1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Qiu L, Wu J, Huang Y, Ye M, Song L, Huang H, Jin Y. Comparison of the effects of different functional exercise sequences on lymphedema in breast cancer: protocol for an exploratory randomised controlled cross-over trial. BMJ Open 2024; 14:e076127. [PMID: 38485488 PMCID: PMC10941162 DOI: 10.1136/bmjopen-2023-076127] [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: 05/29/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Breast cancer-related lymphedema (BCRL) is a common postoperative complication of breast cancer. It develops in a chronic and vicious cycle. Once lymphedema occurs, it cannot be cured and bring serious physiological, psychological, social and economic burden to patients. Upper limb functional exercises are an effective and convenient intervention for managing lymphedema. However, the optimal exercise sequence remains unclear. Therefore, we aim to compare the effects of exercise sequences under the guidance of commonly used exercise sequences and lymphatic flow theory. METHODS An exploratory randomised controlled cross-over trial will be conducted. 32 patients with BCRL are randomly allocated into two groups (group A and group B). Group A patients will perform functional exercise from wrist joint to shoulder joint, and the exercise direction of group B is opposite to that of group A, that is, from shoulder joint to wrist joint end. Exercise time is once a day, each 20-30 min, for 2 weeks. After 2 weeks of washout period, A and B groups of exchange exercise sequences (exercise frequency and duration unchanged). The primary outcome is upper limb circumference, and secondary outcomes are upper limb function and lymphedema symptoms. ETHICS AND DISSEMINATION This study protocol is presented in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. All participants will sign a written informed consent. The research ethics regional committee of Shanghai Seventh People's Hospital has approved the study. Regardless of the outcome of this study, the results will be published in open-access journals to ensure public access. TRIAL REGISTRATION NUMBER ChiCTR2200066463.
Collapse
Affiliation(s)
- Lin Qiu
- Department of Thyroid and Breast Surgery, Shanghai Seventh People's Hospital, Shanghai, Shanghai, China
| | - Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China
| | - Yingying Huang
- Department of Nursing, Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China
| | - Maodie Ye
- Department of Nursing, Seventh People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, Shanghai, China
| | - Lifang Song
- Department of Thyroid and Breast Surgery, Shanghai Seventh People's Hospital, Shanghai, Shanghai, China
| | - Haihong Huang
- Department of Thyroid and Breast Surgery, Shanghai Seventh People's Hospital, Shanghai, Shanghai, China
| | - Yongmei Jin
- Department of Nursing, Shanghai Seventh People's Hospital, Shanghai, Shanghai, China
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Bian J, Shen A, Yang W, Zhang L, Qiang W. Financial toxicity experienced by patients with breast cancer-related lymphedema: a systematic review. Support Care Cancer 2023; 31:354. [PMID: 37237237 DOI: 10.1007/s00520-023-07800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE To perform a systematic review on financial toxicity of breast cancer-related lymphedema. METHODS Seven databases were searched on September 11, 2022. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Empirical studies were appraised by the Joanna Briggs Institute (JBI) tools. The Mixed Methods Appraisal Tool version 2018 was used to assess the mixed method studies. RESULTS A total of 963 articles were identified, but only 7 articles reporting on 6 studies met the eligibility criteria. A 2-year treatment for lymphedema was approximately USD$14,877 to USD$23,167 in America. In Australia, the average out-of-pocket costs ranged from A$207 to A$1400 (USD$156.26 to USD$1056.83) per year. Outpatient visits, compressed clothing, and hospital admissions were the dominant costs. The financial toxicity was associated with the severity of lymphedema, and patients with heavy financial burden had to reduce other expenses or even forgo the treatment. CONCLUSION Breast cancer-related lymphedema aggravated the economic burden of patients. The included studies showed great variation in the methods used and therefore differences in cost results. The national government should further improve the healthcare system and increase the insurance coverage of lymphedema treatment to alleviate this burden. More research is needed to focus on financial toxicity experience of breast cancer patients with lymphedema. IMPLICATIONS FOR CANCER SURVIVORS The cost of the ongoing treatment of breast cancer-related lymphedema influences patients' economic situation and quality of life. Survivors need to be informed early about the potential financial burden associated with lymphedema treatment.
Collapse
Affiliation(s)
- Jingru Bian
- School of Nursing, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Aomei Shen
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Wanwan Yang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Liyuan Zhang
- School of Nursing, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Wanmin Qiang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China.
