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Mahmood S, Graham F, Cooke S, Kane R, Nelson D. Cancer survivorship in urban people living with cancer following primary treatment: A secondary analysis of qualitative interview data. Support Care Cancer 2024; 32:261. [PMID: 38561508 PMCID: PMC10984881 DOI: 10.1007/s00520-024-08464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Urban cancer survivors have been shown to have better opportunities for recovery of health and wellbeing than their rural counterparts. Whilst there is a considerable body of evidence that explores urban people with cancers' experiences and outcomes, there is a dearth of research that explicitly explores 'urban cancer survivorship' in its own right. This study aimed to explore cancer survivorship in urban people living with cancer who have completed primary treatment. METHODS Secondary analysis of in-depth interview data (n = 18) with adults living with cancer who resided in urban parts of the UK. Data were drawn from a broader study on self-management of people living with cancer. An adapted version of Foster and Fenlon's recovery of health and wellbeing in cancer survivorship framework was used to inform the analysis of the data. RESULTS Recovery of health and wellbeing was impacted by a variety of contributory factors, which had a largely positive impact. Access to amenities, social support, travel, and healthcare factors were opportunities for urban cancer survivors, whilst pollution, traffic and a lack of green spaces acted as challenges for health management. CONCLUSION This study demonstrated how urban residency acted as both a barrier and a facilitator to recovery of health and wellbeing in urban cancer survivors following the completion of primary treatment. Area of residence should be taken into account by health providers and policymakers supporting cancer survivorship and the views of those with lived experiences should be included in informing future practice.
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Affiliation(s)
- Saood Mahmood
- Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Florence Graham
- Lincoln Medical School, Universities of Nottingham and Lincoln, Lincoln, UK
| | - Samuel Cooke
- College of Health and Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Ros Kane
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - David Nelson
- College of Health and Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, LN6 7TS, UK.
- Macmillan Cancer Support, London, UK.
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Lim M, Bohorquez NG, Mitchell R, Cramb S, Bradford N, Naicker S, Kularatna S, Senanayake S. Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review. J Adolesc Young Adult Oncol 2024. [PMID: 38451723 DOI: 10.1089/jayao.2023.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.
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Affiliation(s)
- Megumi Lim
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalia Gonzalez Bohorquez
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Remai Mitchell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Natalie Bradford
- Cancer and Palliative Care Outcomes Centre at the Centre for Children's Health Research, School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, Singapore
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Shi Y, Gao Y, Huai Q, Du Z, Yang L. Experiences of financial toxicity among caregivers of cancer patients: a meta-synthesis of qualitative studies. Support Care Cancer 2024; 32:146. [PMID: 38326575 DOI: 10.1007/s00520-024-08349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVES The purpose of this study was to explore the experience of financial toxicity among caregivers of cancer patients and to provide recommendations for subsequent intervention strategies. METHODS Computer searches of PubMed, EmBase, The Cochrane Library, Web of Science, CINAHL (EBSCO), CNKI, Wanfang database, and SinoMed for qualitative studies experience of financial toxicity among caregivers cancer patients. The search time frame was from the establishment of the database to May 2023. The quality of included studies was assessed using the Qualitative Research Checklist from the Joanna Briggs Institute (JBI) Reviewer's Manual. The meta-synthesis was integrated following the meta-aggregation method proposed by the Joanna Briggs Institute (JBI) and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. RESULTS A total of nine studies were included, distilling 25 qualitative findings into nine new categories and synthesizing three synthesized findings: caregivers have strong negative experiences that affect their family relationships, daily work and life; caregivers use different strategies to cope with financial toxicity; needs and expectations of caregivers coping with financial toxicity. CONCLUSIONS Financial toxicity among caregivers of cancer patients affects their daily lives. Receiving timely recognition of this financial burden and providing assistance to enhance their coping skills are crucial in mitigating its impact. Healthcare professionals should focus on the financial toxicity experienced by caregivers of people with cancer, address their supportive needs, and develop a comprehensive support system to improve caregivers' coping abilities and quality of life.
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Affiliation(s)
- Yanan Shi
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Ying Gao
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Qiyang Huai
- School of Nursing, Weifang Medical University, 7166 Baotong West Street, Weifang, 261053, China
| | - Zhongyan Du
- School of Nursing and Rehabilitation, Shandong University, 44 West Culture Road, Jinan, 250000, China
| | - Lijuan Yang
- Department of Nursing, Shandong Provincial Hospital, Jingwuweiqi Road, Jinan, 250000, China.
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Ngan TT, Tien TH, Donnelly M, O’Neill C. Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review. J Public Health (Oxf) 2023; 45:e702-e713. [PMID: 37541834 PMCID: PMC10687873 DOI: 10.1093/pubmed/fdad143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The aim of this scoping review was to identify key research gaps and priorities in order to advance policy and practice for people living with cancer in the UK. METHODS The review adhered to PRISMA guidelines for scoping review. We searched MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar on 16 July 2022. There were no restrictions in terms of study design and publication time; gray literature was included. The key words, 'financial' or 'economic', were combined with each of the following words 'hardship/stress/burden/distress/strain/toxicity/catastrophe/consequence/impact.' RESULTS 29/629 studies/reports published during 1982-2022 were eligible to be included in the review. No study conducted a comprehensive inquiry and reported all aspects of financial toxicity (FT) or used a validated measure of FT. The most three commonly reported outcomes related to financial hardship were financial well-being (24/29), benefit/welfare (17/29) and mental health status (16/29). CONCLUSIONS It is evident that FT is experienced by UK cancer patients/survivors and that the issue is under-researched. There is an urgent need for further research including rigorous studies which contribute to a comprehensive understanding about the nature and extent of FT, disparities in experience, the impacts of FT on outcomes and potential solutions to alleviate FT and related problems.
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Affiliation(s)
- Tran T Ngan
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Tran H Tien
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
- Department of Pharmacy, University Medical Center Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
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Nicoli I, Lockwood G, Fitch L, Longo CJ, Fitch MI. Impact of Income on Physical Concerns, Help Seeking, and Unmet Needs of Adult Cancer Survivors. Physiother Can 2023; 75:339-347. [PMID: 38037576 PMCID: PMC10686300 DOI: 10.3138/ptc-2021-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/29/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2023]
Abstract
Purpose Cancer treatment can have consequences for individuals which may have profound impact on daily living. Accessing assistance can be problematic. This study explores associations between income and concerns, help-seeking, and unmet needs related to physical changes following cancer treatment. Method A national survey was conducted with cancer survivors about experiences with follow-up care one to three years after treatment. We report a trend analysis describing associations between income and cancer survivors' concerns, help-seeking, and unmet needs related to physical changes after treatment. Results In total 5,283 cancer survivors between 18 and 64 years responded, of which 4,264 (80.7%) indicated annual household income. The majority of respondents were survivors of breast (34.4%), colorectal (15.0%), and prostate (14.0%) cancers. Over 90% wrote about experiencing physical changes following cancer treatment. Survivors with low annual household incomes of less than $25,000 (CAN) reported the highest levels of concern about multiple physical changes and were more likely to seek help to address them. Conclusions Cancer survivors can experience various physical challenges and unmet needs following cancer treatment and difficulty obtaining relevant help across all income levels. Those with low income are more severely affected. Financial assessment and tailored follow-up are recommended.
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Affiliation(s)
- Irene Nicoli
- From the:
From the: Health Care Independent Consultant, Toronto, Ontario, Canada
| | - Gina Lockwood
- Biostatistician Independent Consultant, Toronto, Ontario, Canada
| | - Lauren Fitch
- Davidson Physiotherapy, Riverview, New Brunswick, Canada
| | - Christopher J. Longo
- Associate Health Policy and Management, De Groote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Nicoll I, Lockwood G, Fitch MI. Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care. Curr Oncol 2023; 30:8134-8148. [PMID: 37754505 PMCID: PMC10528685 DOI: 10.3390/curroncol30090590] [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: 07/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors' perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors' physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship.
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Affiliation(s)
- Irene Nicoll
- Health Care Consultant, Toronto, ON M4C 4V9, Canada;
| | - Gina Lockwood
- Biostatistician Consultant, Toronto, ON M4C 4V9, Canada;
| | - Margaret I. Fitch
- Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, ON M4C 4V9, Canada
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Pham PD, Schlander M, Eckford R, Hernandez-Villafuerte K, Ubels J. Developing a Conceptual Framework for Socioeconomic Impact Research in European Cancer Patients: A 'Best-Fit' Framework Synthesis. THE PATIENT 2023; 16:515-536. [PMID: 37368196 PMCID: PMC10409844 DOI: 10.1007/s40271-023-00632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Multiple studies have indicated a socioeconomic impact of cancer and cancer care on patients and their families. Existing instruments designed to measure this impact lack consensus in their conceptualization of the issue. Further, various terminologies have been used in the literature (e.g., financial burden, financial hardship, financial stress) without clear definitions and consistent conceptual background. Based on a targeted review of existing models addressing the socioeconomic impact of cancer, our goal was to develop a comprehensive framework from a European perspective. METHOD A 'best-fit' framework synthesis was applied. First, we systematically identified existing models to generate a priori concepts. Second, we systematically identified relevant European qualitative studies and coded their results against these a priori concepts. Inclusion and exclusion criteria were predefined and applied thoroughly in these processes. Thematic analysis and team discussions were applied to finalize the (sub)themes in our proposed conceptual framework. Third, we examined model structures and quotes from qualitative studies to explore relationships among (sub)themes. This process was repeated until no further change in (sub)themes and their relationships emerged. RESULT Eighteen studies containing conceptual models and seven qualitative studies were identified. Eight concepts and 20 sub-concepts were derived from the included models. After coding the included qualitative studies against the a priori concepts and following discussions among team members, seven themes and 15 sub-themes were included in our proposed conceptual framework. Based on the identified relationships, we categorized themes into four groups: causes, intermediate consequences, outcomes and risk factors. CONCLUSION We propose a Socioeconomic Impact Framework based on a targeted review and synthesis of existing models in the field and adapted to the European perspective. Our work contributes as an input to a European consensus project on socioeconomic impact research by an Organization European Cancer Institute (OECI) Task Force.
