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Marion S, Ghazal L, Roth T, Shanahan K, Thom B, Chino F. Prioritizing Patient-Centered Care in a World of Increasingly Advanced Technologies and Disconnected Care. Semin Radiat Oncol 2024; 34:452-462. [PMID: 39271280 DOI: 10.1016/j.semradonc.2024.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
With more treatment options in oncology lead to better outcomes and more favorable side effect profiles, patients are living longer-with higher quality of life-than ever, with a growing survivor population. As the needs of patients and providers evolve, and technology advances, cancer care is subject to change. This review explores the myriad of changes in the current oncology landscape with a focus on the patient perspective and patient-centered care.
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Affiliation(s)
- Sarah Marion
- Department of Internal Medicine, The University of Pennsylvania Health System, Philadelphia, PA
| | - Lauren Ghazal
- University of Rochester, School of Nursing, Rochester, NY
| | - Toni Roth
- Memorial Sloan Kettering Cancer Center, Medical Physics, New York, NY
| | | | - Bridgette Thom
- University of North Carolina, School of Social Work, Chapel Hill, NC
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, Radiation Oncology, New York, NY.
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Parsons SK, Murphy-Banks R, Rodday AM, Roth ME, Miller K, Linendoll N, Chan R, Crosswell HE, Xiang Q, Freyer DR. Financial distress and medical financial hardship among young adult survivors of blood cancer. JNCI Cancer Spectr 2024; 8:pkae071. [PMID: 39153000 PMCID: PMC11401610 DOI: 10.1093/jncics/pkae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/16/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. METHODS Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility-namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. RESULTS Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). CONCLUSIONS Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. CLINICALTRIALS.GOV NCT05620979.
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Affiliation(s)
- Susan K Parsons
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Rachel Murphy-Banks
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Angie Mae Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Michael E Roth
- Department of Pediatrics Patient Care, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimberly Miller
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nadine Linendoll
- Division of Hematology and Oncology and Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Randall Chan
- Department of Pediatrics, Los Angeles General Medical Center, Los Angeles, CA, USA
| | - Howland E Crosswell
- AYA Cancer Care Program, Bon Secours Mercy, St Francis Cancer Center, Greenville, SC, USA
| | - Qingyan Xiang
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - David R Freyer
- Departments of Pediatrics, Medicine, and Population and Public Health Sciences, Cancer and Blood Disease Institute, Children's Hospital Los Angeles & University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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Lapen K, Mishra Meza A, Dee EC, Mao JJ, Raghunathan NJ, Jinna S, Brens J, Korenstein D, Furberg-Barnes H, Salz T, Chino F. Patient out-of-pocket costs for cannabis use during cancer treatment. J Natl Cancer Inst Monogr 2024; 2024:305-312. [PMID: 39108238 PMCID: PMC11303855 DOI: 10.1093/jncimonographs/lgad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/27/2023] [Accepted: 08/30/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND We assessed patient costs associated with cannabis use during cancer treatment. METHODS Adults treated for cancer at a large, comprehensive center completed an anonymous survey regarding their thoughts and experiences with cannabis and cancer. Bivariate and weighted multivariable logistic regression assessed clinical and sociodemographic factors associated with patient-reported out-of-pocket costs for cannabis products. RESULTS Overall, 248 cannabis users provided data on cost and were analyzed. Median monthly out-of-pocket cost for cannabis was $80 (interquartile range = $25-$150). On regression analysis, male gender (odds ratio = 2.5, 95% confidence interval = 1.2 to 5.5, P = .026) and being 45 years of age or older (odds ratio = 7.5, 95% confidence interval = 1.9 to 30.0, P = .0042) were associated with spending $100 a month or more on cannabis. Of the 166 patients who stopped using cannabis early or used less than preferred, 28% attributed it to cost and 26% to lack of insurance coverage. CONCLUSION Cannabis use during cancer treatment may contribute to significant out-of-pocket costs, with men and younger patients more likely to pay higher costs.