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China.
| |
Collapse
|
5
|
Ehsan AN, Wu CA, Minasian A, Singh T, Bass M, Pace L, Ibbotson GC, Bempong-Ahun N, Pusic A, Scott JW, Mekary RA, Ranganathan K. Financial Toxicity Among Patients With Breast Cancer Worldwide: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2255388. [PMID: 36753274 PMCID: PMC9909501 DOI: 10.1001/jamanetworkopen.2022.55388] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
Importance Financial toxicity (FT) is the negative impact of cost of care on financial well-being. Patients with breast cancer are at risk for incurring high out-of-pocket costs given the long-term need for multidisciplinary care and expensive treatments. Objective To quantify the FT rate of patients with breast cancer and identify particularly vulnerable patient populations nationally and internationally. Data Sources A systematic review and meta-analysis were conducted. Four databases-Embase, PubMed, Global Index Medicus, and Global Health (EBSCO)-were queried from inception to February 2021. Data analysis was performed from March to December 2022. Study Selection A comprehensive database search was performed for full-text, English-language articles reporting FT among patients with breast cancer. Two independent reviewers conducted study screening and selection; 462 articles underwent full-text review. Data Extraction and Synthesis A standardized data extraction tool was developed and validated by 2 independent authors; study quality was also assessed. Variables assessed included race, income, insurance status, education status, employment, urban or rural status, and cancer stage and treatment. Pooled estimates of FT rates and their 95% CIs were obtained using the random-effects model. Main Outcomes and Measures FT was the primary outcome and was evaluated using quantitative FT measures, including rate of patients experiencing FT, and qualitative FT measures, including patient-reported outcome measures or patient-reported severity and interviews. The rates of patients in high-income, middle-income, and low-income countries who incurred FT according to out-of-pocket cost, income, or patient-reported impact of expenditures during breast cancer diagnosis and treatment were reported as a meta-analysis. Results Of the 11 086 articles retrieved, 34 were included in the study. Most studies were from high-income countries (24 studies), and the rest were from low- and middle-income countries (10 studies). The sample size of included studies ranged from 5 to 2445 people. There was significant heterogeneity in the definition of FT. FT rate was pooled from 18 articles. The pooled FT rate was 35.3% (95% CI, 27.3%-44.4%) in high-income countries and 78.8% (95% CI, 60.4%-90.0%) in low- and middle-income countries. Conclusions and Relevance Substantial FT is associated with breast cancer treatment worldwide. Although the FT rate was higher in low- and middle-income countries, more than 30% of patients in high-income countries also incurred FT. Policies designed to offset the burden of direct medical and nonmedical costs are required to improve the financial health of vulnerable patients with breast cancer.
Collapse
Affiliation(s)
- Anam N. Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Catherine A. Wu
- Harvard Medical School, Boston, Massachusetts
- Department of Plastic Surgery, University of California, Orange
| | - Alexandra Minasian
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tavneet Singh
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lydia Pace
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Geoffrey C. Ibbotson
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Nefti Bempong-Ahun
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Andrea Pusic
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - John W. Scott
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor
| | - Rania A. Mekary
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Kavitha Ranganathan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
6
|
Mudaranthakam DP, Wick J, Calhoun E, Gurley T. Financial burden among cancer patients: A national-level perspective. Cancer Med 2023; 12:4638-4646. [PMID: 35852258 PMCID: PMC9972087 DOI: 10.1002/cam4.5049] [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: 09/07/2021] [Revised: 05/26/2022] [Accepted: 07/08/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND This research study aimed to evaluate the financial burden among older cancer patients and its corresponding risk factors. Factors such as increasing treatment costs and work limitations often lead cancer patients to bankruptcy and poor quality of life. These consequences, in turn, can cause higher mortality rates among these patients. METHODS This retrospective cohort study utilized data from the Health Retirement Study (HRS), conducted by the University of Michigan (N = 18,109). Eligible participants had responses captured from years 2002 to 2016. Participants were classified according to any self-reported cancer diagnosis (yes or no) and were compared on the basis of financial, work, and health-related outcomes. Propensity score (PS) matching was applied to reduce the effects of potential confounding factors. Also only, individuals with an age ≥50 and ≤85 during Wave 6 were retained. RESULTS Multivariate analysis with random effects revealed several indicators of financial burden when comparing participants with a cancer diagnosis to those with no history of cancer. Mean out-of-pocket costs associated with a cancer diagnosis were $1058 higher when compared to participants with no history of cancer, suggesting that even cancer patients with insurance coverage faced out-of-pocket costs. Respondents with cancer patients had higher odds of encountering financial hardship if they are facing Work Limitations (OR = 2.714), Regular use of Medications (OR = 2.518), Hospital Stays (OR = 2.858), Declining Health (OR = 2.349), or were being covered under government health insurance (OR = 5.803) than respondents who did not have cancer, or suffered from mental health issues such as Depression (OR = 0.901). CONCLUSION Cancer patients contend with increasing financial costs during their treatment. However, most newly diagnosed patients are not aware of these costs and are given few resources to handle them.
