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Vadlakonda A, Cho NY, Chervu N, Porter G, Curry J, Sakowitz S, Coaston T, Rook JM, Juillard C, Benharash P. Association of uninsured status and rurality with risk of financial toxicity after pediatric trauma. Surgery 2024; 176:455-461. [PMID: 38772775 DOI: 10.1016/j.surg.2024.03.055] [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: 12/14/2023] [Revised: 02/18/2024] [Accepted: 12/14/2023] [Indexed: 05/23/2024]
Abstract
BACKGROUND Pediatric traumatic injury is associated with long-term morbidity as well as substantial economic burden. Prior work has labeled the catastrophic out-of-pocket medical expenses borne by patients as financial toxicity. We hypothesized uninsured rural patients to be vulnerable to exorbitant costs and thus at greatest risk of financial toxicity. METHODS Pediatric patients (<18 years) experiencing traumatic injury were identified in the 2016-2019 National Inpatient Sample. Patients were considered to be at risk of financial toxicity if their hospitalization cost exceeded 40% of post-subsistence income. Individual family income was computed using a gamma distribution probability density function with parameters derived from publicly available US Census Bureau data, in accordance with prior work. A multivariable logistic regression was developed to assess factors associated with risk of financial toxicity. RESULTS Of an estimated 225,265 children identified for study, 34,395 (15.3%) were Rural. Rural patients were more likely to experience risk of financial toxicity (29.1 vs 22.2%, P < .001) compared to Urban patients. After adjustment, rurality (reference: urban status; adjusted odds ratio 1.45, 95% confidence interval 1.36-1.55) and uninsured status (reference: private; adjusted odds ratio 1.85, 95% confidence interval 1.67-2.05) remained linked to increased odds of risk of financial toxicity. Specifically among those with private insurance, Rural patients experienced markedly higher predicted risk of financial toxicity, relative to Urban. CONCLUSION Our findings suggest a complex interplay between rural status and insurance type in the prediction of risk of financial toxicity after pediatric trauma. To target policy interventions, future studies should characterize the patients and communities at greatest risk of financial devastation among rural pediatric trauma patients.
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Affiliation(s)
- Amulya Vadlakonda
- Department of Surgery, University of California, Los Angeles, CA. https://twitter.com/amulyavad
| | - Nam Yong Cho
- Department of Surgery, University of California, Los Angeles, CA
| | - Nikhil Chervu
- Department of Surgery, University of California, Los Angeles, CA
| | - Giselle Porter
- Department of Surgery, University of California, Los Angeles, CA
| | - Joanna Curry
- Department of Surgery, University of California, Los Angeles, CA
| | - Sara Sakowitz
- Department of Surgery, University of California, Los Angeles, CA
| | - Troy Coaston
- Department of Surgery, University of California, Los Angeles, CA
| | - Jordan M Rook
- Department of Surgery, University of California, Los Angeles, CA; Greater Los Angeles Veterans Administration Healthcare System, Los Angeles CA; National Clinician Scholars Program, University of California, Los Angeles, CA; Fielding School of Public Health, University of California, Los Angeles, CA
| | - Catherine Juillard
- Division of General Surgery (Trauma and Surgical Critical Care Section), University of California, Los Angeles, CA
| | - Peyman Benharash
- Department of Surgery, University of California, Los Angeles, CA.