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Affiliation(s)
- Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akriti Mishra Meza
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Sankeerth Jinna
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica Brens
- Department of Nursing, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Deborah Korenstein
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helena Furberg-Barnes
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Waters AR, Wheeler SB, Tan KR, Rosenstein DL, Roberson ML, Kirchhoff AC, Kent EE. Material, Psychological, and Behavioral Financial Hardship Among Lesbian, Gay, and Bisexual Cancer Survivors in the United States. JCO Oncol Pract 2024:OP2400114. [PMID: 38991169 DOI: 10.1200/op.24.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE Driven by anti-LGBTQ+ stigma, emerging literature suggests that lesbian, gay, and bisexual (LGB) cancer survivors experience financial hardship (FH) more frequently than heterosexual survivors. However, few studies have used nationally representative samples to estimate this inequity. METHODS National Health Interview Survey data from 2019 to 2022 were pooled and weighted. Outcomes included material, psychological, and behavioral FH. The behavioral domain was further broken down into subdomains including medical care, prescription medications, and mental health care. Multivariable logit models controlling for a variety of factors were used to generate LGB and heterosexual predicted probabilities and differential effects for each FH outcome. Stratified estimates were generated by sex and age groups. RESULTS A total of N = 374 LGB and N = 12,757 heterosexual cancer survivors were included in this analysis. In adjusted analyses, LGB cancer survivors had significantly higher material (19%, 95% CI, 15 to 24 v 12%, 95% CI, 11 to 13; P = .004), psychological (44%, 95% CI, 38 to 51 v 37%, 95% CI, 36 to 38; P = .035), and behavioral (23%, 95% CI, 18 to 28 v 13%, 95% CI, 13 to 14; P < .0001) FH than heterosexual survivors. LGB cancer survivors also had higher medical behavioral (11%, 95% CI, 7 to 15 v 7%, 95% CI, 6 to 7; P = .030), prescription medication behavioral (14%, 95% CI, 10 to 19 v 10%, 95% CI, 9 to 10; P = .032), and mental health behavioral (9%, 95% CI, 6 to 13 v 3%, 95% CI, 3 to 4; P < .0001) FH than heterosexual survivors. Stratified estimates revealed young LGB cancer survivors had the highest probability of each outcome (material: 31%, 95% CI, 23 to 40; psychological: 58%, 95% CI, 50 to 66; behavioral: 45%, 95% CI, 36 to 53). CONCLUSION In this nationally representative analysis, LGB cancer survivors experience substantial inequities in all FH outcomes. It is crucial that future FH interventional work should prioritize populations at the highest risk of FH, such as LGB cancer survivors.
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Affiliation(s)
- 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
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - 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
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kelly R Tan
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA
- Hillman Comprehensive Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Donald L Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mya L Roberson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - 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
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Salsman JM, Nightingale CL, Canzona MR, Howard DS, Tucker-Seeley RD, Wiseman KD, Victorson DE, Robles JM, Roth M, Smith R, Reeve BB, Danhauer SC. Asking the "Right" Questions about Financial Hardship: Using Cognitive Interviews with Adolescents and Young Adults with Cancer and Their Caregivers to Inform Measure Development. J Adolesc Young Adult Oncol 2024. [PMID: 38959182 DOI: 10.1089/jayao.2024.0041] [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: 07/05/2024] Open
Abstract
Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers.
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Affiliation(s)
- John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
| | - Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
| | - Mollie R Canzona
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
- Department of Communication, Wake Forest University, Winston Salem, North Carolina, USA
| | - Dianna S Howard
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | | | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
| | - David E Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joanna M Robles
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Michael Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Regina Smith
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Center for Health Measurement, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne C Danhauer
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
- The Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina, USA
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Zhang BX, Brantley KD, Rosenberg SM, Kirkner GJ, Collins LC, Ruddy KJ, Tamimi RM, Schapira L, Borges VF, Warner E, Come SE, Winer EP, Bellon JR, Partridge AH. Second primary non-breast cancers in young breast cancer survivors. Breast Cancer Res Treat 2024:10.1007/s10549-024-07400-z. [PMID: 38858235 DOI: 10.1007/s10549-024-07400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE We evaluated the incidence, timing, and risk factors for second primary non-breast cancers (SPNBC) among young breast cancer (BC) survivors. METHODS This study included participants of the Young Women's BC Study (YWS) who were diagnosed with stage 0-III BC between 2006 and 2016 and age 40 or younger at diagnosis (N = 1,230). Patient characteristics, treatment information, and clinical events were collected via serial surveys. Tumor and treatment data were obtained from medical record review. Five- and 10-year risks of SPNBCs were estimated via the cumulative incidence function, considering death, metastasis, or second primary BC as competing events. Fine and Gray subdistribution hazard models estimated subdistribution hazard ratios (sHRs) and 95% confidence intervals (CI) for SPNBC risk based on risk factors including demographics, germline genetics, primary BC characteristics, and treatments. RESULTS Among 1,230 women, over a median follow-up of 10.1 years, 47 patients (4%) developed an SPNBC. Types of malignancy included melanoma (n = 10), thyroid (n = 10), ovarian (n = 4), sarcoma (n = 4), uterine (n = 3), rectal (n = 3), bladder (n = 2), cervical (n = 2), head/neck (n = 2), lung (n = 2), lymphoma (n = 2), pancreatic (n = 2), and renal (n = 1). Five and 10-year cumulative incidence were 1.4% and 3.2%, respectively. Median time between primary BC and SPNBC was 7.3 years. No patient factors, primary tumor characteristics, or treatments were statistically significantly associated with SPNBC in univariable or multivariable models. CONCLUSION In this population, five-year cumulative incidence was higher than that reported among healthy women under 50 years of age, highlighting the importance of long-term surveillance for new non-breast cancers in young adult BC survivors.
