among patients with breast cancer (BC). This paper describes EH in women with early-stage BC prior to or at their first chemotherapy treatment (baseline) and explores whether there are differences by race, area deprivation, stress, symptom distress, and social support. PATIENTS AND METHODS A descriptive comparative/correlational design was employed using baseline data of a multisite, longitudinal, multimethod study comparing the symptom experience and management prior to prescribed chemotherapy for women with early-stage BC. Participants completed measures for EH, perceived stress, symptom distress, and social support. Race was measured by self-report. Area deprivation indices (ADI) measuring neighborhood economic factors were calculated from publicly available websites. RESULTS Participants (N = 248; age = 52.9 ± 12.3 years) were 62% White and 38% Black, 54% partnered, and 98% insured. Compared to White patients, Black patients reported higher (worse) EH (1.2 ± 3.0 vs. -0.7 ± 2.4), lived in areas of greater deprivation (80.1 ± 2.1 vs. 50.5 ± 23.5),and were more likely to report inadequate household income (Black: 30.5%; White: 11.1%). Adjusting for race and age, being Black (P< .001), living in an area of greater deprivation (P = .049), higher perceived stress (P = .008), lower perceived appraisal (P = .040), and less tangible support (P < .001) contributed to greater EH. Worse symptom distress trended toward greater EH (P = .07). CONCLUSIONS This study emphasizes the importance of incorporating baseline holistic assessment to identify patients most likely to experience EH during early-stage BC treatment.
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Affiliation(s)
- Hiba Abujaradeh
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Susan M Sereika
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Mary C Connolly
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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18
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Harris T, Brinzo J, Pell C. A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice. J Adv Pract Oncol 2024; 15:16-27. [PMID: 39055367 PMCID: PMC11173661 DOI: 10.6004/jadpro.2024.15.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Background Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. Objective The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. Methods The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Results Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores' observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Conclusion Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.
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Affiliation(s)
- Tina Harris
- From University of North Georgia, Dahlonega, Georgia
| | - Julie Brinzo
- From University of North Georgia, Dahlonega, Georgia
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19
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Shah SA, Zhang Y, Correa AM, Hijaz BA, Yang AZ, Fayanju OM, Cerullo M. Rates of price disclosure associated with the surgical treatment of early-stage breast cancer one year after implementation of federal regulations. Breast Cancer Res Treat 2024; 203:397-406. [PMID: 37851289 DOI: 10.1007/s10549-023-07160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE Mastectomy, breast reconstruction (BR) and breast conserving therapy (BCT) are core components of the treatment paradigm for early-stage disease but are differentially associated with significant financial burdens. Given recent price transparency regulations, we sought to characterize rates of disclosure for breast cancer-related surgery, including mastectomy, BCT, and BR (oncoplastic reconstruction, implant, pedicled flap and free flap) and identify associated factors. METHODS For this cross-sectional analysis, cost reports were obtained from the Turquoise Health price transparency platform for all U.S. hospitals meeting national accreditation standards for breast cancer care. The Healthcare Cost Report Information System was used to collect facility-specific data. Addresses were geocoded to identify hospital referral and census regions while data from CMS was also used to identify the geographic practice cost index. We leveraged a Poisson regression model and relevant Medicare billing codes to analyze factors associated with price disclosure and the availability of an OOP price estimator. RESULTS Of 447 identified hospitals, 221 (49.4%) disclosed prices for mastectomy and 188 42.1%) disclosed prices for both mastectomy and some form of reconstruction including oncoplastic reduction (n = 184, 97.9%), implants (n = 187, 99.5%), pedicled flaps (n = 89, 47.3%), and free flaps (n = 81, 43.1%). Non-profit status and increased market competition were associated with price nondisclosure. 121 hospitals (27.1%) had an out-of-pocket price estimator that included at least one breast surgery. CONCLUSIONS Most eligible hospitals did not disclose prices for breast cancer surgery. Distinct hospital characteristics were associated with price disclosure. Breast cancer patients face persistent difficulty in accessing costs.
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Affiliation(s)
- Shivani A Shah
- Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Yuqi Zhang
- Duke National Clinician Scholar Program, Durham, NC, USA
- Department of Surgery, Yale New Haven Hospital, New Haven, CT, USA
| | - Arlene M Correa
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | - Marcelo Cerullo
- Duke National Clinician Scholar Program, Durham, NC, USA.
- Department of Surgery, Duke University Hospital, Durham, NC, USA.
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20
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Forbat L. Multiple myeloma in people of working age in Czechia, Germany, and Poland: findings from a qualitative interview study. J Cancer Surviv 2023:10.1007/s11764-023-01510-1. [PMID: 38114713 DOI: 10.1007/s11764-023-01510-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The study sought to understand the experiences of working age adults with myeloma and their partner/family members, living in Czechia, Germany, and Poland. METHODS Qualitative interviews were conducted with 36 working age adults living with myeloma, and three family members. Data were collected from May to October 2022. Thematic analysis was applied to the data. RESULTS Healthcare and state support within each country are described. The degree of work engagement was informed by patients' symptom burden, treatment needs, state financial aid, and family/financial obligations. Many did not conceptualise their status as involving 'return to work' as they had continued to be engaged with their jobs throughout. For some, remote working enabled them to manage treatments/side-effects and their job, while avoiding infection. In some cases, patients did not tell their employer or colleagues about their illness, for fear of discrimination. CONCLUSION While experiences varied between countries, common across accounts was a struggle to balance ongoing treatments with employment, at a time when participants were expected to finance their own households and maintain their income and roles. Implications for Cancer Survivors To improve quality of life, clinical discussions around treatment decision-making should take into account patients' attitudes/approach to work, type of work engaged in, and other activities considered important to them. European Union and national cancer plans should set out optimum standards for employers, to ensure an equitable benchmark for how employees are supported. Such approaches would improve legal protections and better enforcement of employer policies to accommodate patients' limitations in the workplace.
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21
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Lee S, Olvera RG, Shiu-Yee K, Rush LJ, Tarver WL, Blevins T, McAlearney AS, Andersen BL, Paskett ED, Carson WE, Chen JC, Obeng-Gyasi S. Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study. Support Care Cancer 2023; 32:24. [PMID: 38095729 DOI: 10.1007/s00520-023-08199-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The rising cost of breast cancer treatment has increased patients' financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients' perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization. METHODS We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches. RESULTS Two overarching themes captured patients' experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients' focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients' lifestyles and outlooks for the future. CONCLUSION Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization.