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Raggini E, Mattavelli D, Zigliani G, Bossi P, Piazza C. Measuring financial toxicity in head and neck cancer: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:1-12. [PMID: 38420716 PMCID: PMC10914354 DOI: 10.14639/0392-100x-n2762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/26/2023] [Indexed: 03/02/2024]
Abstract
Objective The current study systematically reviews the literature about financial toxicity (FT) in head and neck cancer patients. Three databases were reviewed: PubMed, Scopus and Web of Science. Methods Full text English papers published from 2000 to 2022 reporting on quantitative results about FT in head and neck cancer survivors collected through structured questionnaires or interviews were included. Results Twenty-seven articles were included. Most of the articles were published after 2015 and from United States. There was a slight prevalence of papers dealing with oropharyngeal cancer, squamous-cell carcinoma and locally advanced head and neck cancer. Measures of FT were obtained through validated questionnaires like COST, FIT and FDQ. Collected data were mostly referrable to financial spending, financial resources, psychosocial aspect, support seeking, coping care and coping lifestyle subdomain. FT scores by COST were found to be worse in the COVID era. Financial counseling and adequate information about the costs of treatment were two effective strategies to mitigate FT. Conclusions FT is a relatively new challenge in head and neck cancer treatment, whose expenses are higher than therapies for other cancers. A universal method to assess FT and a unified guideline for the administration of questionnaires are needed to mitigate FT and to improve patient outcomes.
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Affiliation(s)
- Elisa Raggini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Azzani M, Atroosh WM, Anbazhagan D, Kumarasamy V, Abdalla MMI. Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis. Front Public Health 2024; 11:1266533. [PMID: 38229668 PMCID: PMC10789858 DOI: 10.3389/fpubh.2023.1266533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Background There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology, International Medical School (IMS), Management & Science University (MSU), Shah Alam, Selangor, Malaysia
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Mona Mohamed Ibrahim Abdalla
- Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
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Pangestu S, Harjanti EP, Pertiwi IH, Rencz F, Nurdiyanto FA. Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis. Value Health Reg Issues 2023; 41:25-31. [PMID: 38154366 DOI: 10.1016/j.vhri.2023.11.007] [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: 07/12/2023] [Revised: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia. METHODS Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis. RESULTS We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members. CONCLUSIONS This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.
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Affiliation(s)
- Stevanus Pangestu
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | | | - Ika Hana Pertiwi
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - F A Nurdiyanto
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
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Smith J, Yu J, Gordon LG, Chilkuri M. Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer. Curr Oncol 2023; 30:4922-4935. [PMID: 37232829 DOI: 10.3390/curroncol30050371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/07/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
AIM To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL). METHODS A cross-sectional survey was administered to patients with HNC 1-3 years after radiotherapy at a regional hospital in Australia. The survey included questions on sociodemographics, out-of-pocket expenses, HRQoL, and the Financial Index of Toxicity (FIT) tool. The relationship between high financial toxicity scores (top quartile) and HRQoL was explored. RESULTS Of the 57 participants included in the study, 41 (72%) reported out-of-pocket expenses at a median of AUD 1796 (IQR AUD 2700) and a maximum of AUD 25,050. The median FIT score was 13.9 (IQR 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs. 114.5, p < 0.001). Patients who were not married had higher FIT scores (23.1 vs. 11.1, p = 0.01), as did those with lower education (19.3 vs. 11.1, p = 0.06). Participants with private health insurance had lower financial toxicity scores (8.3 vs. 17.6, p = 0.01). Medications (41%, median AUD 400), dietary supplements (41%, median AUD 600), travel (36%, median AUD 525), and dental (29%, AUD 388) were the most common out-of-pocket expenses. Participants living in rural locations (≥100 km from the hospital) had higher out-of-pocket expenses (AUD 2655 vs. AUD 730, p = 0.01). CONCLUSION Financial toxicity is associated with poorer HRQoL for many patients with HNC following treatment. Further research is needed to investigate interventions aimed at reducing financial toxicity and how these can best be incorporated into routine clinical care.
