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Samaha NL, Mady LJ, Armache M, Hearn M, Stemme R, Jagsi R, Gharzai LA. Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review. J Am Coll Radiol 2024; 21:1380-1397. [PMID: 38762031 DOI: 10.1016/j.jacr.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT. METHODS A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States. RESULTS Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies. DISCUSSION FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.
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Affiliation(s)
- Nadia L Samaha
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madison Hearn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rachel Stemme
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reshma Jagsi
- Chair, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois.
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Tran BT, Nguyen TG, Le DD, Nguyen MT, Nguyen NPT, Nguyen MH, Ong TD. Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer. J Prev Med Public Health 2024; 57:407-419. [PMID: 38938045 PMCID: PMC11309834 DOI: 10.3961/jpmph.24.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/28/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. METHODS This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. RESULTS The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. CONCLUSIONS FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.
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Affiliation(s)
- Binh Thang Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thanh Gia Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Duong Le
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Minh Tu Nguyen
- Undergraduate Training Office, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | | | | | - The Due Ong
- Health Strategy & Policy Institute, Ministry of Health, Hanoi, Vietnam
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Kimura G, Fujii Y, Honda K, Osawa T, Uchitomi Y, Kondo M, Otani A, Wako T, Kawai D, Mitsuda Y, Sakashita N, Shinohara N. Financial Toxicity in Japanese Patients with Metastatic Renal Cell Carcinoma: A Cross-Sectional Study. Cancers (Basel) 2024; 16:1904. [PMID: 38791981 PMCID: PMC11119599 DOI: 10.3390/cancers16101904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0-36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL.
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Affiliation(s)
- Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan;
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan;
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan;
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Miki Kondo
- Department of Nursing, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan; (M.K.); (A.O.)
| | - Ariko Otani
- Department of Nursing, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan; (M.K.); (A.O.)
| | - Tetsuya Wako
- Department of Pharmacy, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan;
| | - Daisuke Kawai
- Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan; (D.K.); (Y.M.)
| | - Yoshihide Mitsuda
- Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan; (D.K.); (Y.M.)
| | - Naotaka Sakashita
- Medilead, Inc., 24F Tokyo Opera City Tower, 3-20-2, Nishishinjyuku, Shinjyuku-ku, Tokyo 163-1424, Japan;
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan;
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Xu B, So WK, Choi KC, Huang Y, Liu M, Qiu L, Tan J, Tao H, Yan K, Yang F. Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study. Asia Pac J Oncol Nurs 2024; 11:100443. [PMID: 38665637 PMCID: PMC11039943 DOI: 10.1016/j.apjon.2024.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Objective We assessed financial toxicity (FT) among Chinese patients with cancer and investigated associated risk factors guided by a multilevel conceptual framework. Methods Applying multistage stratified sampling, we selected six tertiary and six secondary hospitals across three economically diverse provinces in China. From February to October 2022, 1208 patients with cancer participated. FT was measured using the COmprehensive Score for financial Toxicity (COST), with 28 potential risk factors identified at multilevel. Multiple regression analysis was used for risk factor identification. Results FT prevalence was 82.6% (95% confidence interval [CI]: 80.5%, 84.8%), with high FT (COST score ≤ 18.5) observed in 40.9% of participants (95% CI: 38.1%, 43.7%). Significant risk factors included younger age at cancer diagnosis, unmarried status, low annual household income, negative impact of cancer on participants' or family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side effects, high perceived stress, poor emotional/informational support, lack of social medical insurance or having urban and rural resident basic medical insurance, lack of commercial medical insurance, tertiary hospital treatment, and inadequate cost discussions with healthcare providers (all P < 0.05). Conclusions Cancer-related FT is prevalent in China, contributing to disparities in cancer care access and health-related outcomes. The risk factors associated with cancer-related FT encompasses multilevel, including patient/family, provider/practice, and payer/policy levels. There is an urgent need for collective efforts by patients, healthcare providers, policymakers, and insurers to safeguard the financial security and well-being of individuals affected by cancer, promoting health equities in the realm of cancer care.