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Affiliation(s)
- Sandy Lee
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Ramona G Olvera
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Karen Shiu-Yee
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Tessa Blevins
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
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22
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Deboever N, Eisenberg M, Hofstetter WL, Mehran RJ, Rice DC, Roth J, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Antonoff MB, Rajaram R. Financial Toxicity in Patients With Resected Lung Cancer. Ann Surg 2023; 278:1038-1044. [PMID: 37249193 DOI: 10.1097/sla.0000000000005926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To describe financial toxicity (FT) in patients with resected lung cancer and identify risk factors in this population. BACKGROUND FT describes the financial burden associated with cancer care and its impact on the quality of survivorship. Few prior studies have examined FT in patients with lung cancer. METHODS Patients who underwent lung cancer resection at our institution between January 1, 2016 and December 31, 2021, were surveyed to gather demographic information and evaluate FT using a validated questionnaire. A multivariable model was built to identify risk factors for FT. RESULTS Of the total, 1477 patients were contacted, of whom 463 responded (31.3%). Most patients were stage I (n = 349, 75.4%) and lobectomy was performed often (n = 290, 62.8%). There were 196 patients (42.3%) who experienced FT. Upon multivariable analyses, divorced marital status [odds ratio (OR) = 3.658, 95% CI: 1.180-11.337], household income <$40,000 (OR = 2.544, 95% CI: 1.003-6.455), credit score below 739 (OR = 2.744, 95% CI: 1.326-5.679), clinical stage >I (OR = 2.053, 95% CI: 1.088-3.877), and change in work hours or work cessation (all P < 0.05) were associated with FT. Coping mechanisms, such as decreased spending on food or clothing and increased use of savings or borrowing money, were more likely to be reported by patients experiencing FT than those who did not ( P < 0.001). CONCLUSIONS Patients undergoing lung cancer resection often experienced significant financial stress with several identifiable risk factors. FT should be considered early in the care of these patients to alleviate detrimental coping mechanisms and enhance their quality of survivorship.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX
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23
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Masood S, Silverstein MJ. Is it Time to Retire the Term of Low-Grade Ductal Carcinoma in Situ and Replace it With Ductal Neoplasia? Adv Anat Pathol 2023; 30:361-367. [PMID: 37746902 DOI: 10.1097/pap.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
As the leading cause of cancer morbidity and the second leading cause of cancer mortality among women, breast cancer continues to remain a major global public health problem. Consequently, significant attention has been directed toward early breast cancer detection and prevention. As a result, the number of image-detected biopsies has increased, and minimally invasive diagnostic procedures have almost replaced open surgical biopsies. Therefore, pathologists are expected to provide more information with less tissue and diagnose increasing numbers of atypical proliferative breast lesions, in situ lesions, and small breast carcinomas. This is a difficult task, as reflected by continuous reports highlighting the challenges associated with morphologic distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. The current interobserver variability among pathologists to accurately define these two entities often leads to silent overdiagnosis and overtreatment. Up to now, there are no reproducible morphologic features and/or any reliable biomarkers that can accurately separate the above-mentioned entities. Despite these reports, patients diagnosed with low-grade ductal carcinoma in situ are subject to cancer therapy regardless of the fact that low-grade ductal carcinoma in situ is known to be an indolent lesion. Studies have shown that low and high-grade ductal carcinoma in situ are genetically different forms of breast cancer precursors; however, the term ductal carcinoma in situ is followed by cancer therapy regardless of the grade and biology of the tumor. In contrast, patients with the diagnoses of atypical ductal hyperplasia do not undergo cancer therapy. In the current article, attempts are made to highlight the continuous dilemma in distinction between atypical ductal hyperplasia and low-grade ductal carcinoma in situ. Going forward, we suggest that low-grade ductal carcinoma in situ be referred to as ductal neoplasia. This alternative terminology allows for different management and follow-up strategies by eliminating the word carcinoma.
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Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine. University of Florida College of Medicine, Jacksonville
- UF Health Jacksonville Breast Center
- UF Health Jacksonville Laboratories
- UF Health Jacksonville Cancer Program, Jacksonville, FL
| | - Melvin J Silverstein
- Hoag Breast Program, Hoag Memorial Hospital Presbyterian, Newport Beach
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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24
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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25
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Financial navigation: Staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2023; 17:1461-1470. [PMID: 35080699 PMCID: PMC9314461 DOI: 10.1007/s11764-022-01175-2] [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: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe perceptions of financial navigation staff concerning patients' cancer-related financial burden. METHODS This qualitative descriptive study used a semi-structured interview guide to examine perceptions of financial navigation staff concerning patients' cancer-related financial burden. Staff who provided financial navigation support services to cancer patients were interviewed from different types of cancer programs across seven states representing rural, micropolitan, and urban settings. Interviews lasted approximately one hour, were audio recorded, and transcribed. Transcripts were double coded for thematic analysis. RESULTS Thirty-five staff from 29 cancer centers were interviewed. The first theme involved communication issues related to patient and financial navigation staff expectations, timing and the sensitive nature of financial discussions. The second theme involved the multi-faceted impact of financial burden on patients, including stress, difficulty adhering to treatments, and challenges meeting basic, non-medical needs. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer-related financial burden has a profound impact on cancer survivors' health and non-health outcomes. Discussions regarding cancer-related costs between cancer survivors and healthcare team members could help to normalize conversations and mitigate the multi-faceted determinants and effects of cancer-related financial burden. As treatment may span months and years and unexpected costs arise, having this discussion regularly and systematically is needed.
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Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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26
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Saeki S, Iwatani T, Kitano A, Sakurai N, Tanabe Y, Yamauchi C, Igarashi A, Kajimoto Y, Kuba S, Hara F, Sagara Y, Ohno S. Factors associated with financial toxicity in patients with breast cancer in Japan: a comparison of patient and physician perspectives. Breast Cancer 2023; 30:820-830. [PMID: 37310584 PMCID: PMC10404186 DOI: 10.1007/s12282-023-01476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Financial toxicity (FT) is a notable concern for patients with breast cancer worldwide. The situation regarding FT in Japan, however, has not been well explored. This study examined FT in patients with breast cancer in Japan and presented an overview of the group study's overall findings. METHODS The survey used the Questant application and primarily targeted patients with breast cancer attending research facilities and physicians who are members of the Japanese Breast Cancer Society. The Japanese version of the Comprehensive Score for FT (COST) was used to quantify patients' FT. Multiple regression analysis was used to identify factors related to FT in patients with breast cancer in Japan and evaluate the sufficiency of information support level (ISL) for medical expenses. RESULTS We collected 1558 responses from patients and 825 from physicians. In terms of factors affecting FT, recent payments had the highest impact, followed by stage, and related departments positively affecting FT. Conversely, factors such as income, age, and family support were found to negatively affect FT. A significant discrepancy was identified between patients and physicians in perceived information support, with patients frequently feeling unsupported and physicians believing that they have provided adequate support. Furthermore, differences in the frequency of explanations and opportunities to ask questions about medical costs across FT grades were found. The analysis also showed that physicians with a better understanding of information support needs and greater knowledge of medical costs tended to provide more support that is comprehensive. CONCLUSION This study emphasizes the importance of addressing FT in patients with breast cancer in Japan and highlights the need for enhanced information support, deeper understanding by physicians, and collaborative efforts among professionals to mitigate financial burden and provide personalized, tailored support for individual needs.