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Affiliation(s)
- Justin Smith
- Townsville University Hospital, Townsville, QLD 4814, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Justin Yu
- Townsville University Hospital, Townsville, QLD 4814, Australia
| | - Louisa G Gordon
- Health Economics, Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD 4006, Australia
- School of Nursing, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Madhavi Chilkuri
- Townsville University Hospital, Townsville, QLD 4814, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
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Nguyen OT, Donato U, McCormick R, Reblin M, Kim L, Hume E, Otto AK, Alishahi Tabriz A, Islam JY, Hong Y, Turner K, Patel KB. Financial toxicity among head and neck cancer patients and their caregivers: A cross‐sectional pilot study. Laryngoscope Investig Otolaryngol 2023; 8:450-457. [PMID: 37090884 PMCID: PMC10116977 DOI: 10.1002/lio2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives Head and neck cancer (HNC) patients experience greater financial toxicity than other cancer patients. Research on financial toxicity has concentrated on patients despite many informal caregivers sharing finances and reducing work hours to provide patient care. Thus, our pilot study: (1) assessed the feasibility of financial toxicity screening of HNC patients and their caregivers, and (2) described financial toxicity levels of HNC patients and their caregivers. Methods We surveyed English-speaking adult HNC patients initiating treatment at a National Cancer Institute-designated Comprehensive Cancer Center and their informal caregivers. This survey assessed demographics and financial toxicity through the Comprehensive Score for Financial Toxicity (COST) measure (0-44 range; lower score indicates higher financial toxicity). Screening feasibility was defined as ≥50% consent rate and ≥60% data completion rate. Results Our sample included 27 HNC patients and 9 caregivers. They both had slightly lower consent and completion rates than our goals. Patients reported a median COST score of 27 while caregivers reported a median COST score of 16. Approximately 25.9% of patients and 44.4% of caregivers reported high financial toxicity (COST < 17.5). Caregivers reported high concerns about their future financial health and their ability to control the amount of their financial contributions to the patient's care. Conclusions Patients and caregivers may require additional outreach approaches beyond emailed questionnaires to screen for their financial toxicity systematically. Future research is needed to replicate our results to determine whether differences in financial toxicity occur between patients and caregivers and identify areas of focus for interventions. Level of evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Umberto Donato
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | | | - Maija Reblin
- Department of Family Medicine University of Vermont Burlington Vermont USA
- Cancer Control and Population Health Sciences Program University of Vermont Cancer Center Burlington Vermont USA
| | - Lindsay Kim
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | - Emma Hume
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Amy K. Otto
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jessica Y. Islam
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Young‐Rock Hong
- Department of Health Services, Research, and Management University of Florida Gainesville Florida USA
| | - Kea Turner
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Krupal B. Patel
- Department of Head and Neck Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
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Pangestu S, Rencz F. Comprehensive Score for Financial Toxicity and Health-Related Quality of Life in Patients With Cancer and Survivors: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:300-316. [PMID: 36064514 DOI: 10.1016/j.jval.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Financial toxicity is recognized as an important adverse effect of cancer treatment that may decrease patients' health-related quality of life (HRQOL). We aim to perform a systematic review and meta-analysis on studies investigating the association of HRQOL and financial toxicity measured with the Comprehensive Score for Financial Toxicity in patients with cancer and survivors. METHODS A systematic literature search was completed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (last update April 2022). Methodological quality of included studies was assessed using the Appraisal Tool for Cross-Sectional Studies and the Critical Appraisal Skills Program Cohort Study Checklist. Where possible, study outcomes were pooled by random-effects meta-analysis. RESULTS Thirty-one studies were included with a combined sample of 13 481 patients and survivors with more than 25 cancer types from 9 countries. Nineteen different validated HRQOL instruments were used in these studies, with the Functional Assessment of Cancer Therapy - General (n = 9), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (n = 5), and EQ-5D (n = 5) being the most common. All but one included studies reported that higher financial toxicity was significantly associated with worse HRQOL. Ten HRQOL domains were correlated with financial toxicity, including physical health (r = 0.34-0.66), social health (r = 0.16-0.55), mental health (r = 0.21-0.54), and daily functioning (r = 0.23-0.52). The meta-analysis indicated a moderate correlation between financial toxicity and overall HRQOL as measured by the Functional Assessment of Cancer Therapy instruments (r = 0.49, 95% confidence interval 0.44-0.54). CONCLUSIONS This is the first systematic review and meta-analysis to summarize the literature on the association of financial toxicity and HRQOL in patients with cancer and survivors. Our findings substantiate financial toxicity as a relevant outcome of cancer care that is associated with a decline of HRQOL.