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Affiliation(s)
| | - Kristen D Brantley
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | | | - Gregory J Kirkner
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Laura C Collins
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | - Lidia Schapira
- Stanford University, Stanford, CA, USA
- Stanford Cancer Institute, Stanford, CA, USA
| | | | - Ellen Warner
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Steven E Come
- Harvard Medical School, Boston, MA, USA
- Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jennifer R Bellon
- Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA, USA
| | - Ann H Partridge
- Harvard Medical School, Boston, MA, USA.
- Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
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Dibble KE, Rosenberg SM, Zheng Y, Sella T, Poorvu P, Snow C, Darai S, Rene C, Mack JW, Partridge AH. Psychosocial and supportive care concerns of young women living with advanced breast cancer: baseline findings from a prospective virtual support intervention study. Support Care Cancer 2024; 32:336. [PMID: 38727753 DOI: 10.1007/s00520-024-08557-5] [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: 12/20/2023] [Accepted: 05/07/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE Adolescent and young adults (AYAs) with metastatic breast cancer (MBC) experience high physical and psychosocial burdens compounded by a disrupted life trajectory. We sought to determine the psychosocial and supportive care concerns of this population to better understand and address unmet needs. METHODS AYAs diagnosed with MBC (18-39 years) participating in a prospective interventional study (Young, Empowered, and Strong) at Dana-Farber Cancer Institute completed an electronic survey following enrollment. Measures evaluated sociodemographics, health behaviors, quality of life, and symptoms, among others. We used two-sided Fisher's exact tests to determine associations between concerns (e.g., cancer progression, side effects, lifestyle, finances, fertility) and demographic variables. RESULTS Among 77 participants enrolled from 9/2020-12/2022, average age at MBC diagnosis and survey was 35.9 (range: 22-39) and 38.3 years (range: 27-46), respectively. Most were non-Hispanic white (83.8%) and 40.3% reported their diagnosis caused some financial problems. Many were concerned about fertility (27.0%), long-term treatment side effects (67.6%), exercise (61.6%), and diet (54.1%). Select concerns varied significantly by age, race/ethnicity, and education. Younger women at survey reported greater concern about familial cancer risk (p = 0.028). Women from minority racial/ethnic groups more frequently reported issues talking about their cancer to family/friends (p = 0.040) while those with more education were more frequently concerned with long-term effects of cancer on their health (p = 0.021). CONCLUSION Young women living with MBC frequently report psychosocial, health, and cancer management concerns. Tailoring supportive care and communications to address prevalent concerns including disease progression and treatment side effects may optimize wellbeing.
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Affiliation(s)
- Kate E Dibble
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Shoshana M Rosenberg
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Yue Zheng
- Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Tal Sella
- Deparment of Medical Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Philip Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Craig Snow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Sonja Darai
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Christamar Rene
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston, MA, USA.
- Department of Medicine, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
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Price M, Neff C, Nagarajan N, Kruchko C, Waite KA, Cioffi G, Cordeiro BB, Willmarth N, Penas-Prado M, Gilbert MR, Armstrong TS, Barnholtz-Sloan JS, Ostrom QT. CBTRUS Statistical Report: American Brain Tumor Association & NCI Neuro-Oncology Branch Adolescent and Young Adult Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016-2020. Neuro Oncol 2024; 26:iii1-iii53. [PMID: 38709657 PMCID: PMC11073545 DOI: 10.1093/neuonc/noae047] [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] [Indexed: 05/08/2024] Open
Abstract
Recent analyses have shown that, whereas cancer survival overall has been improving, it has not improved for adolescents and young adults ages 15-39 years (AYA). The clinical care of AYA with primary brain and other central nervous system (CNS) tumors (BT) is complicated by the fact that the histopathologies of such tumors in AYA differ from their histopathologies in either children (ages 0-14 years) or older adults (ages 40+ years). The present report, as an update to a 2016 publication from the Central Brain Tumor Registry of the United States and the American Brain Tumor Association, provides in-depth analyses of the epidemiology of primary BT in AYA in the United States and is the first to provide biomolecular marker-specific statistics and prevalence by histopathology for both primary malignant and non-malignant BT in AYA. Between 2016 and 2020, the annual average age-specific incidence rate (AASIR) of primary malignant and non-malignant BT in AYA was 12.00 per 100,000 population, an average of 12,848 newly diagnosed cases per year. During the same period, an average of 1,018 AYA deaths per year were caused by primary malignant BT, representing an annual average age-specific mortality rate of 0.96 per 100,000 population. When primary BT were categorized by histopathology, pituitary tumors were the most common (36.6%), with an AASIR of 4.34 per 100,000 population. Total incidence increased with age overall; when stratified by sex, the incidence was higher in females than males at all ages. Incidence rates for all primary BT combined and for non-malignant tumors only were highest for non-Hispanic American Indian/Alaska Native individuals, whereas malignant tumors were more frequent in non-Hispanic White individuals, compared with other racial/ethnic groups. On the basis of histopathology, the most common molecularly defined tumor was diffuse glioma (an AASIR of 1.51 per 100,000). Primary malignant BT are the second most common cause of cancer death in the AYA population. Incidence rates of primary BT overall, as well as specific histopathologies, vary significantly by age. Accordingly, an accurate statistical assessment of primary BT in the AYA population is vital for better understanding the impact of these tumors on the US population and to serve as a reference for afflicted individuals, for researchers investigating new therapies, and for clinicians treating these patients.