Collapse
Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA.,The University of Kansas Cancer Center, Kansas City, Kansas, USA.,Department of Population Health, Health Policy & Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, USA.,The University of Kansas Cancer Center, Kansas City, Kansas, USA
| | - Elizabeth Calhoun
- The University of Kansas Cancer Center, Kansas City, Kansas, USA.,Department of Population Health, Health Policy & Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Tami Gurley
- The University of Kansas Cancer Center, Kansas City, Kansas, USA.,Department of Population Health, Health Policy & Management, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
7
|
Lakkad M, Martin B, Li C, Harrington S, Dayer L, Painter JT. Healthcare costs and utilization associated with pain among breast cancer survivors: a propensity score matched cohort study using SEER-Medicare data. J Cancer Surviv 2022:10.1007/s11764-022-01282-0. [DOI: 10.1007/s11764-022-01282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
|
8
|
Coughlin SS, Datta B, Williams LB, Bevel M, Cortes JE. Characteristics of Cancer Survivors Living in Poverty in the United States: Results From the 2020 Behavioral Risk Factor Surveillance System Survey. JCO Oncol Pract 2022; 18:e1831-e1838. [PMID: 36067453 DOI: 10.1200/op.22.00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE There has been increasing concern over the high cost of oncology care and its long-lasting impact on the well-being of cancer survivors. METHODS We examined characteristics of impoverished cancer survivors in the United States, including their physical and mental health, using data from the 2020 Behavioral Risk Factor Surveillance System. We used binomial logistic regressions for binary outcome variables, and negative binomial regressions for count variables, to estimate the odds ratios (ORs) and incident rate ratios (IRRs) of the physical, mental, and socioeconomic-related health factors for low-income cancer survivors versus higher-income survivors. We compared the ORs and IRRs for low-income cancer survivors with those of higher income cancer survivors. RESULTS There was a two-fold increased odds (adjusted OR, 2.33; 95% CI, 1.86 to 2.91) of having fair/poor health for low-income cancer survivors compared with higher-income cancer survivors. There was an almost two-fold increased odds (adjusted OR, 1.97; 95% CI, 1.50 to 2.59) of not being able to see a doctor among low-income cancer survivors, and a 42% lower odds (adjusted OR, 0.58; 95% CI, 0.39 to 0.86) of having health insurance coverage for low-income cancer survivors compared with higher-income survivors. Incidence rate ratios for physical (IRR, 1.52; 95% CI, 1.31 to 1.75) and mental (IRR, 1.53; 95% CI, 1.26 to 1.86) unhealthy days were significantly higher among low-income cancer survivors compared with nonpoor cancer survivors. CONCLUSION Strategies are available to ameliorate financial hardship at multiple levels. Implementation of these strategies is urgently needed.
Collapse
Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Biplab Datta
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Lovoria B Williams
- Univesity of Kentucky College of Nursing, Lexington, KY.,Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Malcolm Bevel
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Cancer Center, Augusta, GA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Cancer Center, Augusta, GA
| |
Collapse
|
9
|
Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment. Support Care Cancer 2022; 30:2713-2721. [PMID: 34822002 PMCID: PMC9512060 DOI: 10.1007/s00520-021-06697-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/10/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Financial toxicity is common and pervasive among cancer patients. Research suggests that gynecologic cancer patients experiencing financial toxicity are at increased risk for engaging in harmful cost-coping strategies, including delaying/skipping treatment because of costs, or forsaking basic needs to pay medical bills. However, little is known about patients' preferences for interventions to address financial toxicity. METHODS Cross-sectional surveys to assess financial toxicity [Comprehensive Score for Financial Toxicity (COST)], cost-coping strategies, and preferences for intervention were conducted in a gynecologic cancer clinic waiting room. Associations with cost-coping were determined using multivariate modeling. Unadjusted odds ratios (ORs) explored associations between financial toxicity and intervention preferences. RESULTS Among 89 respondents, median COST score was 31.9 (IQR: 21-38); 35% (N = 30) scored < 26, indicating they were experiencing financial toxicity. Financial toxicity was significantly associated with cost-coping (adjusted OR = 3.32 95% CI: 1.08, 14.34). Intervention preferences included access to transportation vouchers (38%), understanding treatment costs up-front (35%), minimizing wait times (33%), access to free food at appointments (25%), and assistance with minimizing/eliminating insurance deductibles (23%). In unadjusted analyses, respondents experiencing financial toxicity were more likely to select transportation assistance (OR = 2.67, 95% CI: 1.04, 6.90), assistance with co-pays (OR = 9.17, 95% CI: 2.60, 32.26), and assistance with deductibles (OR = 12.20, 95% CI: 3.47, 43.48), than respondents not experiencing financial toxicity. CONCLUSIONS Our findings confirm the presence of financial toxicity in gynecologic cancer patients, describe how patients attempt to cope with financial hardship, and provide insight into patients' needs for targeted interventions to mitigate the harm of financial toxicity.
