Employment outcomes among cancer patients in the United States

Profiles of financial toxicity and influencing factors among cancer patients: A latent profile analysis

BACKGROUND

While cancer treatment has improved patient prognosis, it has also become more costly. The high hospitalization expenses for cancer patients place a significant financial burden on individuals, families, and society.

OBJECTIVES

To identify the potential categories and characteristics of Financial Toxicity (FT) among cancer patients and explore the associated influencing factors.

METHODS

A cross-sectional study was conducted on 299 cancer patients in southwest China from February 2023 to May 2023(response rate 96.45 %). FT was measured by Financial Toxicity based on Patient-Reported Outcome Measures (COST-PROM), emotional inhibition was measured by the emotional inhibition scale (EIS), and treatment burden was measured by the Treatment Burden Questionnaire (TBQ). We used latent profile analysis (LPA) by Mplus.8.0 to identify latent classes of the FT. Multinomial logistic regression analysis was used to analyze the relevant factors on the different categories.

RESULTS

The FT of cancer patients can be identified into 3 groups: high-level (43.1 %), medium-level (36.1 %), and low-level (20.7 %) groups. Literacy, annual household income, health problem dimension scores, verbal inhibition scores, and self-control scores can be the predictors of FT among different profiles.

CONCLUSIONS

Our findings may provide a new viewpoint for managing FT among cancer patients. Healthcare providers should pay attention to the FT of cancer patients and develop targeted interventions to reduce their FT levels.

Facilitators and barriers to employment for rural women cancer survivors

PURPOSE

Limited research exists on the employment experiences of rural women cancer survivors, yet this population may face unique barriers to employment following a cancer diagnosis. This study aims to identify facilitators and barriers to employment for rural women cancer survivors.

METHODS

We used a qualitative descriptive design to examine facilitators and barriers to employment for rural women cancer survivors. We conducted interviews with 33 rural women with cancer histories.

RESULTS

Facilitators of employment included paid time off, flexible work arrangements, and supportive workplace social networks, while barriers to employment included compromised immunity, long-term treatment effects, stigma and discrimination, and limited rural job markets. Rural women with secure employment histories generally experienced facilitators of employment, while rural women with insecure (e.g., temporary, informal, non-standard) employment histories generally faced barriers to retaining jobs and finding employment.

CONCLUSIONS

Formal and informal workplace support helped rural women retain their jobs during and following cancer treatment, especially those with secure employment. However, women with insecure employment histories generally faced multiple barriers to retaining and finding employment. More inclusive policies to support workers facing disabling illnesses, such as paid medical leave, are needed to ensure cancer survivors can maintain employment and/or financial security during and following their cancer treatment.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors with secure employment may benefit from formal and informal workplace support in retaining their employment. Those with insecure employment histories may benefit from access to job placement services and inclusive policies protecting employment for all workers experiencing disabling illness.

Financial toxicity: A practical review for gynecologic oncology teams to understand and address patient-level financial burdens

Financial toxicity describes the adverse impact patients experience from the monetary and time costs of cancer care. The financial burden patients experience comes from substantially increased out-of-pocket spending that often occurs concurrent with reduced income due to sick leave from work. Financial toxicity is common affecting approximately half of patients with a gynecological cancer depending on the validated instrument used for measurement. Financial toxicity is experienced by patients in three domains: economic hardship affecting patients' material conditions (i.e., medical debt), psychological response (i.e., distress), and health-related coping behaviors that patients adopt (i.e., foregoing care due to costs). Higher financial toxicity among cancer patients has been associated with decreased quality of life, impaired adherence to recommended care, and worse overall survival. In this review, we describe the current literature on financial toxicity, including how it can be assessed with validated tools, the downstream impact on patients, risk factors, and employment concerns of survivors. Whenever possible, we highlight data from research featuring patients with gynecologic cancer specifically. We also review studies with interventions aimed to mitigate financial toxicity and offer the reader real world examples of interventions currently being used. Lastly, we provide an overview of health policy developments relevant to financial toxicity and advocate for innovation in the development and implementation of strategies to decrease the financial toxicity patients experience following a diagnosis of gynecologic cancer.