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Affiliation(s)
- Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Brittany B Cordeiro
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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9
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Kirchhoff AC, van Thiel Berghuijs KM, Waters AR, Kaddas HK, Warner EL, Vaca Lopez PL, Perez GK, Ray N, Chevrier A, Allen K, Fair DB, Tsukamoto T, Lewis MA, Haaland B, Park ER. Health Insurance Literacy Improvements Among Recently Diagnosed Adolescents and Young Adults With Cancer: Results From a Pilot Randomized Controlled Trial. JCO Oncol Pract 2024; 20:93-101. [PMID: 38060990 PMCID: PMC10827289 DOI: 10.1200/op.23.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Adolescents and young adults (AYAs; age 18-39 years) with cancer report needing support with health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and acceptability of a virtual health insurance navigation intervention (HIAYA CHAT) to improve health insurance literacy (HIL), awareness of Affordable Care Act (ACA) protections, financial toxicity, and stress. MATERIALS AND METHODS HIAYA CHAT is a four-session navigator delivered program; it includes psychoeducation on insurance, navigating one's plan, insurance-related laws, and managing costs. Participants were eligible if they could access an internet-capable device, were <1 year from diagnosis, and received treatment from University of Utah Healthcare or Intermountain Health systems. We assessed the feasibility, acceptability, and preliminary efficacy of HIAYA CHAT compared with usual navigation care, including HIL (nine items), insurance knowledge (13 items), ACA protections (eight items), COmprehensive Score for financial Toxicity (COST; 11 items), and Perceived Stress Scale (PSS; four items), using t tests and Cohen's d. RESULTS From November 2020 to December 2021, N = 86 AYAs enrolled (44.6% participation) and 89.3% completed the 5-month follow-up survey; 68.6% were female, 72.1% were White, 23.3% were Hispanic, 65.1% were age 26-39 years, and 87.2% were privately insured. Of intervention participants (n = 45), 67.4% completed all four sessions; among an exit interview subset (n = 10), all endorsed the program (100%). At follow-up, compared with usual navigation care, intervention participants had greater improvements in HIL, insurance and ACA protections knowledge, and PSS; effect sizes ranged from moderate to large (0.42-0.77). COST did not differ. CONCLUSION The results support the feasibility and acceptability of HIAYA CHAT with related improvements in HIL.
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Affiliation(s)
- Anne C. Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Austin R. Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Heydon K. Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Echo L. Warner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- University of Utah College of Nursing, Salt Lake City, UT
| | | | | | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amy Chevrier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karlie Allen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Douglas B. Fair
- Department of Pediatrics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | | | | | - Ben Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Thom B, Arora N, Benedict C, Aviki EM, Chino F, Friedman DN, Watson SE, Zeitler MS. Using Real-World Data to Explore the Impact of One-Time Financial Grants Among Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:912-917. [PMID: 37852000 PMCID: PMC10739788 DOI: 10.1089/jayao.2022.0188] [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: 10/20/2023] Open
Abstract
Young adult (YA) cancer survivors experience worse financial outcomes than older survivors. This analysis used data from Expect Miracles Foundation to explore the impact of one-time financial grants on financial well-being and access to health care. Among 300 respondents, the average grant was $1526 (standard deviation = $587; range $300-$3000). Respondents reported improved ability to pay expenses (t = 4.45, p < 0.001), increased financial decision-making power (t = 2.79, p = 0.06), decreased medical debt impact (t = 2.1, p = 0.04), improved transportation access (t = 2.38, p = 0.02), and fewer challenges in accessing care (t = 3.0, p = 0.005) 6 months after receiving a financial grant. Financial assistance offers YAs an opportunity to meet medical and nonmedical expenses.
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Affiliation(s)
- Bridgette Thom
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Arora
- Texas A&M School of Medicine, College Station, Texas, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, California, USA
| | - Emeline M. Aviki
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fumiko Chino
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danielle N. Friedman
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
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