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Affiliation(s)
- Sumito Saeki
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
- Graduate School of Medicine, Department of Cancer Therapy and Surgery, Tohoku University, Sendai, Japan.
| | - Tsuguo Iwatani
- Department of Breast Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Atsuko Kitano
- Department of Medical Oncology, St Luke's International Hospital, Tokyo, Japan
| | | | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Chikako Yamauchi
- Radiation Therapy Center, Shiga General Hospital, Moriyama, Japan
| | - Ataru Igarashi
- Department of Pharmaceutical Policy, The University of Tokyo, Tokyo, Japan
| | - Yusuke Kajimoto
- Graduate School of Pharmaceutical Sciences, University of Tokyo, Tokyo, Japan
- Oncology Science Unit, MSD K.K, Tokyo, Japan
| | - Sayaka Kuba
- Graduate School of Biomedical Sciences, Department of Surgery, Nagasaki University, Nagasaki, Japan
| | - Fumikata Hara
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yasuaki Sagara
- Department of Breast and Thyroid Surgical Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Shinji Ohno
- Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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27
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Arevalo MVPN, Maslog EAS, Manlongat KD, Ornos EDB, Chitapanarux I, Eala MAB, Dee EC. Social determinants of sex disparities in cancer in Southeast Asia. iScience 2023; 26:107110. [PMID: 37456827 PMCID: PMC10339016 DOI: 10.1016/j.isci.2023.107110] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Sex disparities in cancer exist along the cancer spectrum, ranging from genomic predisposition and behavioral risk factors to access to screening, diagnostics, treatment, and survivorship care. A growing body of research is studying the biological underpinnings of these differences, from cancer risk to tumor biology to treatment response. It is well known, however, that the social determinants of health play a large role across the cancer disease continuum, which encompasses risk, prevention, diagnosis, treatment, survivorship, rehabilitation, and palliative care. Less literature focuses on the gendered disparities that are epidemiologic in nature, especially in Southeast Asia (SEA), a diverse region that is home to nearly 670 million people, where most are lower middle income countries, and where socioeconomic and cultural factors increase cancer risk for women. In this review, we highlight the social drivers of gendered disparities, namely the geographic, environmental, sociocultural, economic, and political forces that contribute to the increased mortality and poorer health outcomes in the region.
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Affiliation(s)
| | | | | | - Eric David B. Ornos
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Michelle Ann B. Eala
- College of Medicine, University of the Philippines, 1000 Manila, Philippines
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Díaz JFR. Impact of outpatient radiotherapy on direct non-medical cost in patients in the Central Macro Region of Peru 2021. Ecancermedicalscience 2023; 17:1580. [PMID: 37533938 PMCID: PMC10393304 DOI: 10.3332/ecancer.2023.1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 08/04/2023] Open
Abstract
Background Financial toxicity arises in cancer patients due to the objective financial burden of the disease or treatment, being associated with worse clinical outcomes. Direct non-medical spending on cancer patients undergoing radiotherapy in Peru under its publicly funded health system has not been described. Objective To know the expenses related to the transfer of the radiotherapy outpatient. Methodology For patients who started radiation therapy in 2021, treatment demographics and expenses related to transporting the patient from home to the radiation therapy center were prospectively collected. Association and connection tests were used, such as the Mann-Whitney/Kruskal-Wallis U-test and Spearman's Rho. A value of p < 0.05 is considered statistically significant. Results 398 patients were collected, with average weekly expenses for transportation, lodging and food of $17.04, $6.69 and $45.91, respectively. Confirmation was positive between weekly spending and remoteness, likewise it was negative between effective teletherapy and remoteness, both analyses being statistically significant. Conclusion The expense associated with transfer for radiotherapy is high, exceeding the average monthly income of the patient, as a consequence they have a worse therapeutic result, and may cause financial toxicity in cancer patients.
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Affiliation(s)
- José Fernando Robles Díaz
- Regional Institute for Neoplastic Diseases, Central Region, Concepción, Junín 12731, Peru and Universidad Peruana Los Andes, Huancayo, Junín 12731, Perú
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29
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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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30
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Hastert TA, Nair M, Eggly S. Providers' communication-related concerns in helping patients address the financial impact of cancer. PATIENT EDUCATION AND COUNSELING 2023; 114:107860. [PMID: 37421848 DOI: 10.1016/j.pec.2023.107860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES This study describes the communication-related concerns of oncology providers in addressing financial issues with patients. METHODS We conducted semi-structured interviews with 17 providers (9 clinicians, 5 social workers/navigators, 3 attorneys) who addressed financial concerns with cancer patients and analyzed resulting transcripts using qualitative thematic analysis. Interview topics included cost-related concerns of patients, resources providers used, and unmet needs related to addressing financial issues. Here we present codes and content related to a cross-cutting cost communication, stratified by provider discipline. RESULTS Communication-related issues varied by provider type. Clinicians identified lack of information, lack of time, and the need for additional support as major barriers to effective cost discussions. Social workers/navigators expressed the importance of establishing a relationship before discussing costs and on the need to revisit cost concerns over time to meet patients' changing needs. The attorneys endorsed the need for more and earlier cost communication to prevent financial hardship. CONCLUSION Communication concerns and strategies were central to providers' experiences of addressing cancer patient cost concerns. PRACTICE IMPLICATIONS Understanding the experiences of diverse oncology providers can inform the development and implementation of interventions to prevent and mitigate financial hardship in people with cancer.
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Affiliation(s)
- Theresa A Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.
| | - Mrudula Nair
- Department of Public Health Sciences, Henry Ford Medical Group, Detroit, MI, USA
| | - Susan Eggly
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI, USA; Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
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31
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Hahn E, Rodin D, Sutradhar R, Nofech-Mozes S, Trebinjac S, Paszat LF, Rakovitch E. Can Molecular Biomarkers Help Reduce the Overtreatment of DCIS? Curr Oncol 2023; 30:5795-5806. [PMID: 37366916 DOI: 10.3390/curroncol30060433] [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: 04/12/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Ductal carcinoma in situ (DCIS), especially in the era of mammographic screening, is a commonly diagnosed breast tumor. Despite the low breast cancer mortality risk, management with breast conserving surgery (BCS) and radiotherapy (RT) is the prevailing treatment approach in order to reduce the risk of local recurrence (LR), including invasive LR, which carries a subsequent risk of breast cancer mortality. However, reliable and accurate individual risk prediction remains elusive and RT continues to be standardly recommended for most women with DCIS. Three molecular biomarkers have been studied to better estimate LR risk after BCS-Oncotype DX DCIS score, DCISionRT Decision Score and its associated Residual Risk subtypes, and Oncotype 21-gene Recurrence Score. All these molecular biomarkers represent important efforts towards improving predicted risk of LR after BCS. To prove clinical utility, these biomarkers require careful predictive modeling with calibration and external validation, and evidence of benefit to patients; on this front, further research is needed. Most trials do not incorporate molecular biomarkers in evaluating de-escalation of therapy for DCIS; however, one-the Prospective Evaluation of Breast-Conserving Surgery Alone in Low-Risk DCIS (ELISA) trial-incorporates the Oncotype DX DCIS score in defining a low-risk population and is an important next step in this line of research.