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Affiliation(s)
- Stevanus Pangestu
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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De Ravin E, Armache M, Campbell F, Rising KL, Worster B, Handley NR, Fundakowski CE, Cognetti DM, Mady LJ. Feasibility and Cost of Telehealth Head and Neck Cancer Survivorship Care: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:1312-1323. [PMID: 36939546 DOI: 10.1002/ohn.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/28/2022] [Accepted: 11/12/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Evaluate the feasibility and cost-effectiveness of telehealth head and neck cancer (HNC) survivorship care. DATA SOURCES Ovid MEDLINE, Embase, Scopus, CINAHL. REVIEW METHODS A systematic search for peer-reviewed feasibility studies on telehealth models for HNC survivorship care published between 2005 and 2021 was conducted using the terms "head and neck cancer" and "telehealth" and their synonyms. Inclusion criteria were studies on telehealth survivorship program interventions for HNC patients with quantitative feasibility outcome measures (eg, enrollment, retention, attrition/dropout rate, adherence/task completion rate, patient satisfaction, cost). RESULTS Thirty-eight studies out of 1557 identified met inclusion criteria and were included for analysis. Feasibility outcomes evaluated were enrollment and attrition rates, adherence/task completion rates, patient satisfaction, and user feedback surveys in different survivorship domains. Patient enrollment ranged from 20.8% to 85.7%, while attrition ranged from 7% to 47.7%. Overall, adherence was 30.2% higher in the intervention group than in the control group (46.8% vs 16.6%). Studies with cost analysis found telehealth models of care to be statistically significantly less expensive and more cost-efficient than the standard model of care, with a $642.30 saving per patient (n = 3). Telehealth models also substantially reduced work time saving per visit (on average, 7 days per visit). CONCLUSION While telehealth survivorship programs are feasible and cost-effective and are associated with improved patient outcomes, they might not be ideal for every patient. Further investigations are needed to understand the role of telehealth in survivorship care, given the variability in study design, reporting, measures, and methodological quality.
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Frank Campbell
- Penn Libraries, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristin L Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brooke Worster
- Department of Hospice and Palliative Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher E Fundakowski
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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9
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Jiang H, Lyu J, Mou W, Jiang L, Zeng Y, Liu Y, Hu A, Jiang Q. Prevalence and risk factors of self-reported financial toxicity in cancer survivors: A systematic review and meta-analyses. J Psychosoc Oncol 2022:1-18. [DOI: 10.1080/07347332.2022.2142877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hua Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianxia Lyu
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenxuan Mou
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Luxi Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Zeng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Ying Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Aiping Hu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinghua Jiang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Margalit DN, Salz T, Venchiarutti R, Milley K, McNamara M, Chima S, Wong J, Druce P, Nekhlyudov L. Interventions for head and neck cancer survivors: Systematic review. Head Neck 2022; 44:2579-2599. [PMID: 35848095 PMCID: PMC9796901 DOI: 10.1002/hed.27142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions for head/neck cancer (HNC) survivors may not address their cancer-related and general health needs. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this systematic review of studies from 2000 to 2021 of interventions targeting cancer survivors treated with curative-intent, using MEDLINE, Embase, Emcare, and PsycINFO. Interventions were categorized into domains of the Quality of Cancer Survivorship Care Framework to characterize the scope and quality of interventions. RESULTS We identified 28 studies for inclusion: 13 randomized and 15 non-randomized. Most targeted surveillance/management of physical effects (n = 24) including 13 that also targeted psychosocial effects. Four studies addressed prevention/surveillance for recurrence/new cancers, one addressed health promotion/disease prevention, and one addressed chronic medical conditions. Most studies (n = 27) had medium-high risk of bias. CONCLUSIONS There are few high-quality studies addressing HNC survivorship. Future rigorously designed studies should address broader areas of care, including chronic disease management and health promotion/disease prevention.