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Affiliation(s)
- Binbin Xu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie K.W. So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Huang
- The Nursing Department of the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Mei Liu
- The Infection Control Department of Xuzhou Cancer Hospital, Xuzhou, China
| | - Lanxiang Qiu
- The Nursing Department of the Third Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jianghong Tan
- The Nursing Department of Zhuzhou Central Hospital, Zhuzhou, China
| | - Hua Tao
- The Oncology Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Keli Yan
- The Internal Medicine Nursing Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yang
- The Nursing Department of Nanjing Pukou People's Hospital, Nanjing, China
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Yamamoto S, Kondoh C, Nakagoshi H, Kakumen M, Yasuhara K, Nakai M, Kodani N, Sunda K, Higashide C, Katayama M, Arao H. Financial toxicity and patient experience associated with financial burden of molecular-targeted and immune therapies for cancer: an observational study under public health insurance. Int J Clin Oncol 2024; 29:417-426. [PMID: 38400876 PMCID: PMC10963472 DOI: 10.1007/s10147-024-02479-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Financial burden of cancer treatment can negatively affect patients and their families. This study aimed to evaluate the financial toxicity of patients treated with molecular-targeted and immune therapies and explore the relationship between financial toxicity and patient experiences associated with the financial burden of cancer treatment. METHODS This anonymous, self-administered questionnaire survey conducted across nine hospitals in Japan included patients aged 20-60 years who were receiving molecular-targeted agents or immune checkpoint inhibitors for any type of cancer for ≥ 2 months. Financial toxicity was evaluated using the COmprehensive Score for Financial Toxicity (COST). Patient experience was examined using 11 items based on previous studies. Independent factors related to financial toxicity were explored using multiple regression analyses. RESULTS The mean COST score was 17.0 ± 8.4, and 68 (49.3%) participants reported COST scores at or below the cutoff point. The factors contributing to financial toxicity were "hesitation regarding continuing treatment based on finances" (sβ = - 0.410, p < 0.001), "cutting through my deposits and savings" (sβ = - 0.253, p = 0.003), and "reducing spending on basics like food or clothing" (sβ = - 0.205, p = 0.046) along with comorbidities (sβ = - 0.156, p = 0.032). CONCLUSION Patients receiving molecular-targeted and immune therapies are at risk of experiencing profound financial toxicity and a reduced quality of life. The independently related factors that we identified have the potential to serve as indicators of profound financial toxicity and the need for specialized intervention.
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Affiliation(s)
- Sena Yamamoto
- Osaka University Graduate School of Medicine, Division of Health Sciences, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Chiharu Kondoh
- Sumitomo Hospital, 5-3-20 Nakanoshima Kita-Ku, Osaka, Osaka, 535-0005, Japan
| | - Hideko Nakagoshi
- Nursing Department, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Mayuko Kakumen
- Matsushita Memorial Hospital, 5-55 Sotojima-Cho, Moriguchi, Osaka, 570-8540, Japan
| | - Kana Yasuhara
- National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-Ku Osaka, Osaka, 540-0006, Japan
| | - Mayumi Nakai
- Department of Nursing, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-Ku, Nagoya, Aichi, 460-0001, Japan
| | - Naoko Kodani
- National Hospital Organization, Yonago Medical Center, 4-17-1 Kuzumo, Yonago, Tottori, 683-0006, Japan
| | - Kazumi Sunda
- Social Welfare Organization Imperial Gift Foundation, Inc. Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Chizuru Higashide
- Shiga General Hospital, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Megumi Katayama
- Kyoto Chubu Medical Center, 25 Yagi-Cho Yagi Ueno, Nantan, Kyoto, 629-0197, Japan
| | - Harue Arao
- Osaka University Graduate School of Medicine, Division of Health Sciences, 1-7 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Vasquez-Trespalacios EM, Rivera Rivera JN, McIntyre M, Santiago-Datil W, Wenham RM, Vadaparampil ST, Buras AL, Conley CC. High Financial Hardship among Patients with Advanced Ovarian Cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:120-132. [PMID: 38635421 DOI: 10.1080/15524256.2024.2342285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
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Affiliation(s)
| | | | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrea L Buras
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
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Zhang M, Wang X, Shao M, Li T, Guo S, Yang Y, Yu L, Bin M, Li D, Zhou H, Yao L, Chen C, Wang T. Financial toxicity of informal caregivers of colorectal cancer patients: A cross-sectional study. Eur J Oncol Nurs 2024; 69:102519. [PMID: 38402718 DOI: 10.1016/j.ejon.2024.102519] [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: 12/13/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To assess the level of financial toxicity of informal caregivers of colorectal cancer patients and explore the related key influencing factors. METHOD A descriptive survey design was used in this study. Data were collected from 236 informal caregivers of colorectal cancer patients between March 2023 and July 2023 from a major hospital in central China (Henan province). Potential influence factors of financial toxicity, including basic information, perceived stress, and social support were analyzed using multivariate linear regression. RESULTS The financial toxicity score of 236 caregivers of colorectal cancer patients was 19.42 ± 9.72. One hundred and fourteen caregivers (accounting for 48.31%) of colorectal cancer patients had high levels of financial toxicity. Financial toxicity scores of caregivers were negatively correlated with perceived stress (r = -0.421, P < 0.001) and positively correlated with social support (r = 0.416, P < 0.001). Our multivariate regression analysis identified some factors that directly affected caregivers' financial toxicity, including caregiver age (t = 2.105, P = 0.036), medical insurance (t = 2.462, P = 0.015), average household income (t = 2.995, P = 0.003), place of residence (t = 2.872, P = 0.004), perceived stress (t = -4.945, P < 0.001), and social support (t = 4.513, P < 0.001). CONCLUSIONS Caregivers of colorectal cancer patients generally experience a higher level of financial toxicity, which could be eased by lower perceived stress and higher social support. In clinical practice, it is necessary to comprehensively assess the level of financial toxicity of particular caregivers and enact targeted interventions such as increasing communication and actively providing information to address the high medical costs, reducing the detrimental effects of financial toxicity, and improving the quality of colorectal cancer care.