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Affiliation(s)
- Phu Duy Pham
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany.
- Alfred Weber Institute (AWI), University of Heidelberg, Heidelberg, Germany.
- Institute for Innovation and Valuation in Health Care (InnoVal-HC), Wiesbaden, Germany.
| | - Rachel Eckford
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jasper Ubels
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
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Mudaranthakam DP, Hughes D, Johnson P, Mason T, Nollen N, Wick J, Welch DR, Calhoun E. Career disruption and limitation of financial earnings due to cancer. JNCI Cancer Spectr 2023; 7:pkad044. [PMID: 37326961 PMCID: PMC10359624 DOI: 10.1093/jncics/pkad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/24/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE This study investigated how cancer diagnosis and treatment lead to career disruption and, consequently, loss of income and depletion of savings. DESIGN This study followed a qualitative descriptive design that allowed us to understand the characteristics and trends of the participants. METHOD Patients recruited (n = 20) for this study were part of the University of Kansas Cancer Center patient advocacy research group (Patient and Investigator Voices Organizing Together). The inclusion criteria were that participants must be cancer survivors or co-survivors, be aged 18 years or older, be either employed or a student at the time of cancer diagnosis, have completed their cancer treatment, and be in remission. The responses were transcribed and coded inductively to identify themes. A thematic network was constructed based on those themes, allowing us to explore and describe the intricacies of the various themes and their impacts. RESULTS Most patients had to quit their jobs or take extended absences from work to handle treatment challenges. Patients employed by the same employer for longer durations had the most flexibility to balance their time between cancer treatment and work. Essential, actionable items suggested by the cancer survivors included disseminating information about coping with financial burdens and ensuring that a nurse and financial navigator were assigned to every cancer patient. CONCLUSIONS Career disruption is common among cancer patients, and the financial burden due to their career trajectory is irreparable. The financial burden is more prominent in younger cancer patients and creates a cascading effect that financially affects close family members.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Dorothy Hughes
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peggy Johnson
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Tracy Mason
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Nicole Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Danny R Welch
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Population Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Biddell CB, Waters AR, Angove RSM, Gallagher KD, Rosenstein DL, Spees LP, Kent EE, Planey AM, Wheeler SB. Facing financial barriers to healthcare: patient-informed adaptation of a conceptual framework for adults with a history of cancer. Front Psychol 2023; 14:1178517. [PMID: 37255517 PMCID: PMC10225523 DOI: 10.3389/fpsyg.2023.1178517] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Background Cancer-related financial hardship is associated with negative clinical outcomes, which may be partially explained by cost-related delayed or forgone care in response to financial barriers. We sought to understand patient experiences facing financial barriers to medical care following a cancer diagnosis. Methods We conducted virtual, semi-structured interviews in Fall 2022 with 20 adults with a history of cancer who had experienced cancer-related financial hardship in the prior year. We used template analysis within a pragmatic paradigm, combining constructivist and critical realist theoretical perspectives, to analyze interview transcripts and adapt an existing conceptual framework of financial barriers to care. Results The majority of interviewees identified as women (70%), non-Hispanic white (60%), and reported an annual household income of <$48,000 (60%). As interviewees sought to overcome financial barriers, they described substantial frustration at the limitations and complexities of United States health and social care systems, resulting in a reliance on a fragmented, uncertain resource landscape. The administrative burden resulting from bureaucratic systems and the advocacy responsibilities required to navigate them ultimately fell on interviewees and their caregivers. Thus, participants described their ability to overcome financial barriers as being influenced by individual and interpersonal factors, such as social support, comfort asking for help, time, prior experience navigating resources, and physical and mental health. However, participants noted health system organizational factors, such as whether all new patients proactively met with a social worker or financial navigator, as having the potential to lessen the administrative and financial burden experienced. Conclusion We present an adapted conceptual framework outlining multi-level factors influencing patient experiences coping with financial barriers to medical care. In addition to influencing whether a patient ultimately delays or forgoes care due to cost, financial barriers also have the potential to independently affect patient mental, physical, and financial health.
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Affiliation(s)
- Caitlin B. Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rebekah S. M. Angove
- Patient Insight Institute, Patient Advocate Foundation, Hampton, VA, United States
| | | | - Donald L. Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States
| | - Lisa P. Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arrianna Marie Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Liew CH, Shabaruddin FH, Dahlui M. The Burden of Out-of-Pocket Expenditure Related to Gynaecological Cancer in Malaysia. Healthcare (Basel) 2022; 10:healthcare10102099. [PMID: 36292545 PMCID: PMC9601824 DOI: 10.3390/healthcare10102099] [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: 08/14/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 01/09/2023] Open
Abstract
This study aimed to estimate the economic burden on gynaecological cancer patients and their households, in terms of out-of-pocket expenditure, catastrophic health expenditure (CHE) and poverty impact. A cross-sectional study was conducted at an academic tertiary-care health centre in an upper-middle-income country. Data were obtained via structured interviews of 120 gynaecological cancer patients alongside review of medical charts. Mean (SD) and median (IQR) annual household out-of-pocket expenditures were USD 2780 (SD = USD 3926) and USD 1396 (IQR = 3013), respectively. Two thirds (n = 77/120, 64%) of households experienced CHE and 17% (n = 20/120) were impoverished due to out-of-pocket expenditure related to gynaecological cancer. Factors associated with CHE, explored using multivariate logistic regression analysis, estimated that the highest income quintile households, Q5, were 90% less likely to incur CHE compared to the lowest income quintile households, Q1 (adjusted odds ratio = 0.100; p-value < 0.05) and that patients who were not receiving chemotherapy were 88% less likely to incur CHE compared to those receiving chemotherapy (adjusted odds ratio = 0.120; p-value < 0.05). These results indicate the necessity to broaden the coverage of existing financial assistance for patients from low- and middle-income households, such as extending coverage to adult patients of all ages and to those treated in all public hospitals, including academic health centres.
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Affiliation(s)
- Chee Hui Liew
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Department of Pharmacy, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur 50586, Malaysia
| | - Fatiha Hana Shabaruddin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence:
| | - Maznah Dahlui
- Centre of Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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11
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Khan KI, Sabir QUA, Shafqat A, Aslam M. Exploring the psychological and religious perspectives of cancer patients and their future financial planning: a Q-methodological approach. Palliat Care 2022; 21:186. [PMID: 36253745 PMCID: PMC9578276 DOI: 10.1186/s12904-022-01079-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer patients are often hesitant to talk about their mental health, religious beliefs regarding the disease, and financial issues that drain them physically and psychologically. But there is a need to break this taboo to understand the perceptions and behaviours of the patients. Previous studies identified many psychological factors that are bothering cancer patients. However, it still requires exploring new elements affecting their mental and physical health and introducing new coping strategies to address patients' concerns. METHODS The current study aims to identify cancer patients' perceived attitudes towards the severity of illness, understand their fears, tend towards religion to overcome the disease, and future financial planning by using a Q-methodological approach. Data were collected in three steps from January-June 2020, and 51 cancer patients participated in the final stage of Q-sorting. RESULTS The findings of the study are based on the principal component factor analysis that highlighted three essential factors: (1) feelings, (2) religious beliefs about the acceptance of death, and (3) their future personal and financial planning. Further, the analysis shows that the patients differ in their beliefs, causes and support that they received as a coping mechanism. CONCLUSION This study explains cancer patients' psychological discomfort and physical pain but cannot relate it to co-morbidities. Q methodology allows the contextualization of their thoughts and future planning in different sets, like acceptance of death, combating religion's help, and sharing experiences through various platforms. This study will help health professionals derive new coping strategies for treating patients and financial managers to design insurance policies that help them to share their financial burdens.
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Affiliation(s)
- Kanwal Iqbal Khan
- Management Sciences Department, New Campus, University of Engineering and Technology, Kala Shah Kaku, Pakistan
| | - Qurat Ul An Sabir
- School of Statistics, Minhaj University Lahore, Lahore, Pakistan.,Biofluids and Biosystems Modelling Lab (BBML), Department of Engineering, Faculty of Agriculture, Dalhousie University, Nova, Scotia, Canada
| | - Ambreen Shafqat
- Department of Basic Sciences, School of Mathematics and Statistics, Riphah International University, Islamabad, Pakistan
| | - Muhammad Aslam
- Department of Statistics, Faculty of Science, King Abdulaziz University, 21551, Jeddah, Saudi Arabia.