Collapse
|
10
|
Bredbeck BC, Baskin AS, Wang T, Sinco BR, Berlin NL, Shubeck SP, Mott NM, Greenup RA, Nathan H, Hughes TM, Dossett LA. Incremental Spending Associated with Low-Value Treatments in Older Women with Breast Cancer. Ann Surg Oncol 2022; 29:1051-1059. [PMID: 34554342 DOI: 10.1245/s10434-021-10807-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy. METHODS Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women ≥ 70 years old undergoing surgery. RESULTS 9074 women ≥70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments. CONCLUSIONS SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.
Collapse
Affiliation(s)
- Brooke C Bredbeck
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Alison S Baskin
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Ton Wang
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Brandy R Sinco
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicholas L Berlin
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Sarah P Shubeck
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole M Mott
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Hari Nathan
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Tasha M Hughes
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA
| | - Lesly A Dossett
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
- Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
| |
Collapse
|
11
|
Cortina CS, Yen TWF, Bergom C, Fields B, Craft MA, Currey A, Kong AL. Breast cancer-related lymphedema rates after modern axillary treatments: How accurate are our estimates? Surgery 2021; 171:682-686. [PMID: 34736790 DOI: 10.1016/j.surg.2021.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/20/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clinical trials have demonstrated methods to minimize the risk of breast cancer-related lymphedema while preserving regional control. We sought to determine the percent lifetime-risk of breast cancer-related lymphedema that surgeons and radiation oncologists discuss with patients before axillary interventions. METHODS A nationwide survey of surgeons and radiation oncologists was performed from July to August 2020. Participants were asked to identify what number they discuss with patients when estimating the percent lifetime-risk of breast cancer-related lymphedema after different axillary interventions. RESULTS Six hundred and eighty surgeons and 324 radiation oncologists responded (14% response rate). While the estimated rate after sentinel lymph node biopsy was clinically similar between surgeons and radiation oncologists, statistically surgeons quoted a higher percent lifetime-risk (5.7% vs 5.0%, P = .03). Surgeons estimated significantly higher rates of breast cancer-related lymphedema compared with radiation oncologists (P < .001) for axillary lymph node dissection (21.8% vs 17.5%), sentinel lymph node biopsy with regional nodal irradiation (14.1% vs 11.2%), and axillary lymph node dissection with regional nodal irradiation (34.8% vs 26.2%). CONCLUSION There is variability in the estimated rates of breast cancer-related lymphedema providers discuss with patients. These findings highlight the need for physician education on the current evidence of percent lifetime-risk of breast cancer-related lymphedema to provide patients with accurate estimates before axillary interventions.
Collapse
Affiliation(s)
- Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Tina W F Yen
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO; Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/@CarmenBergom
| | - British Fields
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/@BritishFields_
| | - Morgan A Craft
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/@_MorganAshleyC
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Amanda L Kong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. https://twitter.com/@AmandaKongMD
| |
Collapse
|
12
|
Lymphedema in Endometrial Cancer Survivor: A Nationwide Cohort Study. J Clin Med 2021; 10:jcm10204647. [PMID: 34682771 PMCID: PMC8539504 DOI: 10.3390/jcm10204647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/09/2021] [Indexed: 01/30/2023] Open
Abstract
Background: Endometrial cancer is the most common gynecological cancer in developed countries. Treatment-related lymphedema negatively affects the quality of life and function of patients. This study investigated the cumulative incidence and risk factors of, and utilization of health care resources for, lymphedema in patients with endometrial cancer. Methods: We conducted a nationwide, retrospective cohort study of women with endometrial cancer who underwent cancer-direct treatment using the Korean National Health Insurance Service (NHIS) database. Patients were categorized by age, region, income, and treatment modality. Cox proportional hazards regression models were used to analyze the incidence and risk factors of lymphedema. We also analyzed utilization of health care resources for lymphedema using diagnostic and treatment claim codes. Results: A total of 19,027 patients with endometrial cancer were evaluated between January 2004 and December 2017. Among them, 2493 (13.1%) developed lymphedema. Age (<40 years, adjusted odds ratio [aOR] = 1 vs. 40–59 years, aOR = 1.413; 95% confidence interval (CI) 1.203–1.66 vs. 60+ years, aOR = 1.472; 95% CI 1.239–1.748) and multimodal treatment (surgery only, aOR = 1 vs. surgery + radiation + chemotherapy, aOR = 2.571; 95% CI 2.27–2.912) are considered to be possible risk factors for lymphedema in patients with endometrial cancer (p < 0.001). The utilization of health care resources for the treatment of lymphedema has increased over the years. Conclusions: Lymphedema is a common complication affecting women with endometrial cancer and leads to an increase in national healthcare costs. Post-treatment surveillance of lymphedema, especially in high-risk groups, is needed.