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Affiliation(s)
- Ezra Hahn
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2C4, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Sabina Trebinjac
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Lawrence Frank Paszat
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Eileen Rakovitch
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5T 1P5, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON M4N 3M5, Canada
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
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Lunders C, Dillon EC, Mitchell D, Cantril C, Jones JB. The Unmet Needs of Breast Cancer Navigation Services: Reconciling Clinical Care With the Emotional and Logistical Challenges Experienced by Younger Women with Breast Cancer in a Healthcare Delivery System. J Patient Exp 2023; 10:23743735231171126. [PMID: 37323760 PMCID: PMC10265349 DOI: 10.1177/23743735231171126] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
This study explores the experience of the breast cancer journey for younger women receiving patient navigation services in a healthcare delivery system and any remaining challenges that navigation services may leave unaddressed. In this qualitative analysis, we used a purposeful sampling approach to conduct a semistructured in-person interview with 19 younger women (under 50 years at the time of diagnosis) at various stages of breast cancer treatment and receiving care that included some form of patient navigation services/within the Sutter Health system. Thematic analysis was performed using an inductive grounded theory approach. The patient experience revealed that women receiving navigation services throughout their cancer journey had little concern related to clinical decision-making and treatment. Rather, emotional, and logistical challenges dominate their experience and perceptions of the cancer journey. Managing day-to-day life and the emotional aspects of a cancer diagnosis cannot be disentangled from clinical care. Navigating the emotional and logistical aspects of the cancer journey is an ongoing unmet need for women under age 50, and navigation services can potentially be enhanced to help address these specific needs. Women with breast cancer may benefit from navigation programs focused not only on clinically related challenges but also on recognizing the daily needs of younger women and guiding them through family and job-related obstacles encountered while navigating cancer care. Health systems could enhance existing nurse navigation programs and redesign other aspects of care to focus on meeting these needs.
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Affiliation(s)
- Chelsea Lunders
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
| | - Ellis C Dillon
- Center for Health Systems Research, Sutter Health, Palo Alto, CA, USA
- Center on Aging, UConn Health, Farmington, CT, USA
| | - Diamonne Mitchell
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
| | | | - JB Jones
- Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
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Cwalina TB, Jella TK, Tripathi R, Carroll BT. Financial stress among skin cancer patients: a cross-sectional review of the 2013-2018 National Health Interview Survey. Arch Dermatol Res 2023; 315:1003-1010. [PMID: 35192005 PMCID: PMC8861625 DOI: 10.1007/s00403-022-02330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Financial stress among skin cancer patients may limit treatment efficacy by forcing the postponement of care or decreasing adherence to dermatologist recommendations. Limited information is available quantifying the anxiety experienced by skin cancer patients from both healthcare and non-healthcare factors. Therefore, the present study sought to perform a retrospective cross-sectional review of the 2013-2018 cycles of the National Health Interview Survey (NHIS) to determine the prevalence, at-risk groups, and predictive factors of skin cancer patient financial stress. Survey responses estimated that 11.45% (95% Cl 10.02-12.88%) of skin cancer patients experience problems paying medical bills, 20.34% (95% Cl 18.97-21.71%) of patients worry about the medical costs, 13.73% (95% Cl 12.55-14.91%) of patients worry about housing costs, and 37.48% (95% Cl 35.83-39.14%) of patients worry about money for retirement. Focusing on at-risk groups, black patients, uninsured patients, and patients with low incomes (< 200% poverty level) consistently experienced high rates of financial stress for each of the four measures. Multivariable logistic regression revealed low education, lack of insurance, and low income to be predictive of financial stress. These findings suggest that a considerable proportion of skin cancer patients experience financial stress related to both healthcare and non-healthcare factors. Where possible, the additional intricacy of treating patients at risk of high financial stress may be considered to optimize patient experience and outcomes.
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Affiliation(s)
- Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
- The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Dermatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Gharzai LA, Jagsi R. Incorporating financial toxicity considerations into clinical trial design to facilitate patient-centered decision-making in oncology. Cancer 2023; 129:1143-1148. [PMID: 36775839 DOI: 10.1002/cncr.34677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PLAIN LANGUAGE SUMMARY Financial toxicity is increasingly being recognized as an important and devastating consequence of cancer treatment that receives little attention when clinical trials are being designed. There is a significant need to obtain this important information in an era of increasingly expensive anticancer treatments. Patients who are informed of all implications of therapy-efficacy, side effects, cost, and broader financial impact-are able to select the best cancer treatment for themselves.
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Affiliation(s)
| | - Reshma Jagsi
- University of Michigan, Ann Arbor, Michigan, USA
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Erickson N, Sullivan ES, Kalliostra M, Laviano A, Wesseling J. Nutrition care is an integral part of patient-centred medical care: a European consensus. Med Oncol 2023; 40:112. [PMID: 36881207 PMCID: PMC9992033 DOI: 10.1007/s12032-023-01955-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.
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Affiliation(s)
- Nicole Erickson
- Comprehensive Cancer Center Munich, Ludwig Maximilian University of Munich Hospital, Munich, Germany.
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK.