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12
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Popa AE. Moving beyond the patients’ views on the process of return to work after cancer: A qualitative evidence synthesis on articles published between 2008 and 2017. Work 2022; 72:1299-1310. [DOI: 10.3233/wor-210554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Important qualitative findings have accumulated on return to work after cancer from the perspective of various stakeholders. OBJECTIVE: The aim of this paper was to critically appraise the evidence produced between 2008–2017 on several key stages of the return to work process against the key stakeholders identified in the articles included. METHODS: A systematic search was done on four databases to identify relevant papers. Papers were selected based on pre-defined selection criteria. A qualitative evidence synthesis was performed on the articles included. RESULTS: A total of 57 articles were included in the analysis. Using the secondary thematic analysis, this study identified three categories of articles relative to the stakeholders included: articles focusing on patients’ experience (n = 41); articles dealing with multiple stakeholders, including patients (n = 12); and articles drawing on stakeholders other than patients (n = 4). The analysis also revealed five key stages of the return to work process which follow a sequential order and provide a comprehensive image of the process. CONCLUSIONS: More research is required on how employers view and are able to facilitate the return to work process after cancer. New forms of support must be planned and delivered by health professionals for patients who return on the labour market. The five stages model proposed in this study can help employers and policymakers to plan and deliver tailored legislation and guidance for RTW facilitation. All stakeholders must be further trained to embrace the idea that return to work is a complex process which continues long after the survivor returns to work.
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Affiliation(s)
- Adela Elena Popa
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania E-mail:
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13
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Nicoll I, Lockwood G, Longo CJ, Loiselle CG, Fitch MI. Relationships between Canadian adult cancer survivors' annual household income and emotional/practical concerns, help-seeking and unmet needs. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1290-e1301. [PMID: 34390067 DOI: 10.1111/hsc.13536] [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: 05/20/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to explore the relationship among income and emotional/practical concerns, help-seeking and unmet needs for cancer survivors aged 18 to 64 years one to three years after treatment. A cross-sectional survey was mailed in 2016 to 40,790 survivors randomly selected from 10 Canadian provincial cancer registries. Thirty-three percent responded. A trend analysis was conducted for survivors most likely to be in the workforce exploring the relationship across four income levels and emotional/practical concerns, whether help was sought for identified concerns, and whether help was received. A total of 4,264 respondents, aged 18-64, provided useable data with breast (34.4%) and colo-rectal (15.0%) accounting for the primary cancer type and 32.0% reporting annual household incomes of <$50,000. More than 94% of respondents indicated having emotional or practical concerns. Between one-third and one-half of the respondents sought help for their concerns and, of those, between one-third and one-half experienced difficulty finding help or did not obtain assistance. Significant trends across income categories indicated greater percentages of those in lower income categories experienced emotional and practical concerns, rated their concerns as 'big', sought help, and had difficulty finding help to address their concerns. Clearly adult cancer survivors experience emotional and practical concerns. Healthcare professionals have important roles monitoring these concerns and connecting those who desire help to relevant services. Opportunities should be given to individuals, regardless of income level, to indicate if they have concerns and if they would like assistance.
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Affiliation(s)
- Irene Nicoll
- Health Care Independent Consultant, Toronto, ON, Canada
| | - Gina Lockwood
- Biostatistician Independent Consultant, Toronto, ON, Canada
| | - Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton, ON, Canada
| | - Carmen G Loiselle
- Department of Oncology and Ingram School of Nursing, Christine and Hershel Victor/Hope & Cope Chair in Psychosocial Oncology, McGill University, Montreal, QC, Canada
- Segal Cancer Centre, Jewish General Hospital, CIUSSS Centre-Ouest, Montreal, QC, Canada
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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14
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Su M, Yao N, Liu L, Cheng J, Sun X, Yue H, Zhang J. Older cancer survivors living with financial hardship in China: A qualitative study of family perspectives. Psychooncology 2021; 31:661-670. [PMID: 34784087 DOI: 10.1002/pon.5854] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/16/2021] [Accepted: 11/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Financial hardship among older cancer survivors has not been well-studied, despite its debilitating effects on their health and well-being. The purpose of this study was to describe the lived experiences of Chinese older cancer survivors who have experienced financial hardship following a cancer diagnosis. METHODS A qualitative study was conducted. Data was collected using in-depth interviews with 21 older cancer survivors (aged ≥ 60) with financial hardship and 20 family caregivers in Shandong Province, China between August 2020 and January 2021. Data were analyzed using Colaizzi's phenomenological method. RESULTS Four main themes emerged: (1) older survivors have insufficient ability to address cancer-related costs; (2) financial transfers from adult children to older parents became prevalent after a cancer diagnosis; (3) cancer-related financial worries and stress extended into children's families; (4) coping and adjustment strategies were used by the extended family. Traditional Confucian culture and the Chinese health care system considerably impacted the interpretation of financial hardship. CONCLUSION Both older cancer survivors and their adult children experienced financial distress impacted by filial piety in China. Strategies adapted to Confucian family values and the health care system are needed to address cancer-related financial hardships.
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Affiliation(s)
- Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Joyce Cheng
- College of Arts and Sciences, University of Virginia, Charlottesville, Virginia, USA.,School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Hanlin Yue
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
| | - Jiajun Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
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15
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Pauge S, Surmann B, Mehlis K, Zueger A, Richter L, Menold N, Greiner W, Winkler EC. Patient-Reported Financial Distress in Cancer: A Systematic Review of Risk Factors in Universal Healthcare Systems. Cancers (Basel) 2021; 13:cancers13195015. [PMID: 34638499 PMCID: PMC8508394 DOI: 10.3390/cancers13195015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/23/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A comprehensive understanding of risk factors associated with experiencing subjective financial distress is needed to inform the development of valid instruments and effective interventions to tackle financial toxicity. Several studies from the US indicate a strong correlation of the US-healthcare system’s systematic organisation and its particular socioeconomic risk factors for cancer patients experiencing financial toxicity. It is assumed that risk factors differ in other high-income countries due to the different structure of universal healthcare coverage. As an exhaustive analysis for other countries is lacking, this review aims to identify risk factors for subjective financial distress in universal healthcare systems. Abstract Financial toxicity is a side effect of cancer that results from the perceived financial distress an individual may experience in the course of the disease. The purpose of this paper is to analyse underlying factors related to subjective financial distress in high-income countries with universal healthcare coverage. A systematic literature review was conducted to identify qualitative and quantitative studies of cancer patient-reported subjective financial distress by performing a search in the databases of PubMed, PsycINFO and CINAHL up to December 2020. A qualitative synthesis was performed linking the time-dependent occurrence of risk factors to derived categories of risk factors. Out of 4321 identified records, 30 quantitative and 16 qualitative studies were eligible. Classification of risk factors resulted in eight categories with a total of 34 subcategories. Subjective financial distress is primarily determined by pre-diagnosis sociodemographic- factors as well as financial and work factors that might change during the course of the disease. The design of healthcare and social security systems shapes the country-specific degree of subjective financial distress. Further research should focus on evolving multidisciplinary intervention schemes and multidimensional instruments for subjective financial distress to account for identified risk factors in universal healthcare systems more precisely.
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Affiliation(s)
- Sophie Pauge
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
- Correspondence: ; Tel.: +49-521-106-4331
| | - Bastian Surmann
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
| | - Katja Mehlis
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
| | - Andrea Zueger
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
| | - Luise Richter
- Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University, 01062 Dresden, Germany; (L.R.); (N.M.)
| | - Natalja Menold
- Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University, 01062 Dresden, Germany; (L.R.); (N.M.)
| | - Wolfgang Greiner
- Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany; (B.S.); (W.G.)
| | - Eva C. Winkler
- Section of Translational Medical Ethics, Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.M.); (A.Z.); (E.C.W.)
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16
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Longo CJ, Fitch MI. Unequal distribution of financial toxicity among people with cancer and its impact on access to care: a rapid review. Curr Opin Support Palliat Care 2021; 15:157-161. [PMID: 34232132 DOI: 10.1097/spc.0000000000000561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Research demonstrates that patients and their families often carry a good portion of the economic burden during and following cancer treatment, frequently resulting in implications for access to care. This rapid review summarizes how this knowledge has evolved in recent years. RECENT FINDINGS The number of articles on patient financial burden is increasing, suggesting awareness about the growing impact of economic burden on patients. This is particularly evident when discussing out-of-pocket costs, and lost work for patients/caregivers. However, there is an increasing focus on 'foregone care' and 'financial distress'. Additionally, emerging literature is examining policies and approaches to screen and/or mitigate these patient financial risks, thereby improving access to care. There is also increasing focus on populations that shoulder a disproportionate financial burden, including ethnic minorities (blacks, Asians, Latinos) as well as those with lower socioeconomic status. Additionally, there is evidence that this burden also affects the middle class. SUMMARY As healthcare budgets become stretched, especially during a pandemic, supportive programs benefiting the less fortunate often shrink, which impacts access to care. The emerging research on strategies with government or institutions to mitigate these burdens and access issues are both welcome and needed.