Collapse
|
13
|
Coughlin SS, Moore JX, Cortes JE. Addressing financial toxicity in oncology care. JOURNAL OF HOSPITAL MANAGEMENT AND HEALTH POLICY 2021; 5. [PMID: 34549166 PMCID: PMC8452270 DOI: 10.21037/jhmhp-20-68] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Justin Xavier Moore
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta University, Augusta, GA, USA
| |
Collapse
|
14
|
Meernik C, Sandler DP, Peipins LA, Hodgson ME, Blinder VS, Wheeler SB, Nichols HB. Breast Cancer-Related Employment Disruption and Financial Hardship in the Sister Study. JNCI Cancer Spectr 2021; 5:pkab024. [PMID: 34104865 PMCID: PMC8178802 DOI: 10.1093/jncics/pkab024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/22/2023] Open
Abstract
Background More than one-half of breast cancer cases are diagnosed among women aged younger than 62 years, which may result in employment challenges. This study examined whether cancer-related employment disruption was associated with increased financial hardship in a national US study of women with breast cancer. Methods Women with breast cancer who were enrolled in the Sister or Two Sister Studies completed a survivorship survey in 2012. Employment disruption was defined as stopping work completely or working fewer hours after diagnosis. Financial hardship was defined as: 1) experiencing financial problems paying for cancer care, 2) borrowing money or incurring debt, or 3) filing for bankruptcy because of cancer. Prevalence ratios and 95% confidence intervals for the association between employment disruption and financial hardship were estimated using multivariable Poisson regression with robust variance. Results We analyzed data from women employed at diagnosis (n = 1628). Women were a median age of 48 years at diagnosis and 5.6 years from diagnosis at survey completion. Overall, 27.3% of women reported employment disruption (15.4% stopped working; 11.9% reduced hours), and 21.0% experienced financial hardship (16.0% had difficulty paying for care; 12.6% borrowed money or incurred debt; 1.8% filed for bankruptcy). In adjusted analysis, employment disruption was associated with nearly twice the prevalence of financial hardship (prevalence ratio = 1.93, 95% confidence interval = 1.58 to 2.35). Conclusions Women experiencing employment disruptions after breast cancer may be more vulnerable to financial hardship. Findings highlight the need to target risk factors for employment disruption, facilitate return to work or ongoing employment, and mitigate financial consequences after cancer.
Collapse
Affiliation(s)
- Clare Meernik
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC, USA
| | - Lucy A Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Victoria S Blinder
- Department of Medicine and Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
15
|
Abstract
Aims: there has been an increasing awareness of the potential for oncology care to result in long-term financial burdens and financial toxicity. Patients who report cancer-related financial problems or high costs are more likely to forgo or delay prescription medications and medical care. Materials and Methods: we examined financial distress using data from a survey of 164 breast cancer survivors who had completed primary therapy for the disease. Key Findings: among respondents, 8.6% (13 of 151) reported that “being less able to provide for the financial needs of their family” was as a severe problem; 14.4% (22 of 153) reported “difficulty in meeting medical expenses” was a severe problem; and 8.4% (13 of 154) reported that “no money for cost of or co-payment for medical visits” was a severe problem. About 8.4% (13 of 154) of the respondents reported that “no money for cost of or co-payment for medicine” was a severe problem. In logistic regression analysis, younger age and lower household income were significant predictors of financial distress. In multiple linear regression analysis, younger age and lower household income were significant predictors of financial distress. Significance: financial toxicity remains a major issue in breast cancer care. Efforts are needed to ensure patients experiencing high levels of financial toxicity are able to access recommended care. In addition, patients should talk with their providers about the costs of oncology care and about opportunities to reduce costs while maintaining high quality of care.