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Affiliation(s)
- Menghan Zhang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China.
| | - Xiaokai Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China.
| | - Mengwei Shao
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Ting Li
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Shengjie Guo
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Yi Yang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Lulu Yu
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Ma Bin
- School of Medical, Molecular and Forensic Sciences, Murdoch University, 6149, Australia
| | - Dunhui Li
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 6150, Australia
| | - Huiyue Zhou
- Ninth People's Hospital of Zhengzhou, Zhengzhou, 450001, China
| | - Liqun Yao
- Weifang Central for Disease and Prevention, Weifang, Shandong Province, China
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China; Telethon Kids Institute, Perth, WA, 6872, Australia; Medical School, University of Western Australia, Perth, WA, 6872, Australia.
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Shao M, Yao L, Zhang M, Zhou H, Ding Y, Bai L, Ma B, Li T, Guo S, Chen C, Wang T. Post-surgery financial toxicity and its influencing factors in colorectal cancer care: A cross-sectional study. Eur J Oncol Nurs 2024; 68:102518. [PMID: 38309254 DOI: 10.1016/j.ejon.2024.102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to investigate the influence factors of financial toxicity experienced by colorectal cancer patients after surgery. The results will provide deep insights for developing effective intervention strategies to address this common issue of colorectal cancer care. METHODS In this cross-sectional study, we recruited 213 postoperative patients with colorectal cancer from February 2023 to July 2023 in two major public hospitals. Patients completed the General Information Questionnaire, Comprehensive Scores for Financial Toxicity (COST), Self-perceived Burden Scale (SPBS), Family Resilience Questionnaire (FaREQ), and Social Support Rating Scale (SSRS). A multiple linear regression model was used to investigate the influence factors of financial toxicity. RESULTS The mean score of financial toxicity was medium (18.91 ± 7.90) in this study. Financial toxicity score was negatively correlated with self-perceived burden (r = -0.333, P < 0.01) and positively associated with family resilience (r = 0.365, P < 0.01) and social support (r = 0.388, P < 0.01). Via multiple linear regression analysis, we identified seven significant factors associated with financial toxicity, including family income [(95 %CI: 1.075-3.123); P = 0.000], self-perceived burden [(95 %CI: 0.300∼-0.038); P = 0.012], stoma [(95 %CI: 5.309∼-1.682); P = 0.000], social support [(95 %CI:0.058-0.407); P = 0.009], cancer stage [(95 %CI: 2.178∼-0.170); P = 0.022], postoperative duration [(95 %CI: 1.900∼-0.332); P = 0.005], and family resilience [(95 %CI: 0.028-0.203); P = 0.010]. CONCLUSIONS Financial toxicity was prevalent among postoperative colorectal cancer patients. Additional support and early interventions should be given to high-risk patients, including those with stomas, advanced disease stages, or experiencing longer postoperative duration. Apart from demographic factors, we identified that self-perceived burden, family resilience, and social support were also associated with financial toxicity, providing a new perspective for developing effective strategies against financial toxicity.
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Affiliation(s)
- Mengwei Shao
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China.
| | - Liqun Yao
- Weifang Center for Disease Control and Prevention, Weifang, 261053, China.
| | - Menghan Zhang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Huiyue Zhou
- The Ninth People's Hospital of Zhengzhou, Zhengzhou, 450053, China
| | - Yangqing Ding
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lin Bai
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, 6149, Australia
| | - Ting Li
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Shengjie Guo
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China; Telethon Kids Institute, Perth, WA, 6872, Australia; Medical School, University of Western Australia, Perth, WA, 6872, Australia; People' S Hospital of Hebi, Hebi, 458010, China.
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9
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Wang S, Wang J, Kang H, Zeng L, Liu G, Qiu Y, Wei M. Assessment of the prevalence and related factors of financial toxicity in cancer patients based on the COST scale: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 68:102489. [PMID: 38118267 DOI: 10.1016/j.ejon.2023.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE The high cost of cancer treatment exposes patients to financial toxicity during treatment; however, no study has comprehensively analyzed the incidence of financial toxicity using a validated assessment tool. In this study, the objective was to ascertain the incidence of financial toxicity in cancer patients and the factors influencing it. METHODS Nine electronic databases were retrieved to collect cross-sectional studies reporting financial toxicity in cancer patients. A random effects meta-analysis was applied to yield the overall prevalence of financial toxicity. Subgroup analyses were conducted depending on the factors affecting financial toxicity. RESULTS In total, 30 studies met our inclusion criteria. The pooled prevalence of financial toxicity in cancer patients was 48% (95%CI:38%-58%, I2 = 99.4%, p < 0.001). In the subgroup analysis, a higher prevalence of financial toxicity in patients aged <67 years (47%, 95%CI: 28%-66%, I2 = 97.5%, p < 0.001), female (46%, 95%CI:39%-53%, I2 = 94.9%,p < 0.001), lung cancer(57%, 95%CI:38%-75%, I2 = 96.9%, p < 0.001), developing countries (64%, 95%CI:55%-72%, I2 = 98.1%, p < 0.001), time of investigation following COVID-19 (53%, 95%CI:37%-69%, I2 = 99.4%, p < 0.001). CONCLUSION Financial toxicity is prevalent in cancer patients and is increasingly evident after COVID-19. Furthermore, the odds of financial toxicity are higher in patients who are female, younger, whose cancer type is lung cancer, and from developing countries. These findings emphasize the significance of evaluating financial toxicity in cancer patients after COVID-19, especially in developing countries. This may play a pivotal role in helping patients cope with financial toxicity.