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Affiliation(s)
- Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Hamilton
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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17
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Johnson EM, Ross DB. The Cost of Cancer: The Association of Financial and Cancer-Related Stress on Maladaptive Coping Styles in Families with a Cancer Diagnosis. CONTEMPORARY FAMILY THERAPY 2021; 45:1-10. [PMID: 34305314 PMCID: PMC8290390 DOI: 10.1007/s10591-021-09595-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/05/2022]
Abstract
According to the American Cancer Society (2020), it is estimated that 1.8 million new cancer diagnoses will occur in 2019 in the United States. Due to the frequency of cancer diagnoses and the increasing costs of treatment, financial stress is common among cancer patients. Guided by the Family Systems Illness Model (FSI), a cross-sectional study of individuals and family members where there was an active cancer diagnosis (n = 53) was conducted. The study utilized structural equation modeling to examine the impact of cancer stress and financial stress on maladaptive family coping mechanisms, and in turn, their effect on family communication and satisfaction. Findings indicate individuals with higher financial stress reported greater cancer stress. In turn, individuals with higher cancer stress, reported higher rigidity in their family coping which was associated with less family satisfaction. Additionally, as individuals reported greater family disengagement and chaos, lower levels of family communication and satisfaction were found. These findings provide evidence to the complex stresses experienced by cancer patients and their families. Therapeutic implications of how emotionally focused therapy may support these families dealing with a cancer diagnosis are discussed.
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18
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Fitch MI, Longo CJ, Chan RJ. Cancer patients' perspectives on financial burden in a universal healthcare system: Analysis of qualitative data from participants from 20 provincial cancer centers in Canada. PATIENT EDUCATION AND COUNSELING 2021; 104:903-910. [PMID: 32843264 DOI: 10.1016/j.pec.2020.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To seek understanding of financial burden from the perspective of cancer patients, in a largely publicly funded health care system, about the impacts of financial hardship on their lives. METHODS A qualitative descriptive analysis was completed for comments written in response to an open-ended, free-text item on a pan-Canadian survey about costs incurred during cancer treatment and follow-up and the impact of financial difficulties. RESULTS A total 378 of the 901 survey respondents provided comments about their financial situations during cancer treatment. Forty percent of those individuals indicated experiencing financial struggles and resulting emotional distress. Themes were identified as follows: cost incurred, reduced income and reserves, impact of costs and reduced financial income/reserve, and managing financial distress. CONCLUSION Even within a universal health care system, a significant proportion of cancer patients experienced financial struggle and resulting emotional distress. PRACTICE IMPLICATIONS Regular monitoring of financial and emotional distress and its sources can facilitate the identification of those who are experiencing financial difficulty and the provision of appropriate interventions.
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Affiliation(s)
- Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | - Christopher J Longo
- Health Policy and Management, DeGroote School of Business, McMaster University, Burlington, Ontario, Canada.
| | - Raymond Javan Chan
- Queensland University of Technology, Brisbane, Australia; Princess Alexandra Hospital, Brisbane, Australia.
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19
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Experiencing financial toxicity associated with cancer in publicly funded healthcare systems: a systematic review of qualitative studies. J Cancer Surviv 2021; 16:314-328. [DOI: 10.1007/s11764-021-01025-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
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20
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Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [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: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
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Affiliation(s)
- Saurabh Joshi
- Consultant Palliative and Pain Medicine, Hospice India, New Delhi, India
| | - Upkar Joshi
- Senior Finance and Economics Expert, Founder Ascent Wealth Desk, Visiting Faculty- Delhi University, New Delhi, India
| | - Ankur Bahl
- Senior Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Devavrat Arya
- Principal Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - A K Anand
- Chief Radiation Oncology and Senior Director, Max Super Specialty Hospital, New Delhi, India
| | - Ramandeep Singh Arora
- Senior Consultant, Paediatric Oncology, Max Super Speciality Hospital, New Delhi, India
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21
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Jiang Z, Wei Y, Cao L, Chen Q, Yang H, Lin Z, Jiang L, Mei Z, Liu Z, Chen Z. The use of acupuncture for advanced cancer care: Protocol for a systematic review and meta-analysis. J Adv Nurs 2021; 77:2085-2091. [PMID: 33426711 DOI: 10.1111/jan.14748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
AIM To assess the up-to-date evidence of acupuncture for the management of cancer-related and cancer treatment-related outcomes among people with advanced cancer. DESIGN Systematic review with meta-analyses involving multidimensional outcomes. METHODS The protocol of this systematic review has been registered in PROSPERO with the registration number CRD42020212982. Six databases (including Pubmed, EMBASE, Cochrane Library, SinoMed, ClinicalTrials.gov and Chinese Clinical Trial Registry) will be searched from inception through November 2020 to identify relevant interventional trials examining acupuncture management on multidimensional outcomes in patients with advanced cancer. Main outcomes will include cancer and treatment-related symptoms, quality of life, sleep quality and adverse events. DerSimonian & Laird random-effects meta-analysis will be applied to calculate pooled relative risks for binary data and pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) for continuous data. Trial quality ratings and risk of bias will be evaluated using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development and Evaluation approach. DISCUSSION The efficacy of acupuncture on advanced cancer care and outcomes has not yet been determined. Palliative care for patients with advanced cancer may involve multiple challenges that include physical and mental health care. This systematic review will offer updated and comprehensive evidence of acupuncture on specific outcomes induced by advanced cancer and cancer-related treatment, which can give high level clinical recommendations to improve patient care and clinical outcomes.
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Affiliation(s)
- Zhi Jiang
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueliao Wei
- Department of Gastroenterology, The People's Hospital of Hechi, Hechi, China
| | - Lixing Cao
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qicheng Chen
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Huimin Yang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhanhong Lin
- Department of Minimally Invasive Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixia Jiang
- Preventive Treatment of Disease Centre, ShunDe Hospital GuangZhou University of Chinese Medicine, Shunde, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Zhongqiu Liu
- International Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiqiang Chen
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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22
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Fitch MI, Nicoll I, Lockwood G. Exploring the impact of physical, emotional, and practical changes following treatment on the daily lives of cancer survivors. J Psychosoc Oncol 2020; 39:219-234. [PMID: 33357142 DOI: 10.1080/07347332.2020.1848967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To understand the impact of changes following treatment on daily lives of cancer survivors. METHODS A national survey was conducted with cancer survivors about experiences with follow-up care. The survey included open-ended questions about changes in daily lives following treatment. A qualitative descriptive analysis was completed with the written comments. RESULTS A total of 4575 individuals (33.8% of survey respondents) wrote about impact of changes following cancer treatment. Sixty-one percent were females. Breast (35.2%) and colorectal (17.7%) cancer accounted for largest respondent groups. Survivors identified a myriad of physical, emotional, and practical changes. Impacts on daily living occurred from changes in each domain with change in one area impacting others as well. Predominant issues included physical limitations, mood swings, fear of recurrence, return to work, and financial burdens. IMPLICATIONS Cancer survivors can experience a range of changes following cancer treatment that impact on their daily lives. Individualized assessment and tailored plans for follow-up are recommended.
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Affiliation(s)
| | - Irene Nicoll
- Health Care Consultant, Toronto, Ontario, Canada
| | - Gina Lockwood
- Biostatistician Consultant, Toronto, Ontario, Canada
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23
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Kayser K, Smith L, Washington A, Harris LM, Head B. Living with the financial consequences of cancer: A life course perspective. J Psychosoc Oncol 2020; 39:17-34. [PMID: 32876547 DOI: 10.1080/07347332.2020.1814933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Financial hardship can be a major cause of distress among persons with cancer, resulting in chronic stress and impacting physical and emotional health. This paper provides an analysis of the lived experience of cancer patients' financial hardship from diagnosis to post-treatment. METHODS In-depth interviews were conducted with 26 cancer survivors who reported financial hardship during and/or after treatment. The interviews were analyzed using DedooseTM as an organizational tool, the life course perspective as an organizing theoretical framework, and a thematic analysis tool 1 to answer our research questions. Our analysis identified that timing and sequencing of life transitions and stress proliferation furthered the process of financial stress over time. FINDINGS Cancer survivors do not experience financial toxicity as a singular process; the experience can be quite different depending on age and life transitions. PRACTICE/POLICY IMPLICATIONS These findings provide psychosocial oncology providers with a framework for identifying patients at risk for financial distress and addressing the critical needs related to their life stage.
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Affiliation(s)
- Karen Kayser
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Lisa Smith
- Grace Abbott School of Social Work, University of Nebraska at Omaha, Omaha, NE, USA
| | - Ariel Washington
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Barbara Head
- University of Louisville School of Medicine, Louisville, KY, USA
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24
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Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies. Psychooncology 2020; 29:945-959. [DOI: 10.1002/pon.5361] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/28/2019] [Accepted: 02/10/2020] [Indexed: 12/19/2022]
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25
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The mediator role of unmet needs on quality of life in myeloma patients. Qual Life Res 2020; 29:2641-2650. [PMID: 32356277 DOI: 10.1007/s11136-020-02511-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The diagnosis of multiple myeloma (MM) has a significant impact on patients. This study analyzed the mediating role of patients' unmet needs in the relationship between psychological morbidity/social support and quality of life (QoL). METHODS This study included 213 patients with MM recruited from the outpatient medical oncology and clinical hematology services from five hospitals. Patients who meet the study criteria were referred by physicians and invited to participate in the study by the researcher. All participants answered the following questionnaires: Hospital Anxiety and Depression Scale, Satisfaction with Social Support Scale, Short-Form Survivor Unmet Needs Survey, and The European Organization for Research and Treatment of Cancer's Multiple Myeloma Module. Descriptive statistics, bivariate correlations, and structural equation modeling were performed to analyze the data. RESULTS The indirect effect of psychological morbidity on patients' future perspectives (MYFP) was partially mediated by information unmet needs (INF), while the indirect effect of psychological morbidity on treatment side effects (MYSE) was partially mediated by relationship and emotional unmet needs (REH). In turn, the indirect effect of psychological morbidity on disease symptoms (MYDS) was fully mediated by REH. Social support had an indirect effect on MYDS and MYSE fully mediated by REH. CONCLUSION Intervention programs tailored to promote MM patients' QoL should specifically address information and emotional needs, raising awareness and training health professionals, caregivers, and family members to attend MM patients' unmet needs.