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands.
| | - Erin Stella Sullivan
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Marianna Kalliostra
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- European Federation of the Associations of Dietitians (EFAD), Naarden, The Netherlands
- The European Nutrition for Health Alliance, London, UK
| | - Alessandro Laviano
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joost Wesseling
- Writing Group, The European Union Thematic Network on Integrated Nutrition in Cancer Care (INC2), Croydon, UK
- The European Nutrition for Health Alliance, London, UK
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36
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Proussaloglou EM, Rosenthal AE, Raker CA, Wilbur JS, Stuckey AR, Robison KM. Financial toxicity in BRCA1 and BRCA2 carriers. Gynecol Oncol 2023; 170:160-166. [PMID: 36701836 DOI: 10.1016/j.ygyno.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Financial toxicity (FT), the cumulative financial burden experienced due to medical care, is a well-established adverse effect of healthcare. Patients with BRCA mutations have significantly increased cancer risks compared to non-affected individuals, requiring more frequent screenings and, at times, prophylactic surgery, increasing their risk for FT. Our primary aim in this study was to describe rates of FT among BRCA carriers. METHODS We performed a novel, cross-sectional study of FT in BRCA1/2 carriers. Participants were recruited via phone and/or email to complete consents and surveys on REDCap. The FACIT-COST tool, a validated tool for measuring FT, was used to assess FT; scores were divided into tertiles, with high FT defined as COST score < 24. RESULTS 265 BRCA positive female participants met enrollment criteria; 76 (28.7%) consented to participate and completed the survey. Participants were primarily non-Hispanic White (97.4%), privately insured (82.9%), and employed full time (67.1%). A significant proportion (22.7%) of participants reported delaying or avoiding care secondary to finances. No statistically significant association was seen between financial toxicity groups and analyzed demographics. Participants with high FT were more likely to engage in all surveyed cost-saving measures, with 41.7% of participants reporting delays/avoidance of care due to cost (p = 0.02). CONCLUSIONS This study of FT in BRCA carriers shows that financial toxicity exists as an issue in this high-risk patient population. This work serves as the first description of FT in BRCA mutation carriers and highlights the importance of incorporating routine counseling on cost when discussing recommendations for screening and clinical care with this patient population.
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Affiliation(s)
- Ellie M Proussaloglou
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America.
| | - Alex E Rosenthal
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Christina A Raker
- Women & Infants Hospital/Brown University, Providence, RI, United States of America
| | | | - Ashley R Stuckey
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Katina M Robison
- Women & Infants Hospital/Brown University, Providence, RI, United States of America; The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
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Shamsunder MG, Sheckter CC, Sheinin A, Rubin D, Parikh RP, Rose J, Momoh AO, Offodile AC, Matros E. Impact of High-Deductible Health Plans on Breast Reconstruction: Considerations for Financial Toxicity. Plast Reconstr Surg 2023; 151:245-253. [PMID: 36696302 PMCID: PMC10586232 DOI: 10.1097/prs.0000000000009823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND High-deductible health plans (HDHPs) are used within the United States to curb unnecessary health care spending; however, the resulting increased out-of-pocket (OOP) costs may be associated with financial toxicity. The aim was to assess the impact of HDHPs on use and seasonality of mastectomy and breast reconstruction procedures. The hypothesis is that the high OOP costs of HDHPs will lead to decreased overall service use and greater fourth-quarter use after the deductible has been met. METHODS MarketScan was queried from 2014 to 2017 for episodes of mastectomy, breast reconstruction (immediate and delayed), breast revision, and reduction. Only patients continuously enrolled for the full calendar year after the index operation were included. HDHPs and low-deductible health plans (LDHPs) were compared based on OOP cost sharing. Outcomes included surgery use rates, seasonality of operations, and median/mean OOP costs. RESULTS Annual mastectomy and breast reconstruction use rates varied little between LDHPs and HDHPs. Mastectomies, delayed breast reconstruction, and elective breast procedures (P < 0.001) all showed significant increases in fourth-quarter use, whereas immediate breast reconstruction did not. Regardless of timing and reconstruction method, HDHPs had significantly greater median OOP costs compared to LDHPs (all P < 0.001). CONCLUSIONS Mastectomy and breast reconstruction rates did not differ between LDHPs and HDHPs, but seasonality for all breast procedures was measured with the exception of immediate breast reconstruction, suggesting that women are rational economic actors. Regardless of service timing and reconstruction modality, HDHP patients had greater OOP costs compared to LDHP patients, which serves as a good starting point for provider engagement in financial toxicity.
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Affiliation(s)
- Meghana G. Shamsunder
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clifford C. Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
| | - Avraham Sheinin
- Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Rubin
- Department of Finance, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajiv P. Parikh
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John Rose
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Adeyiza O. Momoh
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | | | - Evan Matros
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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38
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Gordon LG, Nabukalu D, Chan RJ, Goldsbury DE, Hobbs K, Hunt L, Karikios DJ, Mackay G, Muir L, Leigh L, Thamm C, Lindsay D, Whittaker K, Varlow M, McLoone J, Financial Toxicity Working Group OBOTC. Opinions and strategies of Australian health professionals on tackling cancer-related financial toxicity: A nationwide survey. Asia Pac J Clin Oncol 2023; 19:126-135. [PMID: 35589922 DOI: 10.1111/ajco.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/20/2023]
Abstract
AIM To understand the opinions and current practices of health professionals on the topic of addressing cancer-related financial toxicity among patients. METHODS A cross-sectional online survey was distributed through Australian clinical oncology professional organizations/networks. The multidisciplinary Clinical Oncology Society of Australia Financial Toxicity Working Group developed 25 questions relating to the frequency and comfort levels of patient-clinician discussions, opinions about their role, strategies used, and barriers to providing solutions for patients. Descriptive statistics were used and subgroup analyses were undertaken by occupational groups. RESULTS Two hundred and seventy-seven health professionals completed the survey. The majority were female (n = 213, 77%), worked in public facilities (200, 72%), and treated patients with varied cancer types across all of Australia. Most participants agreed that it was appropriate in their clinical role to discuss financial concerns and 231 (88%) believed that these discussions were an important part of high-quality care. However, 73 (28%) stated that they did not have the appropriate information on support services or resources to facilitate such conversations, differing by occupation group; 7 (11%) social workers, 34 (44%) medical specialists, 18 (25%) nurses, and 14 (27%) of other occupations. Hindrances to discussing financial concerns were insufficient resources or support systems to refer to, followed by lack of time in a typical consultation. CONCLUSION Health professionals in cancer care commonly address the financial concerns of their patients but attitudes differed across occupations about their role, and frustrations were raised about available solutions. Resources supporting financial-related discussions for all health professionals are urgently needed to advance action in this field.