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Affiliation(s)
- Danielle N. Margalit
- Department of Radiation Oncology, Head and Neck Oncology ProgramDana‐Farber Cancer Institute/Brigham & Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Talya Salz
- Department of Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck SurgeryChris O'Brien LifehouseCamperdownNew South WalesAustralia,School of Public Health, Faculty of Medicine and HealthThe University of SydneyNew South WalesAustralia
| | - Kristi Milley
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia
| | - Mairead McNamara
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Department of Cancer Imaging, Peter MacCallum Cancer CentreMelbourneVICAustralia
| | - Sophie Chima
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Jamieson Wong
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia
| | - Paige Druce
- Primary Care Collaborative Cancer Clinical Trials Group (PC4)Centre for Cancer ResearchMelbourneVictoriaAustralia,Department of General PracticeUniversity of MelbourneMelbourneVictoriaAustralia,Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Larissa Nekhlyudov
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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11
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Nguyen OT, McCormick R, Patel K, Reblin M, Kim L, Hume E, Powers B, Otto A, Alishahi Tabriz A, Islam J, Hong Y, Kirchhoff AC, Turner K. Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1820-1829. [PMID: 36544972 PMCID: PMC9764792 DOI: 10.1002/lio2.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0-84). Objective health insurance literacy was measured through correct answers to a previously developed 10-question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10-item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out-of-pocket costs for out-of-network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Krupal Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA,Cancer Control & Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Benjamin Powers
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amy Otto
- Department of Public Health SciencesUniversity of MiamiCoral GablesFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
| | - Jessica Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services Research and ManagementUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
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12
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Verdonck-de Leeuw I, Dawson C, Licitra L, Eriksen JG, Hosal S, Singer S, Laverty DP, Golusinski W, Machczynski P, Varges Gomes A, Girvalaki C, Simon C, Leemans CR. European Head and Neck Society recommendations for head and neck cancer survivorship care. Oral Oncol 2022; 133:106047. [PMID: 35932637 DOI: 10.1016/j.oraloncology.2022.106047] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Survivors of head and neck cancer can experience long-term consequences of the cancer and subsequent treatments even after the cancer has resolved. Increasingly clinicians are aware of the social, psychological, financial, and emotional impacts of these cancers, in addition to the support required for the physical symptoms. This review provides recommendations on the long-term management and support required for survivors of head and neck cancer in the European healthcare setting.
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Affiliation(s)
- Irma Verdonck-de Leeuw
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department Otolaryngology-Head and Neck Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department Clinical, Neuro and Developmental Psychology, Van der Boechorststraat 7-9, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands.
| | - Camilla Dawson
- Speech and Language Therapist-Dysphagia and Altered Airways University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit and Head & Neck Research Program at the Istituto Nazionale Tumori in Milan, Italy.
| | - Jesper Grau Eriksen
- Experimental Clinical Oncology, Aarhus University Hospital, Entrance C, Level 1, C108, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark.
| | - Sefik Hosal
- Department of Otolaryngology-Head & Neck Surgery, Atılım University Faculty of Medicine, Ankara, Turkey.