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Lueckmann SL, Schumann N, Hoffmann L, Roick J, Kowalski C, Dragano N, Richter M. 'It was a big monetary cut'-A qualitative study on financial toxicity analysing patients' experiences with cancer costs in Germany. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:771-780. [PMID: 31802578 DOI: 10.1111/hsc.12907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/28/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
Receiving information about expected costs promptly after a cancer diagnosis through psycho-oncology care or social counselling is crucial for patients to be prepared for the financial impact. Nevertheless, less is known about financial impacts for cancer patients in countries with statutory health insurance. This study aims to explore the full scope of costs that constitute the financial impact of a cancer diagnosis in Germany and to identify the reasons for high financial decline. Semistructured interviews with 39 cancer patients were conducted between May 2017 and April 2018. Narratives were analysed via qualitative content analysis. Several factors influenced cancer patients' indirect costs and direct medical and non-medical costs. For many patients, these changes resulted in higher indirect costs caused by income losses, especially when surcharges for shift work, travel expenses or company benefits ceased and were not reimbursed. Higher direct medical costs were caused by co-payments and additional non-refundable costs. Non-medical costs were reported to increase for some patients and to decrease for others, as for example, leisure activity costs either increasing because of pampering oneself to cope with the diagnosis and undergoing therapy or decreasing because of not being able to participate in leisure activities during therapy. When analysing the financial impacts of individuals' total costs, we found that some patients experienced no financial decline or an overall financial increase. Most patients experienced overall higher costs, and income loss was the main driver of a high financial decline. Nevertheless, decreased non-medical costs due to lower work-related and leisure activity costs could compensate for these higher costs. Cancer patients are confronted with a variety of changes in their financial situations, even in countries with statutory health insurance. Screening for cancer patients with a high risk of financial decline should consider any effects on indirect costs and direct medical and nonmedical costs.
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Affiliation(s)
- Sara Lena Lueckmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nadine Schumann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Laura Hoffmann
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Julia Roick
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Nico Dragano
- Institute of Medical Sociology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Abstract
PURPOSE This study explored the experiences of cancer survivors remaining in the workforce, or transitioning back into the workforce following treatment. METHODS Using an exploratory qualitative design, eight individual interviews were conducted with participants undergoing treatment for various cancer diagnoses, all of whom were employed prior to their cancer diagnosis. FINDINGS Participants revealed that work provided them with a sense of normalcy, purpose, and personal identity. All but one participant voiced the benefits of having a supportive work environment. Many also shared they had experienced financial burden and were unaware of where to seek financial assistance. CONCLUSION Future research needs to further explore how the healthcare team and employer can promote supportive work environments and increase cancer survivors' awareness and access to financial resources.
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Affiliation(s)
- Debbie Kane
- Associate Dean, Faculty of Graduate Studies, University of Windsor, 401 Sunset Ave., Windsor, ON N9B 3P4, (519) 253-3000 #2268, ,
| | - Dale Rajacich
- Professor Emeritus, Faculty of Nursing, University of Windsor, Windsor, ON
| | - Chantal Andary
- 4 year Nursing student, Faculty of Nursing, University of Windsor, Windsor, ON
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Watanabe K, Katayama K, Yoshioka T, Narimatsu H. Impact of individual background on the unmet needs of cancer survivors and caregivers - a mixed-methods analysis. BMC Cancer 2020; 20:263. [PMID: 32228490 PMCID: PMC7106842 DOI: 10.1186/s12885-020-06732-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/10/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Cancer survivors and their caregivers may have various unmet needs that are medically difficult to solve. Previous studies have suggested the relations between individuals' backgrounds and their unmet needs. We conducted a large-scale analysis to clarify the influence of individuals' backgrounds, primarily cancer type, on specific types of unmet needs. METHODS Using a mixed-methods approach, we analyzed records of first-time callers to a cancer-focused telephone consultation service that was provided by the Kanagawa Cancer Clinical Research Information Organization from October 2006 to May 2014. The qualitative approach concerned extracting unmet needs mentioned in each consultation and classifying them into themes of specific needs, while the quantitative approach comprised multi-variated analysis of the relationships between the frequency by which the needs in each theme arose and the associated callers' backgrounds. RESULTS A total of 1938 consultation cases were analyzed. In the qualitative analysis, the needs were classified into 16 themes. The mean number of unmet needs for each caller was 1.58 (standard deviation = 0.86). In the multi-variated analysis, caregivers for colorectal cancer survivors had a lower frequency of "emotional/mental health" needs (OR: 0.31, 95%CI: 0.11-0.88, p = 0.028) than did caregivers for breast-cancer survivors. Nevertheless, this was the only significant difference in needs frequency among callers (including survivors and their caregivers) with specific cancer types. Meanwhile, there significant difference in the frequency of occurrence of each unmet need theme was found among items concerning other background elements. Among survivors, sex was related to the frequency of needs among "physical" and "resources" themes, and "emotions/mental health"; their age group with "employment"; treatment course with "physical" and "resources" themes and "cure"; residence with "physical" themes; presence of symptom with "physical," "education/information," "resources," "emotions/mental health," and "cure" themes. CONCLUSIONS This large-scale study suggests that cancer type is not a significant factor for specific unmet needs and that individuals' backgrounds and presence of symptoms play a more important role. Through this study, it was found that instruments to predict people's needs and a system to provide individualized cancer care across cancer types should be developed in the future.
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Affiliation(s)
- Kaname Watanabe
- Department of Clinical Oncology, Yamagata University, Faculty of Medicine, Yamagata, Japan.,Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center, Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kayoko Katayama
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center, Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Takashi Yoshioka
- Department of Clinical Oncology, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Hiroto Narimatsu
- Cancer Prevention and Cancer Control Division, Kanagawa Cancer Center, Research Institute, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan. .,Graduate School of Health of Innovation, Kanagawa University of Human Services, Kawasaki, Kanagawa, Japan.
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Cerone VL. A Brief Psychodynamic and Person-Centered Approach to Address Anticipatory Loss in Acute Care Settings . JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2019; 15:145-156. [PMID: 31608809 DOI: 10.1080/15524256.2019.1670323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Palliative care addresses the biopsychosocial and spiritual distress of people with critical and chronic illness. Depending on the trajectory of an illness, a social worker in an acute care setting may have a limited number of opportunities to engage in meaningful interaction with an emotionally distressed patient. The social worker is often faced with providing care to a patient who is having the dual experience of maintaining hope for medical improvement and anticipating loss. This article offers therapeutic practice skills needed by social workers to address the experience of anticipatory loss in an acute care setting. Brief psychodynamic and person-centered therapy, provided in combination, are highlighted as one method to explore a patient's feelings and wishes in the face of critical illness. Case-based vignettes illustrate how five open-ended questions help mitigate suffering and heighten a patient's sense of autonomy and self-worth.
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Affiliation(s)
- Victoria L Cerone
- New York University Silver School of Social Work & New York University Langone Medical Center, Department of Social Work , New York , NY , USA
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Coumoundouros C, Ould Brahim L, Lambert SD, McCusker J. The direct and indirect financial costs of informal cancer care: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e622-e636. [PMID: 31293013 DOI: 10.1111/hsc.12808] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
Informal caregivers are the primary source of support for cancer patients, providing assistance with household tasks, medical care and emotional support. These responsibilities often result in high levels of emotional, physical, social and financial burden for the caregiver. The aim of this study was to perform a scoping review exploring what is known regarding the financial costs experienced by caregivers and identify gaps in the literature. Seven databases were searched for articles published between May 2008 and May 2018 related to direct and indirect costs of informal cancer care. Included articles reported on the costs incurred by cancer caregivers as a dollar value, relied on caregiver-reported costs and were peer reviewed. A total of 19 studies met the inclusion criteria. These studies reported out of pocket costs' opportunity costs of informal care time and caregiver time loss from paid employment. Care time was the largest source of cancer caregiver costs, averaging $4,809 per month when valued using the proxy good method or $2,877 per month when the opportunity cost approach was used. Caregiver costs were highest when the care recipient was in the palliative phase of the disease. There was an absence of literature reporting costs for cancer caregivers in low and middle income countries and none of the included studies considered costs related to the caregivers' medical expenditures. There were many challenges when comparing the costs across studies due to variations in the type of expenses reported and the methods used to value expenses. Quantifying the financial costs associated with being an informal caregiver can facilitate the communication of the financial burden caregivers experience, potentially spurring the development of policies and programs to reduce their financial burden and better support cancer caregivers.