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Affiliation(s)
- Shuping Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Jialin Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Hua Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Li Zeng
- Sichuan Nursing Vocational College, Chengdu City, Sichuan province, China.
| | - Guiling Liu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Yinong Qiu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Meng Wei
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
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10
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Yamamoto S, Nakagoshi H, Kondoh C, Iwagami Y, Katayama M, Fukae A, Kakumen M, Kodani N, Kumagai A, Higashide C, Mizuta C, Oyamada S, Arao H. Relationship between nurses' perceptions and financial toxicity management in the public health insurance system. Future Oncol 2024; 20:269-282. [PMID: 38440864 DOI: 10.2217/fon-2023-1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Aims: To describe nursing practices for financial toxicity management based on nurses' perceptions. Materials & methods: A survey was conducted with 615 oncology nurses in Japan, focusing on nurses' perspectives on the importance of financial toxicity, nursing practices to manage financial toxicity and factors inhibiting its management. Results: A total of 521 participated, of whom 266 respondents (51.1%) considered nurses' role important, and they engaged in a significantly higher proportion of nursing practices. Participants with greater perceptions of their role included certified or specialized nurses and nurses responsible for outpatient care. Conclusion: Interventions leveraging the expertise of certified or specialized nurses and nurses involved in outpatient care could help to spread proactive nurse practices addressing financial toxicity.
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Affiliation(s)
- Sena Yamamoto
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideko Nakagoshi
- Nursing Department, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | | | - Yuichi Iwagami
- Social Welfare Organization Saiseikai Imperial Gift, Foundation, Inc. Osaka Saiseikai Senri Hospital, Suita, Osaka, Japan
| | | | - Ai Fukae
- Hakuaikai Sagara Hospital, Kagoshima, Kagoshima, Japan
| | | | - Naoko Kodani
- National Hospital Organization, Yonago Medical Center, Yonago, Tottori, Japan
| | | | | | - Chiharu Mizuta
- Nursing Department, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Hyogo, Japan
| | - Shunsuke Oyamada
- Department of Biostatistics, JORTC Data Center, Arakawa-ku, Tokyo, Japan
| | - Harue Arao
- Division of Health Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan
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11
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Xu B, So WKW, Choi KC. Determination of a cut-off COmprehensive Score for financial Toxicity (COST) for identifying cost-related treatment nonadherence and impaired health-related quality of life among Chinese patients with cancer. Support Care Cancer 2024; 32:136. [PMID: 38279988 PMCID: PMC10821980 DOI: 10.1007/s00520-024-08320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE This study aimed to determine a cut-off for the simplified Chinese version of the COmprehensive Score for financial Toxicity (COST) that could identify cost-related treatment nonadherence among Chinese patients with cancer. The study also sought to validate this cut-off score by using it to assess impaired health-related quality of life (HRQoL) in the same population. METHODS A secondary analysis was conducted using data from a cross-sectional survey of 1208 Chinese patients with cancer who were recruited from 12 hospitals in six cities across three provinces of the Chinese mainland. Sociodemographic information and data on financial toxicity (FT), cost-related treatment nonadherence, and HRQoL were used in the analysis. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off for the simplified Chinese version of the COST. RESULTS The ROC analysis identified a COST cut-off of 18.5 for identifying cost-related treatment nonadherence, yielding a sensitivity of 76.5% and specificity of 71.4%. In the validation study, this cut-off score yielded a sensitivity of 64.2% and a specificity of 67.1% for identifying impaired HRQoL. CONCLUSION Early and dynamic assessment of cancer-related FT in routine clinical practice may play a crucial role in the early identification and management of FT. Accordingly, a COST cut-off of 18.5 was identified to indicate cost-related treatment nonadherence and impaired HRQoL in a population of patients with cancer from the Chinese mainland. This finding may facilitate the implementation of universal FT screening among patients with cancer in specific settings such as the Chinese mainland.