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Affiliation(s)
- Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia.,Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia.,Nepean Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | | | - Carla Thamm
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
| | | | | | - Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.,Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia
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Dee EC, Taunk NK, Chino FL, Deville C, McClelland S, Muralidhar V, McBride SN, Gillespie EF, Yamoah K, Nguyen PL, Mahal BA, Winkfield KM, Vapiwala N, Santos PMG. Shorter Radiation Regimens and Treatment Noncompletion Among Patients With Breast and Prostate Cancer in the United States: An Analysis of Racial Disparities in Access and Quality. JCO Oncol Pract 2023; 19:e197-e212. [PMID: 36399692 PMCID: PMC9970278 DOI: 10.1200/op.22.00383] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Compared with conventional external-beam radiation therapy (cEBRT) for patients with breast cancer (BC) and prostate cancer (PC), shorter radiation regimens may be associated with lower treatment noncompletion rates. We assess disparities in receipt of shorter radiation regimens and treatment noncompletion for BC and PC. PATIENTS AND METHODS The 2004-2017 National Cancer Database was queried for adjuvant cEBRT or hypofractionated EBRT (hEBRT) for nonmetastatic BC; and definitive cEBRT, moderate hypofractionation (mEBRT), or stereotactic body radiotherapy (SBRT) for localized PC. Multivariable logistic regression identified factors associated with treatment noncompletion and receipt of shorter regimens. FINDINGS We identified 170,386 men with PC (median age [interquartile range], 70 [64-75] years; Black, 17.5%; White, 82.5%) and 306,846 women with BC (61 [52-69] years; Black, 12.3%; White, 87.7%). Among patients who received cEBRT for PC, Black men had higher treatment noncompletion rates compared with White (14.1% v 13.0%; odds ratio [95% CI] 1.07 [1.03 to 1.12]; P < .001). In contrast, treatment noncompletion was not disparate with SBRT (Black 1.6% v White 1.3%; 1.20 [0.72 to 2.00], P = .49) or mEBRT (Black 9.0% v White 7.1%; 1.05 [0.72 to 1.54], P = .79). From 2004 to 2017, SBRT (0.07% to 11.8%; 1.32 [1.31 to 1.33]) and mEBRT (0.35% to 9.1%; 1.27 [1.25 to 1.28]) increased (both P < .001); however, Black men were consistently less likely to receive SBRT (7.4% v White, 8.3%; 0.84 [0.79 to 0.89], P < .001). Among women with BC, there were no racial differences in treatment noncompletion; however, hEBRT was associated with lower treatment noncompletion rates (1.0% v cEBRT 2.3%; 0.39 [0.35 to 0.44], P < .001). Although hEBRT for BC increased (0.8% to 35.6%) between 2004 and 2017, Black women were less likely to receive hEBRT (10.4% v 15.3%; 0.78 [0.75 to 0.81], P < .001). INTERPRETATION Black patients were consistently less likely to receive hypofractionated radiation for PC or BC, despite evidence suggesting that shorter regimens may lower rates of treatment noncompletion with similar oncologic outcomes.
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Affiliation(s)
| | - Neil K. Taunk
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Fumiko L. Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Curtiland Deville
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shearwood McClelland
- Departments of Radiation Oncology and Neurological Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA
| | - Sean N. McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kosj Yamoah
- Cancer Epidemiology Program, Moffitt Cancer Center, Tampa, FL
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA
| | - Brandon A. Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
| | - Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Nashville, TN
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN
- Department of Medicine, Meharry Medical College; Nashville, TN
| | - Neha Vapiwala
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Skinner A, Buhlmann M, Fridley BL, Reed DR, Vicedo D, Mason NT. Pilot Study in Investigating Material Financial Toxicity Markers by Age in Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:34-42. [PMID: 36094443 PMCID: PMC9968625 DOI: 10.1089/jayao.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Studies have shown that financial toxicity can reduce survival, decrease quality of life, and reduce compliance with treatments. The aim of this retrospective study was to investigate material markers of financial toxicity, including insurance coverage, financial assistance, and balances due among adolescent and young adult (AYA) (18-39), adult (40-64), and senior adult (>65) patients with a sarcoma diagnosis after the Affordable Care Act became effective. Methods: This study performed a retrospective analysis of possible indicators within the material domain of financial toxicity in sarcoma patients, a common diagnosis in young adult patients. Indicators of financial toxicity included: insurance status and number of insurances, charity care, accessing financing options, or having an unpaid balance referred to a collection's agency. Results: The cumulative charges per patient were similar between AYA, adult, and senior adult populations at an average of $194,329 (standard deviation [SD] = $321,425), $236,724 (SD = $368,345), and $188,030 (SD = $271,191), respectively. AYA patients were more likely than adult and senior adult patients to have Medicaid coverage (income-based government insurance) (22.1% vs. 8.4% vs. 1.2%), receive charity care (5.3% vs. 2.6% vs. 1.2%), or have a balance referred to a collection's agency (9.2% vs. 5.8% vs. 1.2%). Conclusions: This study suggests that younger cancer patients are more likely to suffer material financial strain and additional financial resources may need to be made available to ensure they can receive care without an increase of financial toxicity markers and undue financial stress.
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Affiliation(s)
- Amber Skinner
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Melanie Buhlmann
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Brooke L. Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Damon R. Reed
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Cancer Biology and Evolution, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Deborah Vicedo
- Patient Financial Services, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Neil T. Mason
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Precision Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Address correspondence to: Neil Mason, MBA, Precision Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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41
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Hawley ST, Kidwell K, Zahrieh D, McCarthy A, Wills R, Rankin A, Hofer T, Chow S, Jagsi R, Neuman H. Improving patient-centered communication in breast cancer: a study protocol for a multilevel intervention of a shared treatment deliberation system (SharES) within the NCI community oncology research program (NCORP) (Alliance A231901CD). Trials 2023; 24:16. [PMID: 36609349 PMCID: PMC9817354 DOI: 10.1186/s13063-022-07048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Advances in precision medicine have given oncologists new evaluative tools to better individualize treatments for patients with curable breast cancer. These innovations have revealed a need to improve patient understanding of novel, often complex information related to breast cancer treatment decisions. Ensuring patients have the emotional support to face consequential treatment decisions, as well as the opportunity to engage and discuss with their clinicians, is key to improving patient-centered communication and patient understanding. METHODS/DESIGN This study will implement a multilevel intervention with patient and clinician components as a NCORP Cancer Care Delivery Research (CCDR) trial within the Alliance for Clinical Trials in Oncology Research Base (Alliance). The two interventions in this study, the Shared Decision Engagement System (SharES), include (1) two versions of an evidence-based patient-facing breast cancer treatment decision tool (iCanDecide +/- an emotional support module) and (2) a clinician-facing dashboard (Clinician Dashboard) that is reviewed by surgeons/clinicians and summarizes ongoing patient needs. The design is a near minimax, hybrid stepped wedge trial of SharES where both interventions are being evaluated in a crossed design over six 12-week time periods. The primary outcome (knowledge) and key secondary outcomes (i.e., self-efficacy and cancer worry) are assessed via patient report at 5 weeks after surgery. Secondary outcomes are also assessed at 5 weeks after surgery, as well as in a second survey 9 months after registration. We anticipate recruiting a total of 700 breast cancer patients (600 evaluable after attrition) from 25 surgical practices affiliated with Alliance. DISCUSSION Upon study completion, we will have better understanding of the impact of a multilevel intervention on patient-centered communication in breast cancer with a specific focus on whether the intervention components improve knowledge and self-efficacy and reduce cancer worry. TRIAL REGISTRATION ClinicalTrials.gov NCT04549571 . Registered on 16 September 2020.