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Affiliation(s)
- Chelsea Coumoundouros
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lydia Ould Brahim
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
- St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- St. Mary's Research Centre, Montreal, Quebec, Canada
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Xu J, Ellington L, Heyman RE, Vadaparampil ST, Reblin M. Money matters: an analysis of advanced cancer couples' communication about financial concerns. Support Care Cancer 2019; 28:2239-2246. [PMID: 31446485 DOI: 10.1007/s00520-019-05045-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/16/2019] [Indexed: 11/26/2022]
Abstract
Even for the insured, cancer treatment can be expensive and financially burdensome for families, especially in advanced disease. PURPOSE To determine if advanced cancer patient-caregiver spousal dyads identified and/or discussed financial concerns. METHODS Advanced cancer spousal dyads (n = 26) were asked to discuss their concerns (including finances) for 10 min. Discussions were audio-recorded and transcripts were analyzed for content and depth. We used the constant comparative analysis to analyze communication and demographic data from those who identified financial concerns relevant to cancer treatment. RESULTS Of the 26 couples identifying finances as a concern relevant to cancer, there was variability in perception of their overall financial situation, and roughly a third had discordant reports on the degree of financial concern. Thirty-five percent of dyads (n = 9) did not discuss finances during the audio-recorded discussions; for the other dyads, financial conversations varied in depth and breadth for specific concerns. CONCLUSIONS Couples were discordant in reports of concern about finances and perceptions of their financial situations. Even if finances were identified as a concern, many couples chose not to discuss financial concerns in depth. Some degree of shielding or avoidance between spouses may be beneficial, but couple financial discussions are important, especially when decisions may impact long-term plans. More research is needed to determine how to facilitate financial conversations to improve patient's and caregiver's well-being.
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Affiliation(s)
- Jiayun Xu
- College of Health and Human Sciences, School of Nursing, Purdue University, 502 N. University Street, West Lafayette, IN, 47907-2069, USA
| | - Lee Ellington
- College of Nursing, University of Utah, 10 2000 E, Salt Lake City, UT, 84112, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, 137 E 25th Street, 6th Floor, New York, NY, 10010, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Maija Reblin
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA.
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Schröder SL, Schumann N, Fink A, Richter M. Coping mechanisms for financial toxicity: a qualitative study of cancer patients’ experiences in Germany. Support Care Cancer 2019; 28:1131-1139. [DOI: 10.1007/s00520-019-04915-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/31/2019] [Indexed: 10/26/2022]
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Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer. Am J Med 2018; 131:1187-1199.e5. [PMID: 29906429 DOI: 10.1016/j.amjmed.2018.05.020] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/05/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of cancer upon a patient's net worth and debt in the US. METHODS This longitudinal study used the Health and Retirement Study from 1998-2014. Persons ≥50years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models assessed changes in net worth and debt (consumer, mortgage, home equity) at 2 and 4 years after diagnosis (year+2, year+4), controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A 2-year period before cancer diagnosis served as a historical control. RESULTS Across 9.5 million estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At year+2, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, demographic and socioeconomic factors (ie, female, Medicaid, uninsured, retired, increasing age, income, and household size), and clinical characteristics (ie, current smoker, worse self-reported health, hypertension, diabetes, lung disease) (P<.05); average losses were $92,098. At year+4, financial insolvency extended to 38.2%, with several consistent socioeconomic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion. CONCLUSIONS This nationally-representative investigation of an initially-estimated 9.5 million newly-diagnosed persons with cancer who were ≥50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance.
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Affiliation(s)
- Adrienne M Gilligan
- The University of North Texas Health Sciences Center, College of Pharmacy, Fort Worth; Truven Health Analytics, an IBM Company, Houston, Texas
| | - David S Alberts
- The University of Arizona, The University of Arizona Cancer Center, Tucson
| | - Denise J Roe
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson
| | - Grant H Skrepnek
- The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City; The University of Oklahoma Health Sciences Center, Peggy and Charles Stephenson Cancer Center, Oklahoma City.
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Fettro MN, Nomaguchi K. Spousal Problems and Family-to-Work Conflict Among Employed US Adults. JOURNAL OF FAMILY AND ECONOMIC ISSUES 2018; 39:277-296. [PMID: 30555218 PMCID: PMC6289534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using data from the 2011 National Survey of Midlife Development in the United States Refreshed Sample (N = 980), this paper examines how three types of spousal problems-poor physical health, poor mental health, and behavioral disorders-are related to respondents' family-to-work conflict (FWC) among employed adults aged 25-61. Results suggest that all three types of their spouses' problems were related to respondents' higher FWC, with their spouses' poor mental health having the strongest association. These associations were not significant after controlling for respondents' role overload, financial strain, and relationship strain. There were few variations by respondents' gender and parental status in these associations. Relationship strain played the primary role as a mediator, which was stronger for men than women. These findings support the idea of stress proliferation, suggesting that one's problems can be linked to a series of other stressors including one's spouse's FWC.
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Affiliation(s)
- Marshal Neal Fettro
- Department of Sociology & Center for Family and Demographic Research, Bowling Green State University, Williams Hall, Bowling Green, OH 43043, USA
| | - Kei Nomaguchi
- Department of Sociology & Center for Family and Demographic Research, Bowling Green State University, Williams Hall, Bowling Green, OH 43043, USA
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Kiasuwa Mbengi RL, Nicolaie AM, Goetghebeur E, Otter R, Mortelmans K, Missinnne S, Arbyn M, Bouland C, de Brouwer C. Assessing factors associated with long-term work disability after cancer in Belgium: a population-based cohort study using competing risks analysis with a 7-year follow-up. BMJ Open 2018; 8:e014094. [PMID: 29455161 PMCID: PMC5855469 DOI: 10.1136/bmjopen-2016-014094] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The number of workers with cancer has dramatically increasing worldwide. One of the main priorities is to preserve their quality of life and the sustainability of social security systems. We have carried out this study to assess factors associated with the ability to work after cancer. Such insight should help with the planning of rehabilitation needs and tailored programmes. PARTICIPANTS We conducted this register-based cohort study using individual data from the Belgian Disability Insurance. Data on 15 543 socially insured Belgian people who entered into the long-term work disability between 2007 and 2011 due to cancer were used. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the duration of work disability using Kaplan-Meier and the cause-specific cumulative incidence of ability to work stratified by age, gender, occupational class and year of entering the work disability system for 11 cancer sites using the Fine and Gray model allowing for competing risks. RESULTS The overall median time of work disability was 1.59 years (95% CI 1.52 to 1.66), ranging from 0.75 to 4.98 years. By the end of follow-up, more than one-third of the disabled cancer survivors were able to work (35%). While a large proportion of the women were able to work at the end of follow-up, the men who were able to work could do so sooner. Being women, white collar, young and having haematological, male genital or breast cancers were factors with the bestlikelihood to be able to return to work. CONCLUSION Good prognostic factors for the ability to work were youth, woman, white collar and having breast, male genital or haematological cancers. Reviewing our results together with the cancer incidence predictions up to 2025 offers a high value for social security and rehabilitation planning and for ascertaining patients' perspectives.
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Affiliation(s)
- Régine Levo Kiasuwa Mbengi
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | | | | | - Renee Otter
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | | | - Sarah Missinnne
- Belgian Cancer Centre, Scientific Insitute of Public Health, Brussels, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - Catherine Bouland
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
| | - Christophe de Brouwer
- Research Centre for Environmental and Occupational Health, Brussels School of Public Health, Université Libre de Bruxelles (ESP-ULB), Brussels, Belgium
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Impacts on employment, finances, and lifestyle for working age people facing an expected premature death: A systematic review. Palliat Support Care 2017; 16:347-364. [DOI: 10.1017/s1478951517000979] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:The working ages (25–65 years) are a period when most people have significant work, financial, and family responsibilities. A small proportion of working age people will face an expected premature death from cancer or other life-limiting illness. Understanding the impact an expected premature death has on this population is important for informing support. The current study set out to summarize research describing the effects that facing an expected premature death has on employment, financial, and lifestyle of working age people and their families.Method:A systematic review using narrative synthesis approach. Four electronic databases were searched in July 2016 for peer-reviewed, English language studies focusing on the financial, employment, and lifestyle concerns of working age adults living with an advanced life-limiting illness and/or their carers and/or children.Results:Fifteen quantitative and 12 qualitative studies were included. Two-thirds (n = 18) were focused on cancer. All studies identified adverse effects on workforce participation, finances, and lifestyle. Many patients were forced to work less or give up work/retire early because of symptoms and reduced functioning. In addition to treatment costs, patients and families were also faced with child care, travel, and home/car modification costs. Being younger was associated with greater employment and financial burden, whereas having children was associated with lower functional well-being. Changes in family roles were identified as challenging regardless of diagnosis, whereas maintaining normalcy and creating stability was seen as a priority by parents with advanced cancer. This review is limited by the smaller number of studies focussing on the needs of working age people with nonmalignant disease.Significance of results:Working age people facing an expected premature death and their families have significant unmet financial, employment, and lifestyle needs. Comparing and contrasting their severity, timing, and priority for people with nonmalignant conditions is required to better understand their unique needs.