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Affiliation(s)
- Binbin Xu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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12
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Tesfaye EA, O'Neill RC, McGregor T, Clemens MW. Financial Toxicity in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Ann Plast Surg 2024; 92:34-40. [PMID: 37994417 DOI: 10.1097/sap.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Financial toxicity is a growing concern due to its considerable effects on medical adherence, quality of life, and mortality. The cost associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is substantial from diagnosis to treatment, including adjuvant therapy and surgery. This study aims to assess the prevalence of financial toxicity in BIA-ALCL patients. METHODS We performed a cross-sectional, survey-based study on women with confirmed cases of BIA-ALCL from December 2019 to March 2023. The primary study outcomes were financial toxicity measured by Comprehensive Score for Financial Toxicity (COST) score and patient-reported financial burden measured by the responses to the Evaluation of the Financial Impact of BIA-ALCL survey. Lower COST scores signify higher financial toxicity. Responses were linked to patient data extracted from the medical records. RESULTS Thirty-two women treated for confirmed BIA-ALCL were included. Patients were all White and were diagnosed at a median age of 51 years (range, 41-65 years). The mean COST score was 27.9 ± 2.23. Lower COST scores were associated with receipt of radiotherapy ( P = 0.033), exceeding credit card limits ( P = 0.036), living paycheck to paycheck ( P = 0.00027), requiring financial support from friends and family ( P = 0.00044), and instability in household finances ( P = 0.034). CONCLUSIONS Financial toxicity is prevalent in BIA-ALCL patients and has a substantial impact on patient reported burden. Insurance denial is frequent for patients with a prior history of cosmetic augmentation. Risk assessments and cost discussions should occur throughout the care continuum to minimize financial burden.
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Affiliation(s)
- Eliora A Tesfaye
- From the Department of Plastic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Rebecca C O'Neill
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Terri McGregor
- Breast Implant Safety Alliance (BISA), North Bay, Ontario, Canada
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX
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13
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Oshiro NN, Nogueira LDA, dos Santos YH, Guimarães PRB, Kalinke LP. Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19. Rev Lat Am Enfermagem 2023; 31:e3995. [PMID: 37729248 PMCID: PMC10508220 DOI: 10.1590/1518-8345.6688.3995] [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: 01/27/2023] [Accepted: 06/30/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. METHOD observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. RESULTS general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). CONCLUSION the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.
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Affiliation(s)
- Natália Naome Oshiro
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brasil
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14
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So WKW, Au DWH, Chan DNS, Ng MSN, Choi KC, Xing W, Chan M, Mak SSS, Ho PS, Tong M, Au C, Ling WM, Chan M, Chan RJ. Financial well-being as a mediator of the relationship between multimorbidity and health-related quality of life in people with cancer. Cancer Med 2023; 12:15579-15587. [PMID: 37283252 PMCID: PMC10417171 DOI: 10.1002/cam4.6204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND It is unknown whether financial well-being mediates the impact of multimorbidity on the health-related quality of life (HRQoL) of cancer patients. METHODS Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well-being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy - General (FACT-G) and its four sub-dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1. RESULTS Six-hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT-G scores independent of financial well-being (β for path c' = -0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT-G scores through its effect on financial well-being (β for path a = -0.517, p < 0.05; β for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT-G via financial well-being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well-being, and emotional well-being, the indirect effects of multimorbidity on physical and functional well-being through financial well-being remained significant. CONCLUSIONS Poor financial well-being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well-being.
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Affiliation(s)
- Winnie K. W. So
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Doreen W. H. Au
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
- School of Nursing and Health StudiesHong Kong Metropolitan UniversityHong KongChina
| | - Dorothy N. S. Chan
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Marques S. N. Ng
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Weijie Xing
- School of NursingFudan UniversityShanghaiChina
| | - Mandy Chan
- Department of Clinical OncologyPrince of Wales HospitalHong KongChina
| | - Suzanne S. S. Mak
- Department of Clinical OncologyPrince of Wales HospitalHong KongChina
| | - Pui Shan Ho
- Department of Clinical OncologyTuen Mun HospitalHong KongChina
| | - Man Tong
- Department of Clinical OncologyTuen Mun HospitalHong KongChina
| | - Cecilia Au
- Department of Clinical OncologyPamela Youde Nethersole Eastern HospitalHong KongChina
| | - Wai Man Ling
- Department of Clinical OncologyPamela Youde Nethersole Eastern HospitalHong KongChina
| | | | - Raymond J. Chan
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityAdelaideAustralia
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15
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Conley CC, Buras AL, McIntyre M, Santiago-Datil W, English D, Wenham RM, Vadaparampil ST. "It doesn't really apply to what I'm going through": a mixed-methods study of barriers to palliative care among patients with advanced ovarian cancer. Support Care Cancer 2023; 31:397. [PMID: 37326676 PMCID: PMC10343169 DOI: 10.1007/s00520-023-07832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Palliative care aims to provide symptom relief and general support for patients with serious illness. Despite experiencing significant treatment side effects, specialty palliative care is under-utilized by patients with advanced ovarian cancer. We explored barriers to palliative care in this population. METHODS We conducted a sequential mixed-methods study. Qualitative: we interviewed patients with advanced ovarian cancer (N = 7). Guided by the Social Ecological Model (SEM), interviews assessed intrapersonal, interpersonal, organizational, and policy-level barriers to receipt of specialty palliative care. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Quantitative: patients with advanced ovarian cancer (N = 38) completed self-report surveys assessing knowledge about, attitudes towards, and prior experiences with specialty palliative care. Descriptive statistics were used to characterize survey responses. RESULTS Qualitative analysis identified barriers to specialty palliative care at each SEM level. Intrapersonal factors (e.g., knowledge, attitudes) were most frequently discussed. Other common barriers included insurance coverage and distance/travel time. Survey responses indicated most participants were aware of palliative care (74%) but had mixed attitudes towards palliative care and did not feel they needed for palliative care. No survey respondents had received a physician recommendation for palliative care, and a sizable minority (29%) thought palliative care referral should only take place when patients have no remaining treatment options. CONCLUSION Among patients with advanced ovarian cancer, barriers to specialty palliative care exist at multiple levels. Our results underscore the potential value of a multilevel intervention to support receipt of palliative care in this population.