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology, and Informatics, University Hospital of Johannes Gutenberg University Mainz, Germany.
| | - Dominic P Laverty
- Restorative Dentistry, Birmingham Dental Hospital, 5 Mill Pool Way, Birmingham B5 7EG, UK.
| | - Wojciech Golusinski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Piotr Machczynski
- Department of Head and Neck Surgery Poznan University of Medical Sciences, The Greater Poland Cancer Centre, 15 Garbary St., 61-866 Poznan, Poland.
| | - Ana Varges Gomes
- Centro Hospitalar e Universitario do Algarve, Chair of Administration Council, MD Medical Oncologist, Portugal.
| | - Charis Girvalaki
- European Cancer Patient Coalition, Avenue des Arts 6, 1210 Brussels, Belgium.
| | - Christian Simon
- Chef-de-service, Service d'Oto-rhino-laryngologie et chirurgie cervico-faciale CHUV, UNIL, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC - Vumc, P.O. Box 7057, 1007MB Amsterdam, the Netherlands.
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13
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Mott NM, Mierzwa ML, Casper KA, Shah JL, Mallen-St Clair J, Ho AS, Zumsteg ZS, Prince ME, Dossett LA, Chen MM. Financial Hardship in Patients With Head and Neck Cancer. JCO Oncol Pract 2022; 18:e925-e937. [PMID: 35167324 PMCID: PMC9797234 DOI: 10.1200/op.21.00683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Financial hardship is a growing concern for patients with cancer. Patients with head and neck cancer (HNC) are particularly vulnerable, given that a third leave the workforce following treatment. The goal of our study was to characterize financial hardship in the psychologic response (response to increased expenses) and coping behaviors (behaviors patients adopt to manage their care in the setting of increased expenses) domains in patients with HNC compared with patients with other cancers. METHODS This was a retrospective cohort study of nationally representative public survey data from 2013 to 2018 in the National Health Interviews Survey, an annual cross-sectional household survey. We included respondents age ≥ 18 years who reported a diagnosis of cancer and identified a subset of patients with HNC. Our main outcomes were financial hardship in the psychologic response and coping behaviors domains. RESULTS Our sample included a weighted population of 357,052 patients with HNC and 21.4 million patients with other cancers. Compared with patients with other cancers, patients with HNC reported greater levels of coping behaviors hardship (31% v 23%, P = .015), but similar levels of psychologic financial hardship (73% v 72%, P = .787). Medicaid or uninsured patients more often reported coping behaviors hardship. On multivariable analysis, HNC (odds ratio, 1.51; 95% CI, 1.01 to 2.24) was independently associated with coping behaviors hardship. CONCLUSION To our knowledge, this is the first study to evaluate financial hardship in patients with HNC compared with patients with other cancers that includes Medicaid and uninsured patients, who are more often to have financial hardship. Patients with HNC have greater levels of hardship in the coping behaviors domain compared with patients with other cancers, but similar levels in the psychologic response domain.
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Affiliation(s)
| | | | - Keith A. Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Jennifer L. Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary S. Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark E.P. Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI
| | - Lesly A. Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI,Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Michelle M. Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA,Michelle M. Chen, MD, MHS, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 8635 West Third St, Suite 590W, Los Angeles, CA 90048; e-mail:
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14
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Mady LJ, Baddour K, Hodges JC, Magaña LC, Schwarzbach HL, Borrebach JD, Nilsen ML, Johnson JT, Hall DE. The impact of frailty on mortality in non-surgical head and neck cancer treatment: Shifting the clinical paradigm. Oral Oncol 2022; 126:105766. [PMID: 35168191 PMCID: PMC9642850 DOI: 10.1016/j.oraloncology.2022.105766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/11/2022] [Accepted: 02/06/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compare survival of head and neck cancer (HNC) patients treated with surgical or non-surgical management according to frailty, quantify frailty with the Risk Analysis Index (RAI), a validated 14-item instrument. MATERIALS AND METHODS Prospective cohort study of newly diagnosed HNC patients (≥18 years) who had frailty assessment from April 13, 2016 to September 30, 2016. Primary outcome was overall survival at 1- and 3-years. Cox proportional hazard models were utilized to examine mortality with predictor variables. Adjusted and unadjusted (Kaplan-Meier) survival curves stratified by either RAI scores or treatment modality were plotted. Kruskal-Wallis and likelihood ratio chi-square tests were used for comparing clinicodemographic variables. RESULTS Of 165 patients, 54 (32.7%) were managed non-surgically, 49 (29.7%) were treated with definitive surgery only, and 62 (37.6%) were treated with multimodality (surgery + adjuvant) therapy. Among the full cohort and subgroup analysis of the frail/very frail (RAI ≥ 37), non-surgical patients had worse or similar 3-year survival than those treated with surgery +/- adjuvant therapy. Multivariable Cox proportional hazard models demonstrate that frail patients treated non-surgically experienced worse survival than their counterparts treated with surgery (HR = 2.50, p = 0.015, 95% CI: 1.19, 5.23) or multimodality therapy (HR = 3.91, p < 0.001, 95% CI: 1.94-7.89). CONCLUSION Across all levels of frailty, long term survival of HNC patients treated without surgery is either worse than or like those treated with surgery. These findings (1) challenge current practices of steering patients "too frail for surgery" towards non-surgical, "non-invasive" therapy, and (2) suggest equipoise warranting randomized trials to clarify treatment of frail patients.