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Head B, Harris L, Kayser K, Martin A, Smith L. As if the disease was not enough: coping with the financial consequences of cancer. Support Care Cancer 2017; 26:975-987. [DOI: 10.1007/s00520-017-3918-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 10/02/2017] [Indexed: 11/24/2022]
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Shilling V, Starkings R, Jenkins V, Fallowfield L. The pervasive nature of uncertainty-a qualitative study of patients with advanced cancer and their informal caregivers. J Cancer Surviv 2017; 11:590-603. [PMID: 28721677 PMCID: PMC5602354 DOI: 10.1007/s11764-017-0628-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/28/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to explore the impact of extended cancer survival on broader aspects of life and wellbeing such as occupational, financial and family life for patients with advanced cancer and their nominated informal caregivers. METHODS In-depth qualitative interviews were transcribed verbatim. A thematic framework was developed from an initial process of open coding and tested iteratively as new data were collected. RESULTS Twenty-four patient-caregiver dyads with advanced ovarian (9), melanoma (9) or lung cancer (6). Patients were aged 39-84 (median 62 years) and caregivers 19-85 (median 54 years). Caregivers were the partners/spouses (15), children (5), siblings (2) and friends (2) of patients. One particular theme, 'uncertainty', encompassed many issues such as planning for the future, providing for one's family, employment and finances. Uncertainties were related to the timescale and trajectory of the disease and lack of control or ability to make plans. There were marked age effects. Accounts from within the same dyad often differed and patients and caregivers rarely discussed concerns with each other. CONCLUSIONS Both patients and their informal caregivers were challenged by the uncertainties around living with advanced cancer and the lack of a defined trajectory. This impacted many diverse areas of life. Although distressing, dyads seldom discussed these concerns with each other. IMPLICATIONS FOR CANCER SURVIVORS Uncertainty is a recurrent issue for cancer survivors and their families impacting broad aspects of their lives and their ability to move forward; however, patients and caregivers in this study rarely discussed these concerns together. Uncertainty should be discussed periodically, together, and healthcare professionals could facilitate these discussions. The use of one or more 'trigger questions' in clinic appointments may provide an opportunity to start these dialogues.
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Affiliation(s)
- Valerie Shilling
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK.
| | - Rachel Starkings
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Valerie Jenkins
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9QG, UK
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The Development of a Nurse-Led Internet-Based Learning and Self-care Program for Cancer Patients With Symptoms of Anxiety and Depression-A Part of U-CARE. Cancer Nurs 2017; 40:E9-E16. [PMID: 27223884 DOI: 10.1097/ncc.0000000000000402] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Having access to information about the disease and being encouraged to participate in self-care activities may reduce anxiety and depression symptoms in cancer patients. Internet-based interventions may be one way to support effective self-care strategies to improve emotional well-being and health-related quality of life. OBJECTIVE The aim of this study was to describe the development and acceptance of an Internet-based program intended to support cancer patients with anxiety and depression symptoms. METHODS A structured collaboration between patients, clinicians, and researchers was used to develop a theory- and evidence-based interactive health communication application (IHCA) based on Orem's self-care deficit nursing theory with influences from Bandura's social learning theory and psychoeducation. RESULTS The result is an IHCA described as a Nurse-led, Internet-based Learning and Self-care program that helps patients to perform self-care using different types of material in interaction with patients and healthcare staff. The acceptance of the program is consistent with the results of similar studies. CONCLUSIONS Collaboration between patients, clinicians, and researchers seems to be a fruitful approach in the development of an IHCA aiming to support cancer patients' self-care strategies. Well-designed intervention studies are needed to evaluate the effects of the IHCA. IMPLICATIONS FOR PRACTICE This article suggests a theoretical foundation for an IHCA and allows researchers and healthcare providers to take part in the discussion regarding format and content of IHCAs.
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Fitzner K, Oteng-Mensah F, Donley P, Heckinger EA. Safety of Cancer Therapies: At What Cost? Popul Health Manag 2017; 20:318-328. [DOI: 10.1089/pop.2016.0097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Patrick Donley
- Economics Department, DePaul University, Chicago, Illinois
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McGrath P. Financial Assistance for Patients Who Relocate for Specialist Care in Hematology: Practical Findings to Inform Nursing Supportive Care. Nurs Forum 2017; 52:55-61. [PMID: 28152210 DOI: 10.1111/nuf.12167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/16/2015] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Abstract
AIMS This article examines findings on the need for, awareness of, and critical time for referral to financial assistance for patients who have to relocate for specialist care for hematological malignancies. DESIGN The study involved descriptive qualitative research based on in-depth interviews that were audio-recorded, transcribed verbatim, coded, and thematically analyzed. PARTICIPANTS Forty-five hematology patients purposively selected from the client database of the Leukaemia Foundation of Queensland were interviewed for the study. RESULTS AND CONCLUSION The findings indicate that there is a critical period at the initial point of diagnosis and start of treatment when patients are experiencing shock, confusion, and a sense of being overwhelmed by stress, fear, and uncertainty about the future. The stress can be exacerbated by the loss of work and a period of waiting to access income (e.g., from superannuation or approval to receive a pension). For some patients, this is a critical period when individuals need support and advice to avoid long-term financial problems. However, at this point in time, many individuals do not know how to access financial advice or assistance from leading cancer supportive care organizations. The findings have practical implications to inform the work by many nurses who provide psychosocial care to hematology patients.
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Affiliation(s)
- Pam McGrath
- Pam McGrath, BSocWk, MA, PhD, is, Associate Professor and Senior Research Fellow, Centre for Community Science, Griffith University, Meadowbrook Qld, Queensland, Australia
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Arnholdt J, Haier J. Cancer patients' preferences for therapy decisions can be grouped into categories and separated by demographic factors. J Cancer Res Clin Oncol 2017; 143:1573-1584. [PMID: 28361228 DOI: 10.1007/s00432-017-2390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Shared decision-making is based on comparable understanding of decision criteria on both sides that requires knowledge about preferences, reception/prioritization of benefits and covariates influencing these criteria. We addressed identification of cancer patients' preferences for treatment decisions and covariates for preference patterns in certain patient cohorts. DESIGN Using preference surveys ordinal ranking of decisional preferences in life (PL) and during therapy (PT) were obtained and aggregated by factorial analysis. Demographic and clinical data enabled clustering of patient groups including non-malignant control group with distinct preference patterns. Covariates for these patterns were determined by multivariate ANOVA. RESULTS 1777 cancer and 367 non-oncological patients (≥18 years) were evaluable (response 56.0%). Patient-reported PT was grouped into distinctive categories: immediate treatment effectivity, long-term effects and survival, empathy, easy treatment and employability/healing. Gender, parenthood, family status, age and educational level mainly determine importance of PL (52.1% variance) and PT (55.1% variance) enabling discrimination of specific preference patterns in patients: older males, non-single, younger males, non-single female with children and young, single patients without children that mainly significantly differed from non-cancer patients (p < 0.001). CONCLUSION Relevance of decisional PL/PT appears to be cancer-specific and distinct between cancer patient groups. If patients recognize direct social responsibility, immediate treatment effects gain importance accompanied by reduced impact of employability, rehabilitation and financial security. For young and independent patients empathy has similar impact as treatment effects. Consequently, clinical research should consider age-specific endpoints and distinct decisional preferences to match patients' perspective by specific evidence.
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Affiliation(s)
- Jana Arnholdt
- Comprehensive Cancer Center Münster, University Hospital Münster, Münster, Germany
| | - Jörg Haier
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Martinistr. 52 (O24), 20246, Hamburg, Germany.
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Patient-reported outcome measures of the impact of cancer on patients' everyday lives: a systematic review. J Cancer Surviv 2016; 11:211-232. [PMID: 27834041 PMCID: PMC5357497 DOI: 10.1007/s11764-016-0580-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/22/2016] [Indexed: 11/25/2022]
Abstract
Purpose Patients with advanced disease are living longer and commonly used patient-reported outcome measures (PROMs) may miss relevant elements of the quality of extended survival. This systematic review examines the measures used to capture aspects of the quality of survival including impact on patients’ everyday lives such as finances, work and family roles. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO restricted to English language articles. Information on study characteristics, instruments and outcomes was systematically extracted and synthesised. A predefined set of criteria was used to rate the quality of studies. Results From 2761 potentially relevant articles, 22 met all inclusion criteria, including 10 concerning financial distress, 3 on roles and responsibilities and 9 on multiple aspects of social well-being. Generally, studies were not of high quality; many lacked bias free participant selection, had confounding factors and had not accounted for all participants. High levels of financial distress were reported and were associated with multiple demographic factors such as age and income. There were few reports concerned with impacts on patients’ roles/responsibilities in everyday life although practical and emotional struggles with parenting were identified. Social difficulties were common and associated with multiple factors including being a caregiver. Many studies were single time-point surveys and used non-validated measures. Exceptions were employment of the COST and Social Difficulties Inventory (SDI), validated measures of financial and social distress respectively. Conclusions Impact on some important parts of patients’ everyday lives is insufficiently and inconsistently captured. Further PROM development focussing on roles and responsibilities, including work and caring for dependents, is warranted. Implications for Cancer Survivors Factors such as finances, employment and responsibility for caring for dependants (e.g. children and elderly relatives) can affect the well-being of cancer survivors. There is a need to ensure that any instruments used to assess patients’ social well-being are broad enough to include these areas so that any difficulties arising can be better understood and appropriately supported.