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Affiliation(s)
- Claire C Conley
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA.
- Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, USA.
| | - Andrea L Buras
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Diana English
- Department of Gynecologic Oncology, Tampa General Hospital, Tampa, FL, USA
- Department of Palliative Care, Tampa General Hospital, Tampa, FL, USA
| | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
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16
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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17
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Nguyen OT, Donato U, McCormick R, Reblin M, Kim L, Hume E, Otto AK, Alishahi Tabriz A, Islam JY, Hong Y, Turner K, Patel KB. Financial toxicity among head and neck cancer patients and their caregivers: A cross‐sectional pilot study. Laryngoscope Investig Otolaryngol 2023; 8:450-457. [PMID: 37090884 PMCID: PMC10116977 DOI: 10.1002/lio2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives Head and neck cancer (HNC) patients experience greater financial toxicity than other cancer patients. Research on financial toxicity has concentrated on patients despite many informal caregivers sharing finances and reducing work hours to provide patient care. Thus, our pilot study: (1) assessed the feasibility of financial toxicity screening of HNC patients and their caregivers, and (2) described financial toxicity levels of HNC patients and their caregivers. Methods We surveyed English-speaking adult HNC patients initiating treatment at a National Cancer Institute-designated Comprehensive Cancer Center and their informal caregivers. This survey assessed demographics and financial toxicity through the Comprehensive Score for Financial Toxicity (COST) measure (0-44 range; lower score indicates higher financial toxicity). Screening feasibility was defined as ≥50% consent rate and ≥60% data completion rate. Results Our sample included 27 HNC patients and 9 caregivers. They both had slightly lower consent and completion rates than our goals. Patients reported a median COST score of 27 while caregivers reported a median COST score of 16. Approximately 25.9% of patients and 44.4% of caregivers reported high financial toxicity (COST < 17.5). Caregivers reported high concerns about their future financial health and their ability to control the amount of their financial contributions to the patient's care. Conclusions Patients and caregivers may require additional outreach approaches beyond emailed questionnaires to screen for their financial toxicity systematically. Future research is needed to replicate our results to determine whether differences in financial toxicity occur between patients and caregivers and identify areas of focus for interventions. Level of evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Umberto Donato
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | | | - Maija Reblin
- Department of Family Medicine University of Vermont Burlington Vermont USA
- Cancer Control and Population Health Sciences Program University of Vermont Cancer Center Burlington Vermont USA
| | - Lindsay Kim
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | - Emma Hume
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Amy K. Otto
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jessica Y. Islam
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Young‐Rock Hong
- Department of Health Services, Research, and Management University of Florida Gainesville Florida USA
| | - Kea Turner
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Krupal B. Patel
- Department of Head and Neck Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
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18
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Belcher SM, Lee H, Nguyen J, Curseen K, Lal A, Zarrabi AJ, Gantz L, Rosenzweig MQ, Hill JL, Yeager KA. Financial Hardship and Quality of Life Among Patients With Advanced Cancer Receiving Outpatient Palliative Care: A Pilot Study. Cancer Nurs 2023; 46:3-13. [PMID: 34974507 PMCID: PMC11195536 DOI: 10.1097/ncc.0000000000001052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly experiencing financial hardship (FH) and associated negative health outcomes. OBJECTIVE The aims of this study were to describe FH and explore its relationship to quality of life (QOL) in patients with advanced cancer receiving outpatient palliative care (PC). METHODS Validated questionnaires assessed FH, QOL dimensions, symptom burden, and sociodemographic and clinical characteristics. Descriptive statistics characterized the sample and described FH. Pearson correlation and linear regression assessed relationships between FH and QOL. RESULTS The average participant (n = 78) age was 56.6 (SD, 12.2) years. Most were female (56.4%), White (50%) or Black (46.2%), and had a range of education, partner statuses, and cancer diagnoses. Median time since cancer diagnosis was 35.5 months (interquartile range, 9-57.3 months). Highest mean symptom burden scores were for pain (2.5 [SD, 1.0]) and fatigue (2.0 [SD, 1.1]), on a 0- to 3-point scale (higher score representing worse symptom burden). The median COST (COmphrehensive Score for financial Toxicity) score was 15.0 (interquartile range, 9.0-23.0). Most (70%) had some (n = 43) or extreme (n = 9) difficulty paying for basic needs. Greater than 28% (n = 21) incurred cancer-related debt. Multivariate models indicated that FH negatively affected role limitations due to physical health ( P = .008), pain ( P = .003), and emotional well-being ( P = .017) QOL dimensions. CONCLUSIONS Financial hardship, QOL, and symptom burden scores demonstrate need for continued support for and research among patients with advanced cancer. Data support links between FH and important QOL dimensions. Larger, longitudinal studies are needed to understand how FH affects QOL in patients with advanced cancer. IMPLICATIONS FOR PRACTICE Proactive financial assessment and interventions are needed to support patients with advanced cancer experiencing the cumulative effects of cancer and its treatment.