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Affiliation(s)
- Sarah T Hawley
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA.
| | - Kelley Kidwell
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - David Zahrieh
- Department of Quantitative Health Sciences and Alliance Statistics and Data Management Center (SMDC), Mayo Clinic, Rochester, MN, USA
- Ultragenyx Pharmaceutical, Novato, CA, USA
| | | | - Rachel Wills
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Aaron Rankin
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Timothy Hofer
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Selina Chow
- Alliance Protocol Operations Office, Chicago, IL, USA
| | - Reshma Jagsi
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Heather Neuman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Dayan D, Leinert E, Singer S, Janni W, Kühn T, Flock F, Felberbaum R, Herbert SL, Wöckel A, Schwentner L. Association of social service counseling in breast cancer patients with financial problems, role functioning and employment-results from the prospective multicenter BRENDA II study. Arch Gynecol Obstet 2023; 307:541-547. [PMID: 35604446 PMCID: PMC9918582 DOI: 10.1007/s00404-022-06604-2] [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: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study examined the relationship between social service counseling (SSC) and financial and role functioning problems in primary breast cancer (BC) patients over a 5-year observation period. METHODS In the multicenter prospective study, patients were approached before surgery (t1), before initiation of adjuvant treatment (t2), after therapy completion (t3), and 5 years after surgery (t4). We examined the proportion of BC survivors who had financial and role functioning problems and the proportion who were employed at t4. We examined how frequently patients were informed about, offered, or used SSC, and we used multivariate logistic regression analyses to examine the relationship between this and financial and role functioning problem prevalence. RESULTS Of the 456 BC survivors, 33% had financial problems and 22% reported role functioning problems at t4. There was no evidence that women with increased financial problems were informed about SSC more often than those without (OR 1.1, p = 0.84) or that they used SSC more often (OR 1.3, p = 0.25). However, women with role functioning problems were informed about SSC significantly more often (OR 1.7, p = 0.02) and attended counseling significantly more often (OR 1.6, p = 0.03). Among participants aged < 65 years at t4 (n = 255), 70% were employed. Patients who had received SSC were more likely to be employed at t4 than patients who did not (OR 1.9, p = 0.04). CONCLUSION These findings underline the importance of SSC for BC patients with role functioning issues. They indicate that individuals who use SSC are more likely to be employed later on than individuals who do not.
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Affiliation(s)
- Davut Dayan
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany.
| | - Elena Leinert
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
| | - Thorsten Kühn
- Department of Gynecology and Obstetrics, Hospital Esslingen, Esslingen, Germany
| | - Felix Flock
- Department of Gynecology and Obstetrics, Hospital Memmingen, Memmingen, Germany
| | - Ricardo Felberbaum
- Department of Gynecology and Obstetrics, Hospital Kempten, Kempten, Germany
| | | | - Achim Wöckel
- Department of Gynecology and Obstetrics, University of Würzburg, Würzburg, Germany
| | - Lukas Schwentner
- Department of Gynecology and Obstetrics, University of Ulm, Prittwitzstr. 43, 89075, Ulm, Germany
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Financial Toxicity of Breast Cancer Care: The Patient Perspective Through Surveys and Interviews. J Surg Res 2023; 281:122-129. [PMID: 36155269 DOI: 10.1016/j.jss.2022.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although the economic burden of cancer care is an emerging concern in the United States, the potential financial toxicity of breast cancer care at the patient level remains poorly understood. This study aims to characterize the scope of the contributors to financial distress on breast cancer patients and the resources utilized to address them. METHODS Adult female patients diagnosed with invasive breast cancer or ductal carcinoma in situ between 2014 and 2019 at a single institution were retrospectively evaluated. Those who enrolled in copay assistance or indicated financial concerns on an intake distress screen were provided a web-based survey assessing financial changes, resources used, and financial engagement with providers. Semi-structured interviews further explored sources of financial distress and were analyzed by two researchers using grounded theory methodology. RESULTS Sixty-eight patients completed the online survey, 15 of the 68 also participated in semi-structured phone interviews. On the online survey 74% of participants endorsed a financial distress score ≥5 on a scale of 0-10. Seventy-four percent changed their budget, 72% used their savings, and 60% cut down on spending. However, only 40% used resources such as financial counseling or financial assistance. Interviews revealed three major contributors to financial distress: (1) unexpected medical and nonmedical expenses, (2) lost revenue from missed work, and (3) altered budgeting. CONCLUSIONS Many breast cancer patients experience significant financial distress without access to the resources they need. This study highlights the need for financial transparency, supportive financial services counseling at the time of diagnosis, throughout treatment and beyond.
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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Toohey K, Hunter M, McKinnon K, Casey T, Turner M, Taylor S, Paterson C. A systematic review of multimodal prehabilitation in breast cancer. Breast Cancer Res Treat 2023; 197:1-37. [PMID: 36269525 PMCID: PMC9823038 DOI: 10.1007/s10549-022-06759-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Breast cancer is the most prevalent malignancy in women. Prehabilitation may offer improvements in physical and psychological wellbeing among participants prior to treatment. This systematic review aimed to determine the efficacy of prehabilitation in participants diagnosed with breast cancer. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. Studies exploring the impact of prehabilitation in participants with breast cancer were included. Studies were assessed independently according to pre-eligibility criteria, with data extraction and methodological quality assessed in parallel. RESULTS 3184 records were identified according to our search criteria, and 14 articles were included. Articles comprised of quantitative randomised controlled trials (n = 7), quantitative non-randomised studies (n = 5), a qualitative study (n = 1), and a mixed-method study (n = 1). The majority of selected studies completed exercise programs (n = 4) or had exercise components (n = 2), with two focusing on upper-limb exercise. Five articles reported complementary and alternative therapies (n = 5). Two articles reported smoking cessation (n = 2), with a single study reporting multi-modal prehabilitation (n = 1). Mostly, prehabilitation improved outcomes including physical function, quality of life, and psychosocial variables (P < 0.05). The qualitative data identified preferences for multimodal prehabilitation, compared to unimodal with an interest in receiving support for longer. CONCLUSIONS Prehabilitation for patients with breast cancer is an emerging research area that appears to improve outcomes, however, ensuring that adequate intervention timeframes, follow-up, and population groups should be considered for future investigations. IMPLICATIONS FOR CANCER SURVIVORS The implementation of prehabilitation interventions for individuals diagnosed with breast cancer should be utilised by multidisciplinary teams to provide holistic care to patients as it has the potential to improve outcomes across the cancer care trajectory.
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Affiliation(s)
- Kellie Toohey
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia.