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Affiliation(s)
- Leila J. Mady
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Khalil Baddour
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Linda C. Magaña
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Hannah L. Schwarzbach
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Marci L. Nilsen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Daniel E. Hall
- Wolff Center at UPMC, Pittsburgh, PA, USA,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA,Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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15
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Kroll JL, Kim S, Cho D, Weathers SP, Chen AB, Smith G, Bruera E, Milbury K. Financial distress and its associated burden in couples coping with an advanced cancer. Support Care Cancer 2022; 30:4485-4495. [PMID: 35112209 DOI: 10.1007/s00520-021-06758-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE In efforts to understand financial distress (FD) associated with advanced cancer care from the perspective of both patients with incurable disease and their spousal caregivers, we assessed FD in both members of the couple, identified symptom and quality of life (QOL) correlates, and examined the potential role of illness communication. METHODS Patients undergoing treatment for stage III/IV lung cancer or a grade III/IV primary brain tumor and their spousal caregivers (n = 76 dyads) completed measures of somatic and affective symptoms including FD, physical and mental QOL, and ease of engaging in illness communication. Patients and caregivers additionally rated their perception of each other's symptoms, including FD. RESULTS FD was endorsed by both patients (any FD 62.7%; high FD 24%) and spousal caregivers (any FD 64.7%; high FD 32.3%). Self-reported FD was significantly correlated (partial r = .52, p < .001) within couples. FD was associated with greater symptoms of anxiety (r = .29, p = .01; r = .31, p = .01), depression (r = 29, p = 01; r = .39, p = .001), and poorer physical QOL(r = - .25, p = .03; r = - .25, p = .001) for patients and caregivers, respectively. For patients, FD was additionally associated with poorer mental QOL(r = - .44, p < .001). Caregivers accurately perceived patient FD, yet patients tended to underreport their caregiver's FD by almost an entire point (t = 2.8, p = .007). A 3-way interaction (FD X role X illness communication) revealed (b = .40, p = .041) that illness communication moderated the association between FD and physical QOL for spouses so that spouses who reported less ease of illness communication demonstrated a stronger association between financial distress and physical QOL (b = - 2.08, p < .001) than those reporting greater ease of engaging in illness communication (b = .49, p = .508). CONCLUSION In the advanced cancer setting, FD is prevalent in both patients and their spousal caregivers and associated with psychological distress and poor physical QOL. Results suggest that optimal FD assessment should include patients and spouses, and spouse's ease of engaging with illness communication may be a potential target for future intervention studies.
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Affiliation(s)
- Juliet L Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77005, USA.
| | - Seokhun Kim
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77005, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aileen B Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Grace Smith
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation & Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathrin Milbury
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler, Houston, TX, 77005, USA
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