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Klag N, Walter AC, Sheely KM, Manahan KJ, Geisler JP. Is the routine use of bevacizumab in the treatment of women with advanced or recurrent cancer of the cervix sustainable? CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:287-91. [PMID: 27382318 PMCID: PMC4922810 DOI: 10.2147/ceor.s71218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND New chemotherapy combinations are being tested for the treatment of women with advanced, persistent or recurrent cervical cancer. We sought to evaluate the cost effectiveness of some newer combination therapies in cervical cancer. PATIENTS AND METHODS A cost effectiveness decision model was used to analyze Gynecologic Oncology Group 240. All regimens were modeled for seven cycles. The regimens studied are as follows: regimen 1, cisplatin/paclitaxel (CP); regimen 2, CP with bevacizumab (CP+B); regimen 3, paclitaxel/topotecan (PT); and regimen 4, PT with bevacizumab (PT+B). Overall survival, cost, and complications were studied. Sensitivity analyses were performed. RESULTS Mean chemotherapy costs over mean total costs for seven cycles of each follows: CP $571/$32,966; CP+B $61,671/$96,842; PT $9,211/$71,620; and PT+B $70,312/$109,211. Incremental cost-effectiveness ratio (ICER) for CP+B was $133,559/quality adjusted life year (QALY). ICER for PT+B was $124,576/QALY. To achieve an incremental ICER for CP+B:CP of <$50,000/QALY gained, the mean overall survival has to increase from 1.1 years with CP to 3.5 years with CP+B. An ICER <$50,000/QALY for the other regimens would take a survival of >10 years for PT and 4.1 years for PT+B. Treating 1,000 women with cervical cancer with CP+B would cost almost double the cost of treating >18,000 women with ovarian cancer annually (carboplatin/paclitaxel). CONCLUSION CP is the most cost effective regimen. A 12-month increase in overall survival will not even make the newer combinations cost effective. Currently, the use of bevacizumab is not sustainable at today's costs.
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Affiliation(s)
- Natalie Klag
- Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA
| | - Adam C Walter
- Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA
| | - Kristen M Sheely
- Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA
| | - Kelly J Manahan
- Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA
| | - John P Geisler
- Division of Gynecologic Oncology, Cancer Treatment Centers of America Newnan, Georgia, USA
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Stergiou-Kita M, Pritlove C, Holness DL, Kirsh B, van Eerd D, Duncan A, Jones J. Am I ready to return to work? Assisting cancer survivors to determine work readiness. J Cancer Surviv 2016; 10:699-710. [PMID: 26816271 DOI: 10.1007/s11764-016-0516-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/16/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE A critical initial step in work re-entry involves the determination of work readiness. Cancer survivors have requested increased health care provider involvement in their work readiness decisions. However, there has been no exploration of current practices in determining work readiness, and thus no specific recommendations regarding how to assist survivors in answering the question: Am I ready to return to work? METHODS To explore return to work following cancer and the workplace supports survivors require, we completed an exploratory qualitative study. We conducted semi-structured interviews with (i) cancer survivors (n = 16) and (ii) health care/vocational service providers (n = 16). Data were analyzed using thematic analysis. Themes specific to work readiness are discussed. RESULTS Three key processes were deemed relevant to determining work readiness by health care providers and survivors: (1) assessing functional abilities in relation to job demands; (2) identifying survivor strengths and barriers to return to work; and (3) identifying supports available in the workplace. Challenges to work readiness determinations, were described by survivors and providers, related to: (i) the complexity of cancer, (ii) the accuracy of work readiness determinations, and (iii) the lack of established processes for addressing work goals. CONCLUSIONS Health care providers need to work collaboratively with survivors to determine if they are physically, cognitively, and emotionally ready to return to work, and with workplaces to determine if they are prepared to provide the necessary supports. Further stakeholder collaboration is also warranted. IMPLICATIONS FOR CANCER SURVIVORS Supports from health care providers in determining work readiness can ensure survivors do not return to work either "too early" or "too late."
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Affiliation(s)
- Mary Stergiou-Kita
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada. .,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. .,Institute of Work and Health, Toronto, ON, Canada. .,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Cheryl Pritlove
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.,Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre University Health Network, Toronto, ON, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Faculty of Medicine, Toronto, ON, Canada.,Department of Occupational and Environmental Health and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Bonnie Kirsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dwayne van Eerd
- Institute of Work and Health, Toronto, ON, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Andrea Duncan
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Ave., Toronto, ON, M5G 1V7, Canada
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Balfe M, Butow P, O'Sullivan E, Gooberman-Hill R, Timmons A, Sharp L. The financial impact of head and neck cancer caregiving: a qualitative study. Psychooncology 2016; 25:1441-1447. [DOI: 10.1002/pon.4079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry Ireland; Cork Ireland
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making; The University of Sydney; Sydney Australia
| | | | | | | | - Linda Sharp
- Newcastle University; Newcastle upon Tyne UK
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Long A, Halkett GKB, Lobb EA, Shaw T, Hovey E, Nowak AK. Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy. Neurooncol Pract 2015; 3:105-112. [PMID: 31386072 DOI: 10.1093/nop/npv039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
Background Few studies have explored the unmet needs of carers of people with high-grade glioma. We aimed to determine carers' levels of distress during treatment, understand their support needs and explore predictors of distress. Methods Carers of people with high-grade glioma undergoing chemoradiotherapy were recruited to this prospective, longitudinal cohort study. Carers completed the validated Supportive Care Needs Survey, Brain Tumour Specific Supportive Care Needs Scale, Distress Thermometer (DT), and General Health Questionnaire (GHQ-12). Questionnaires were administered during patients' chemoradiotherapy and 3 and 6 months later. Results We recruited 118 carers who were mainly female (72%) and caring for spouse (82%). The mean age was 53 years (SD = 13.6; range, 21-89). Thirty-one percent of carers reported moderate distress (DT score 5-6/10) and 31% reported extreme distress (score 7-10/10) during combined chemoradiotherapy. Carer distress was associated with adverse GHQ scores (r = 0.61, P < .001). Seventy-two percent reported a negative financial impact of caring and 51% of those previously working full-time had taken leave or reduced working hours. The top 5 moderate/high unmet needs were: accessing prognostic information; accessing financial support and government benefits; accessible hospital parking; impact of caring on usual life; reducing stress in the patients' life. Conclusion Carers reported substantial distress, and high distress levels were correlated with greater psychological impact and increased self-reporting of unmet needs. Future research should focus on interventions that aid in reducing carer distress.
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Affiliation(s)
- Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Georgia K B Halkett
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth A Lobb
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Thérèse Shaw
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth Hovey
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
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Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H, Chisholm G, Williams J, Frisbee-Hume S, Bruera E. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Oncologist 2015. [PMID: 26205738 DOI: 10.1634/theoncologist.2015-0026] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. PATIENTS AND METHODS We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). RESULTS The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%-93%) versus 65 of 72 at GPH (90%; 95% CI: 81%-96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1-7) versus 8 (IQR: 3-10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1-8). FD correlated (Spearman correlation) with FACT-G (r = -0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336). CONCLUSION FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. IMPLICATIONS FOR PRACTICE Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
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Affiliation(s)
- Marvin Delgado-Guay
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jeanette Ferrer
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alyssa G Rieber
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Wadih Rhondali
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Supakarn Tayjasanant
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jewel Ochoa
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Hilda Cantu
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gary Chisholm
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Janet Williams
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Susan Frisbee-Hume
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Eduardo Bruera
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Warner EL, Kirchhoff AC, Nam GE, Fluchel M. Financial Burden of Pediatric Cancer for Patients and Their Families. J Oncol Pract 2015; 11:12-8. [PMID: 25316026 PMCID: PMC4295420 DOI: 10.1200/jop.2014.001495] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cancer treatment may cause financial stress for pediatric oncology patients and their families. We evaluated pediatric cancer caregivers' perceived financial burden related to socioeconomic factors (eg, parental employment) and health care use factors (eg, unexpected hospitalizations). METHODS A single-site, cross-sectional survey of primary caretakers of patients with childhood cancer was performed from July 2010 to July 2012. Eligible patients were treated at a pediatric cancer hospital, diagnosed at age ≤ 21 years and were ≤ 5 years from diagnosis (N = 254). Financial burden was rated on a visual analog scale of 0 to 100. Multivariable linear regression models were used to calculate coefficients and 95% CIs of financial burden by time since diagnosis. RESULTS Mean age at diagnosis was 6.8 years (SD = 5.5 years), and average time since diagnosis was 1.6 years (SD = 1.4 years). The most common diagnosis was leukemia (41.9%). When adjusted for sex, age at diagnosis, insurance status, and rural residence, caregivers whose child was 1 to 5 years from diagnosis with ≥ 5 unexpected hospitalizations experienced 24.9 (95% CI, 9.1 to 40.7; P < .01) points higher financial burden than those with no unexpected hospitalizations. In addition, when compared with families without employment disruptions, families of children 1 to 5 years from diagnosis in which a caregiver had quit or changed jobs reported 13.4 (95% CI, 3.2 to 23.6; P = .01) points higher financial burden. CONCLUSIONS Efforts to reduce unexpected hospitalizations and employment disruptions by providing more comprehensive supportive care for pediatric patients with cancer could help ease families' financial burden.
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Affiliation(s)
- Echo L Warner
- Huntsman Cancer Institute; and University of Utah, Salt Lake City, UT
| | - Anne C Kirchhoff
- Huntsman Cancer Institute; and University of Utah, Salt Lake City, UT
| | - Gina E Nam
- Huntsman Cancer Institute; and University of Utah, Salt Lake City, UT
| | - Mark Fluchel
- Huntsman Cancer Institute; and University of Utah, Salt Lake City, UT
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