Collapse
|
16
|
Tagai EK, Hudson SV, Diefenbach MA, Xu J, Bator A, Marziliano A, Miller SM. Social and medical risk factors associated with supportive needs in the first year following localized prostate cancer treatment. J Cancer Surviv 2020; 15:110-118. [PMID: 32681305 PMCID: PMC7872345 DOI: 10.1007/s11764-020-00916-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/10/2020] [Indexed: 01/18/2023]
Abstract
Purpose: Individuals who completed treatment for prostate cancer (PCa) often
report poor coping and practical concerns when adapting to new roles in
their lives—and strong patient-provider communication is critical for
this period. However, there is limited research identifying factors
associated with supportive needs after the completion of PCa treatment. This
study aimed to identify the social and medical risk factors associated with
supportive needs for adapting among individuals who completed treatment for
localized PCa. Methods: Using baseline data from a study evaluating a web-based support
system for patients in the first year following treatment for localized PCa,
self-efficacy for re-entry (e.g., maintaining relationships, symptom
management), medical interactions, and practical concerns (e.g., insurance,
exercise) were assessed. Multivariable regression analyses were completed to
identify risk factors for low readiness. Results: Participants (N=431) with lower health literacy or income, or with
depressive symptoms had lower self-efficacy for re-entry, more negative
interactions with medical providers, and more practical concerns
(ps<.05). Lastly, Non-Hispanic White
participants reported greater readiness compared to all other races
(ps<.05). Conclusions: Multiple social and medical risk factors are associated with greater
supportive needs when adapting to new roles after PCa treatment.
Understanding the risk factors for supportive needs in this period is
critical. Future research is needed to help providers identify and support
individuals at risk for poorer coping and greater practical concerns after
treatment completion. Implications for Cancer Survivors: Identifying individuals with greater supportive needs following
treatment for localized PCa treatment will help ensure successful adaptation
to new roles.
Collapse
Affiliation(s)
- Erin K Tagai
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 125 Patterson St, New Brunswick, NJ, 08901, USA.,Division of Population Science, Rutgers Cancer Institute of New Jersey, The State University of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08903, USA
| | - Michael A Diefenbach
- Center for Health Innovation and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Jenny Xu
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Alicja Bator
- Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, 125 Patterson St, New Brunswick, NJ, 08901, USA
| | - Allison Marziliano
- Center for Health Innovation and Outcomes Research, Feinstein Institute for Medical Research, Northwell Health, 300 Community Dr, Manhasset, NY, 11030, USA
| | - Suzanne M Miller
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| |
Collapse
|
17
|
Dean LT, George M, Lee KT, Ashing K. Why individual-level interventions are not enough: Systems-level determinants of oral anticancer medication adherence. Cancer 2020; 126:3606-3612. [PMID: 32438466 PMCID: PMC7467097 DOI: 10.1002/cncr.32946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Nonadherence to oral anticancer medications (OAMs) in the United States is as low as 33% for some cancers. The reasons for nonadherence to these lifesaving medications are multifactorial, yet the majority of studies focus on patient-level factors influencing uptake and adherence. Individually based interventions to increase patient adherence have not been effective, and this warrants attention to factors at the payor, pharmaceutical, and clinical systems levels. Based on the authors' research and clinical experiences, this commentary brings fresh attention to the long-standing issue of OAM nonadherence, a growing quality-of-care issue, from a systems perspective. In this commentary, the key driving factors in pharmaceutical and payor systems (state and federal laws, payor/insurance companies, and pharmaceutical companies), clinical systems (hospitals and providers), and patient contexts that have trickle-down effects on patient adherence to OAMs are outlined. In the end, the authors' recommendations include examining the influence of laws governing OAM drug pricing, OAM supply, and provider reimbursement; reducing the need for prior authorization of long-approved OAMs; identifying cost-effective ways for providers to monitor nonadherence; examining issues of provider bias in OAM prescriptions; and further elucidating in which contexts patients are likely to be able to adhere. These recommendations offer a starting point for an examination of the chain of systems influencing patient adherence and may help to finally resolve persistently high levels of OAM nonadherence.