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Affiliation(s)
- Sarah M Belcher
- Author Affiliations: Department of Health & Community Systems, University of Pittsburgh School of Nursing (Dr Belcher); and Hillman Cancer Center, University of Pittsburgh Medical Center (Drs Belcher and Rosenzweig), Pennsylvania; Nell Hodgson Woodruff School of Nursing (Ms Lee and Dr Yeager) and Department of Neuroscience and Behavioral Biology, Emory University (Ms Nguyen); Emory Healthcare (Drs Curseen and Zarrabi and Mss Gantz and Hill); School of Medicine, Emory University (Drs Curseen, Lal, and Zarrabi); and Grady Memorial Hospital (Dr Lal), Atlanta, Georgia; Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Rosenzweig); and Winship Cancer Institute, Atlanta, Georgia (Dr Yeager)
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19
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Jiang H, Lyu J, Mou W, Jiang L, Zeng Y, Liu Y, Hu A, Jiang Q. Prevalence and risk factors of self-reported financial toxicity in cancer survivors: A systematic review and meta-analyses. J Psychosoc Oncol 2022:1-18. [DOI: 10.1080/07347332.2022.2142877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hua Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianxia Lyu
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenxuan Mou
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Luxi Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Zeng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Ying Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Aiping Hu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinghua Jiang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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20
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Su CT. Financial Toxicity Interventions in Hematologic Malignancies Are Timely and Necessary. JCO Oncol Pract 2022; 18:607-609. [PMID: 35802841 PMCID: PMC9509202 DOI: 10.1200/op.22.00357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Christopher T. Su
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI
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21
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Yu H, Li H, Zuo T, Cao L, Bi X, Xing H, Cai L, Sun J, Liu Y. Financial Toxicity and psychological distress in Adults with Cancer: A Treatment-based Analysis. Asia Pac J Oncol Nurs 2022; 9:100069. [PMID: 35669288 PMCID: PMC9166374 DOI: 10.1016/j.apjon.2022.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. Methods This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. Results Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P = 0.032) and psychological distress (P < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P = 0.035), 60–69 years (P = 0.007), and 70 years or older (P = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P = 0.009), the surgery group (P < 0.001) and adjuvant therapy group (P < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. Conclusions The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.
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A systematic review of financial toxicity among cancer patients in China. Asia Pac J Oncol Nurs 2022; 9:100071. [PMID: 35692729 PMCID: PMC9184292 DOI: 10.1016/j.apjon.2022.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 12/22/2022] Open
Abstract
Financial toxicity (FT) has been used to describe patients' whole economic experience that negatively impacts their well-being. FT's adverse effects on patients' health outcomes have been reported by reviews conducted in Western countries. However, these findings may not apply to patients in China. This review aimed to analyze existing data on the measures, prevalence, risk factors, and health-related consequences of FT in China. We searched 10 databases in May 2021 and again in January 2022 using Medical Subject Headings terms and free text. We also searched the reference lists of included articles. Two reviewers independently screened the studies, extracted the data, and assessed the quality of the included studies using the Joanna Briggs Institute Critical Appraisal Checklist. Thirty-one articles describing 30 studies were included in the analysis. Various FT measures were identified, but the number of validated measures was limited. The prevalence of material, psychological, and behavioral FT was 6%–78%, 61%–84%, and 10%–79%, respectively. We identified common risk factors and health-related consequences associated with FT similar to those reported in previous reviews. We also identified several potential risk factors (eg, increased length of hospital stay and larger household size) and consequences (patients' self-perceived burden) in a limited number of studies. Our findings show an urgent need for more data on the prevalence, risk factors, and health-related consequences associated with FT in Chinese cancer patients, and these data must be generated using validated measures.