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia.
| | - Maddison Hunter
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
| | - Karen McKinnon
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Tamara Casey
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
| | - Suzanne Taylor
- Australian Capital Territory Breast Care, Calvary Public Hospital, Bruce ACT, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Bruce ACT, 2617, Australia
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce ACT, Australia
- Robert Gordon University, Aberdeen, AB10 7QB, Scotland
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Jiang JM, Eichler J, Bodner W, Fox J, Garg M, Kabarriti R, Mo A, Kalnicki S, Mehta K, Rivera A, Tang J, Yap J, Ohri N, Klein J. Predictors of Financial Toxicity in Patients Receiving Concurrent Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101141. [PMID: 36636262 PMCID: PMC9829707 DOI: 10.1016/j.adro.2022.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Financial toxicity (FT) is a significant concern for patients with cancer. We reviewed prospectively collected data to explore associations with FT among patients undergoing concurrent, definitive chemoradiation therapy (CRT) within a diverse, urban, academic radiation oncology department. Methods and Materials Patients received CRT in 1 of 3 prospective trials. FT was evaluated before CRT (baseline) and then weekly using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire Core-30 questionnaire. Patients were classified as experiencing FT if they answered ≥2 on a Likert scale question (1-4 points) asking if they experienced FT. Rate of change of FT was calculated using linear regression; worsening FT was defined as increase ≥1 point per month. χ2, t tests, and logistic regression were used to assess predictors of FT. Results Among 233 patients, patients attended an average of 9 outpatient and 4 radiology appointments over the 47 days between diagnosis and starting CRT. At baseline, 52% of patients reported experiencing FT. Advanced T stage (odds ratio, 2.47; P = .002) was associated with baseline FT in multivariate analysis. The mean rate of FT change was 0.23 Likert scale points per month. In total, 26% of patients demonstrated worsening FT during CRT. FT at baseline was not associated with worsening FT (P = .98). Hospitalization during treatment was associated with worsening FT (odds ratio, 2.30; P = .019) in multivariate analysis. Conclusions Most patients reported FT before CRT. These results suggest that FT should be assessed (and, potentially, addressed) before starting definitive treatment because it develops early in a patient's cancer journey. Reducing hospitalizations may mitigate worsening FT. Further research is warranted to design interventions to reduce FT and avoid hospitalizations.
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Agarwal A, Karikios DJ, Stockler MR, Morton RL. Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia. PLoS One 2022; 17:e0273620. [PMID: 36269711 PMCID: PMC9586404 DOI: 10.1371/journal.pone.0273620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background A diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion. Aims The aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer. Methods We conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions. Results 547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients. Conclusions Certain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.
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Affiliation(s)
- Anupriya Agarwal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
| | - Deme J. Karikios
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Nepean Cancer Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Chris O’Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Fischer KA, Anand S, Walling A, Larson SM, Glaspy J. Cost-Health Literacy as an Educational Objective in Fellowship Training. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1479-1485. [PMID: 33761118 DOI: 10.1007/s13187-021-01987-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
Physicians are encouraged to communicate with their patients about financial concerns, but are infrequently taught skills necessary to do so. This study describes a curriculum for oncology fellows aimed to improve skills of cost-health literacy, and provides assessment of the curriculum impact on self-perceived cost communication practices. Oncology fellows at a large academic program in 2019 participated in a cost-health literacy curriculum over 3 months. The curriculum consisted of a didactic on financial toxicity (45 min), a problem-based learning case highlighting financial toxicity risk factors and areas for intervention (30 min), and a group discussion (30 min) to review and consolidate strategies to navigate financial toxicity in direct patient care. A cost-health literacy survey was administered at baseline and at the conclusion of the curriculum to evaluate the impact of the program. Of 19 participants, 16 completed both the pre-survey and post-survey and were included in the analysis. After the intervention, participants were more likely to report comfort discussing out-of-pocket costs (50% vs. 19%, p = 0.002) and to feel they could help a patient experiencing financial toxicity (62% vs. 6%, p = 0.005). There was no improvement in the subjective assessment of patient financial distress (57% v 50%, p = 0.759). Oncology fellows can improve self-reported cost-health literacy skills through participation in a targeted, brief curriculum. Further studies are warranted to determine how this approach can be applied in other settings and if it objectively impacts cost communication practices.
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Affiliation(s)
- Katrina A Fischer
- Department of Medicine (Hematology & Oncology), UCLA School of Medicine, Los Angeles, CA, USA.
- 200 UCLA Medical Plaza, Suite 120, Los Angeles, CA, 90095, USA.
| | - Sidharth Anand
- Department of Medicine (Hematology & Oncology), UCLA School of Medicine, Los Angeles, CA, USA
| | - Anne Walling
- Department of Medicine (Division of General Internal Medicine & Health Services Research), UCLA School of Medicine, Los Angeles, CA, USA
| | - Sarah M Larson
- Department of Medicine (Hematology & Oncology), UCLA School of Medicine, Los Angeles, CA, USA
| | - John Glaspy
- Department of Medicine (Hematology & Oncology), UCLA School of Medicine, Los Angeles, CA, USA
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Abdelkarem OAI, Choudhury A, Burnet NG, Summersgill HR, West CML. Effect of Race and Ethnicity on Risk of Radiotherapy Toxicity and Implications for Radiogenomics. Clin Oncol (R Coll Radiol) 2022; 34:653-669. [PMID: 35431121 DOI: 10.1016/j.clon.2022.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/21/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
AIMS Patient factors affect the risk of radiotherapy toxicity, but many are poorly defined. Studies have shown that race affects cancer incidence, survival, drug response, molecular pathways and epigenetics. Effects on radiosensitivity and radiotherapy toxicity are not well studied. The aim of the present study was to identify the effects of race and ethnicity on the risk of radiotherapy toxicity. MATERIALS AND METHODS A systematic review was carried out of PubMed, Ovid Medline and Ovid Embase with no year limit. PRISMA 2020 guidelines were followed. Two independent assessors reviewed papers. RESULTS Of 607 papers screened, 46 fulfilled the inclusion criteria. Papers were published between 1996 and 2021 and involved 30-28,354 individuals (median 433). Most involved patients with prostate (33%), breast (26%) and lung (9%) cancer. Both early and late toxicities were studied. Some studies reported a higher risk of toxicity in White men with prostate cancer compared with other races and ethnicities. For breast cancer patients, some reported an increased risk of toxicity in White women compared with other race and ethnic groups. In general, it was difficult to draw conclusions due to insufficient reporting and analysis of race and ethnicity in published literature. CONCLUSIONS Reporting of race and ethnicity in radiotherapy studies must be harmonised and improved and frameworks are needed to improve the quality of reporting. Further research is needed to understand how ancestral heritage might affect radiosensitivity and risk of radiotherapy toxicity.
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Affiliation(s)
- O A I Abdelkarem
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - N G Burnet
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - H R Summersgill
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - C M L West
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK.
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