Collapse
Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marshalee George
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, California, USA
| |
Collapse
|
18
|
Tangka FKL, Subramanian S, Jones M, Edwards P, Flanigan T, Kaganova Y, Smith KW, Thomas CC, Hawkins NA, Rodriguez J, Fairley T, Guy GP. Insurance Coverage, Employment Status, and Financial Well-Being of Young Women Diagnosed with Breast Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:616-624. [PMID: 32132129 PMCID: PMC7909848 DOI: 10.1158/1055-9965.epi-19-0352] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic cost of breast cancer is a major personal and public health problem in the United States. This study aims to evaluate the insurance, employment, and financial experiences of young female breast cancer survivors and to assess factors associated with financial decline. METHODS We recruited 830 women under 40 years of age diagnosed with breast cancer between January 2013 and December 2014. The study population was identified through California, Florida, Georgia, and North Carolina population-based cancer registries. The cross-sectional survey was fielded in 2017 and included questions on demographics, insurance, employment, out-of-pocket costs, and financial well-being. We present descriptive statistics and multivariate analysis to assess factors associated with financial decline. RESULTS Although 92.5% of the respondents were continuously insured over the past 12 months, 9.5% paid a "higher price than expected" for coverage. Common concerns among the 73.4% of respondents who were employed at diagnosis included increased paid (55.1%) or unpaid (47.3%) time off, suffering job performance (23.2%), and staying at (30.2%) or avoiding changing (23.5%) jobs for health insurance purposes. Overall, 47.0% experienced financial decline due to treatment-related costs. Patients with some college education, multiple comorbidities, late stage diagnoses, and self-funded insurance were most vulnerable. CONCLUSIONS The breast cancer diagnosis created financial hardship for half the respondents and led to myriad challenges in maintaining employment. Employment decisions were heavily influenced by the need to maintain health insurance coverage. IMPACT This study finds that a breast cancer diagnosis in young women can result in employment disruption and financial decline.
Collapse
Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | | | | | | | | | | | - Cheryll C Thomas
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nikki A Hawkins
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juan Rodriguez
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Temeika Fairley
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gery P Guy
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
19
|
Politi MC, Grant RL, George NP, Barker AR, James AS, Kuroki LM, McBride TD, Liu J, Goodwin CM. Improving Cancer Patients' Insurance Choices (I Can PIC): A Randomized Trial of a Personalized Health Insurance Decision Aid. Oncologist 2020; 25:609-619. [PMID: 32108976 DOI: 10.1634/theoncologist.2019-0703] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/17/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many cancer survivors struggle to choose a health insurance plan that meets their needs because of high costs, limited health insurance literacy, and lack of decision support. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. MATERIALS AND METHODS Eligible individuals (18-64 years, diagnosed with cancer for ≤5 years, English-speaking, not Medicaid or Medicare eligible) were randomized to I Can PIC or an attention control health insurance worksheet. Primary outcomes included health insurance knowledge, decisional conflict, and decision self-efficacy after completing I Can PIC or the control. Secondary outcomes included knowledge, decisional conflict, decision self-efficacy, health insurance literacy, financial toxicity, and delayed care at a 3-6-month follow-up. RESULTS A total of 263 of 335 eligible participants (79%) consented and were randomized; 206 (73%) completed the initial survey (106 in I Can PIC; 100 in the control), and 180 (87%) completed a 3-6 month follow-up. After viewing I Can PIC or the control, health insurance knowledge and a health insurance literacy item assessing confidence understanding health insurance were higher in the I Can PIC group. At follow-up, the I Can PIC group retained higher knowledge than the control; confidence understanding health insurance was not reassessed. There were no significant differences between groups in other outcomes. Results did not change when controlling for health literacy and employment. Both groups reported having limited health insurance options. CONCLUSION I Can PIC can improve cancer survivors' health insurance knowledge and confidence using health insurance. System-level interventions are needed to lower financial toxicity and help patients manage care costs. IMPLICATIONS FOR PRACTICE Inadequate health insurance compromises cancer treatment and impacts overall and cancer-specific mortality. Uninsured or underinsured survivors report fewer recommended cancer screenings and may delay or avoid needed follow-up cancer care because of costs. Even those with adequate insurance report difficulty managing care costs. Health insurance decision support and resources to help manage care costs are thus paramount to cancer survivors' health and care management. We developed a web-based decision aid, Improving Cancer Patients' Insurance Choices (I Can PIC), and evaluated it in a randomized trial. I Can PIC provides health insurance information, supports patients through managing care costs, offers a list of financial and emotional support resources, and provides a personalized cost estimate of annual health care expenses across plan types.