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An exploration of financial toxicity among low-income patients with cancer in Central Texas: A mixed methods analysis. Palliat Support Care 2022; 21:411-421. [PMID: 35301963 DOI: 10.1017/s1478951522000256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Financial toxicity is of increasing concern in the United States. The Comprehensive Score for Financial Toxicity (COST) is a validated measure; however, it has not been widely utilized among low-income patients and may not fully capture financial toxicity in this population. Furthermore, the relationships between financial toxicity, quality of life (QOL), and patient well-being are poorly understood. We describe the experience of financial toxicity among low-income adults receiving cancer care. We hypothesized that higher financial toxicity would be associated with less income and lower quality of life. Qualitative interviews focused on the financial impact of cancer treatment. METHOD This study was conducted at a cancer clinic in Central Texas. Quantitative and qualitative data were collected in Fall and Spring 2018, respectively. The quantitative sample (N = 115) was dichotomized by annual income (<$15,000 vs. >$15,000). Outcomes included financial toxicity (COST), quality of life (FACT-G), and patient well-being (PROMIS measures: Anxiety, Depression, Fatigue, Pain Interference, and Physical Function). Associations between quality of life, patient well-being, and financial toxicity were evaluated using linear regression. Sequential qualitative interviews were conducted with a subsample of 12 participants. RESULTS Patients with <$15k had significantly lower levels of QOL and patient well-being such as depression and anxiety compared to patients with >$15k across multiple measures. A multivariate linear regression found QOL (Β = 0.17, 95% CI = 0.05, 0.29, p = 0.008) and insurance status (Β = -3.79, 95% CI = -7.42, -0.16, p = 0.04), but not income, were significantly associated with financial toxicity. Three qualitative themes regarding patient's access to cancer care were identified: obtaining healthcare coverage, maintaining financial stability, and receiving social support. SIGNIFICANCE OF RESULTS Low-income patients with cancer face unique access barriers and are at risk for forgoing treatment or increased symptom burdens. Comprehensive assessment and financial navigation may improve access to care, symptom management, and reduce strain on social support systems.
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Baum LV, Koyama T, Schremp EA, Zhang K, Rodweller CA, Roth MC, Compas BE, Friedman DL. Posttraumatic stress symptoms and financial toxicity among adolescent and young adult oncology patients and their caregivers at cancer diagnosis. Cancer 2022; 128:2005-2014. [PMID: 35226364 DOI: 10.1002/cncr.34146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Adolescent and young adult oncology (AYAO) patients and caregivers may experience significant psychosocial dysfunction and financial toxicity. Understanding early risk factors is critical to improving survivorship trajectories. METHODS The authors conducted a cross-sectional study of baseline survey data from a prospective cohort of AYAO patient-caregiver dyads enrolled within 1 month of medical oncology treatment initiation. Posttraumatic stress symptoms (PTSS) were measured by the Impacts of Events Scale-Revised, and financial toxicity was measured with the Comprehensive Score (COst). The authors fit models of linear association between PTSS, financial toxicity, and other end points and pairwise associations of PTSS and financial toxicity within dyads. RESULTS The analytic cohort contained 41 patients, 37 caregivers, and 34 complete dyads. Clinically-concerning PTSS were observed among patients (44%) and caregivers (52%). The median COst scores were 20.0 for patients (quartiles, 12.5-29.5) and 22.0 for caregivers (quartiles, 12.8-26.0), which were consistent with high financial toxicity (patients, 46%; caregivers, 44%). PTSS were positively associated with financial toxicity (P = .013 for patients, P = .039 for caregivers), subjective distress (P < .001 for all), depressive (P < .001 for all) and anxiety symptoms (P = .005 for patients, P = .024 for caregivers), and poorer quality of life (P < .001 for patients, P = .003 for caregivers). A significant paired association was not found in PTSS (Pearson correlation coefficient [PCC], 0.23; 95% confidence interval [CI], -0.15 to 0.56). Financial toxicity was positively associated within dyads (PCC, 0.65; 95% CI, 0.36-0.83). CONCLUSIONS At diagnosis, AYAO patients and caregivers exhibit substantial PTSS, which are associated with greater financial toxicity and other psychosocial distress.
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Affiliation(s)
- Laura V Baum
- Division of Hematology/Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Master of Public Health Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Emma A Schremp
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Kevin Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Casey A Rodweller
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Marissa C Roth
- Psychological Sciences, Vanderbilt University, Nashville, Tennessee
| | - Bruce E Compas
- Vanderbilt Ingram Cancer Center, Nashville, Tennessee.,Psychological Sciences, Vanderbilt University, Nashville, Tennessee
| | - Debra L Friedman
- Vanderbilt Ingram Cancer Center, Nashville, Tennessee.,Division of Pediatric Hematology Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189541. [PMID: 34574463 PMCID: PMC8464840 DOI: 10.3390/ijerph18189541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
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Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
- Correspondence: ; Tel.: +852-3943-8165
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
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