Collapse
Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel L Grant
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nerissa P George
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Abigail R Barker
- Brown School and Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Timothy D McBride
- Brown School and Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Courtney M Goodwin
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
20
|
Semin JN, Palm D, Smith LM, Ruttle S. Understanding breast cancer survivors' financial burden and distress after financial assistance. Support Care Cancer 2020; 28:4241-4248. [PMID: 31900619 DOI: 10.1007/s00520-019-05271-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/23/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Little is known about how breast cancer may impact survivors' financial well-being. This study aims to investigate the financial status, burden, and opinions of breast cancer survivors who received short-term financial assistance, emotional support, and resource navigation from a community organization during treatment. METHODS Clients previously served by the community organization were mailed a 16-question survey (n = 751) to elicit their perspective on financial status and burden before, during, and after diagnosis and treatment along with general demographic and opinion items. RESULTS 136 surveys (18.1%) were returned yielding 118 (15.7%) suitable for analyses. Clients' average age was 54.3 years. Most were female (99.2%), Caucasian (66.1%), and diagnosed with Stage 1 or 2 breast cancer (58.5%). Clients reported significantly worse (p < 0.001) financial status after being diagnosed compared to before diagnosis. Financial distress was highest during cancer treatment (mean = 3.92, SD = 0.85), lowest prior to treatment (mean = 2.48, SD = 1.05), and remained high after treatment (mean = 3.59, SD = 1.05). Those with higher distress after treatment were significantly (p = 0.01) more likely to report lower social support during treatment. CONCLUSIONS Breast cancer survivors reported worsening financial status and distress after being diagnosed and during treatment despite receiving short-term financial assistance, emotional support, and resource navigation. Survivors' financial distress after treatment remained higher than before treatment. However, most felt receiving financial assistance improved their quality of life and made them feel more in control of financial decision-making. Breast cancer survivors who feel they have low social support during treatment may feel higher financial distress posttreatment.
Collapse
Affiliation(s)
- Jessica N Semin
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA.
| | - David Palm
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA
| | - Lynette M Smith
- College of Public Health, University of Nebraska Medical Center, 984355 Medical Center, Omaha, NE, 68198-4355, USA
| | - Sarah Ruttle
- Visiting Nurse Association, 12565 West Center Road, Suite 100, Omaha, NE, USA
| |
Collapse
|
21
|
Dean LT, Ransome Y, Frasso-Jaramillo L, Moss SL, Zhang Y, Ashing K, Denis GV, Frick KD, Visvanathan K, Schmitz KH. Drivers of cost differences between US breast cancer survivors with or without lymphedema. J Cancer Surviv 2019; 13:804-814. [PMID: 31446591 PMCID: PMC6828620 DOI: 10.1007/s11764-019-00799-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/13/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Breast cancer-related lymphedema is an adverse effect of breast cancer surgery affecting nearly 30% of US breast cancer survivors (BCS). Our previous analysis showed that, even 12 years after cancer treatment, out-of-pocket healthcare costs for BCS with lymphedema remained higher than for BCS without lymphedema; however, only half of the cost difference was lymphedema-related. This follow-up analysis examines what, above and beyond lymphedema, contributes to cost differences. METHODS This mixed methods study included 129 BCS who completed 12 monthly cost diaries in 2015. Using Cohen's d and multivariable analysis, we compared self-reported costs across 13 cost categories by lymphedema status. We elicited quotes about specific cost categories from in-person interviews with 40 survey participants. RESULTS Compared with BCS without lymphedema, BCS with lymphedema faced 122% higher mean overall monthly direct costs ($355 vs $160); had significantly higher co-pay, medication, and other out-of-pocket costs, lower lotion costs; and reported inadequate insurance coverage and higher costs that persisted over time. Lotion and medication expenditure differences were driven by BCS' socioeconomic differences in ability to pay. CONCLUSIONS Elevated patient costs for BCS with lymphedema are for more than lymphedema itself, suggesting that financial coverage for lymphedema treatment alone may not eliminate cost disparities. IMPLICATIONS FOR CANCER SURVIVORS The economic challenges examined in this paper have long been a concern of BCS and advocates, with only recent attention by policy makers, researchers, and providers. BCS identified potential policy and programmatic solutions, including expanding insurance coverage and financial assistance for BCS across socioeconomic levels.
Collapse
Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA.
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Yusuf Ransome
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Livia Frasso-Jaramillo
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yuehan Zhang
- Department of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, CA, USA
| | - Gerald V Denis
- Departments of Medicine and Pharmacology, Medicine and Pharmacology, BU-BMC Cancer Center, Boston University School of Medicine, Boston, MA, USA
| | - Kevin D Frick
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Johns Hopkins Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, E6650, Baltimore, MD, 21205, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|