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Ngan TT, Tien TH, Donnelly M, O’Neill C. Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review. J Public Health (Oxf) 2023; 45:e702-e713. [PMID: 37541834 PMCID: PMC10687873 DOI: 10.1093/pubmed/fdad143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/04/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND The aim of this scoping review was to identify key research gaps and priorities in order to advance policy and practice for people living with cancer in the UK. METHODS The review adhered to PRISMA guidelines for scoping review. We searched MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar on 16 July 2022. There were no restrictions in terms of study design and publication time; gray literature was included. The key words, 'financial' or 'economic', were combined with each of the following words 'hardship/stress/burden/distress/strain/toxicity/catastrophe/consequence/impact.' RESULTS 29/629 studies/reports published during 1982-2022 were eligible to be included in the review. No study conducted a comprehensive inquiry and reported all aspects of financial toxicity (FT) or used a validated measure of FT. The most three commonly reported outcomes related to financial hardship were financial well-being (24/29), benefit/welfare (17/29) and mental health status (16/29). CONCLUSIONS It is evident that FT is experienced by UK cancer patients/survivors and that the issue is under-researched. There is an urgent need for further research including rigorous studies which contribute to a comprehensive understanding about the nature and extent of FT, disparities in experience, the impacts of FT on outcomes and potential solutions to alleviate FT and related problems.
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Affiliation(s)
- Tran T Ngan
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Tran H Tien
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang 10408, Korea
- Department of Pharmacy, University Medical Center Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Michael Donnelly
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
| | - Ciaran O’Neill
- Centre for Public Health, Queen’s University Belfast, Belfast BT12 6BA, UK
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The economic impact of cancer diagnosis to individuals and their families: a systematic review. Support Care Cancer 2022; 30:6385-6404. [PMID: 35235040 PMCID: PMC9213304 DOI: 10.1007/s00520-022-06913-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/13/2022] [Indexed: 11/09/2022]
Abstract
Background The effect of a cancer diagnosis is wide-ranging with the potential to affect income, employment and risk of poverty. The aim of this systematic review is to identify the economic impact of a cancer diagnosis for patients and their families/caregivers. Methods The search covered peer-reviewed journals using MEDLINE, EMBASE, CINAHL, Cochrane Library, Epistemonikos and PsycINFO databases. Quality appraisal was undertaken using CASP tools. Monetary values were converted to US Dollars/2019 using a purchasing power parities (PPP) conversion factor. The review included articles up to and including January 2020, written in English language, for patients with cancer aged ≥ 18 years and focused on the costs up to 5 years following a cancer diagnosis. Results The search was run in January 2020 and updated in November 2021. Of the 7973 articles identified, 18 met the inclusion criteria. Studies were undertaken in the USA, Ireland, Canada, Australia, France, UK, Malaysia, Pakistan, China and Sri Lanka. The majority were cohort studies. Twelve reported out-of-pocket costs (range US$16–US$2523/month per patient/caregiver) consisting of medical expenses (e.g. surgery, radiotherapy and chemotherapy) and non-medical expenses (e.g. travel, food and childcare). Fourteen studies reported patient/caregiver loss of income and lost productivity (range 14–57.8%). Conclusions A high percentage of cancer patients and their families/caregivers experience out-of-pocket expenditure, loss of income and lost productivity. Future research is needed to observe the effects of continuing changes to healthcare policies and social protections on the economic burden among cancer patients and their families/caregivers.
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Abe H, Sumitani M, Matsui H, Inoue R, Fushimi K, Uchida K, Yasunaga H. Use of naldemedine is associated with reduced incidence of hyperactive delirium in cancer patients with opioid-induced constipation: a nationwide retrospective cohort study in Japan. Pharmacotherapy 2021; 42:241-249. [PMID: 34967450 DOI: 10.1002/phar.2658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/10/2021] [Accepted: 11/24/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medical benefits of peripherally-acting mu-opioid receptor antagonists other than improving opioid-induced constipation remain unclear. Our aim was to evaluate the association between the use of naldemedine and incidence of hyperactive delirium in cancer patients receiving chemotherapy and opioid therapy. METHODS We conducted a propensity score-matched analysis using a nationwide inpatient database in Japan. Cancer patients receiving both inpatient chemotherapy and opioid therapy from June 1, 2017 to March 31, 2018 were included. Patients receiving naldemedine were matched to control patients by propensity score. Our primary outcome was the incidence of hyperactive delirium during hospitalization, and secondary outcomes were the length of hospital stay, hospital costs, in-hospital mortality, and incidence of ileus. RESULTS Of 34,031 patients receiving inpatient chemotherapy and opioid therapy, 1905 (5.6%) were included in the naldemedine group. After one-to-four propensity score matching, 1904 patients were included in the naldemedine group and 7616 in the control group. Naldemedine users had significantly reduced incidence of hyperactive delirium compared with the control patients (19.4% vs 23.3%; risk difference, -3.9 [95% confidence interval, -5.9 - -1.9]; risk ratio, 0.83 [0.75-0.92]; P<0.001; subdistribution hazard ratio, 0.85 [0.75-0.97]; P=0.015). The median length of hospital stay was significantly shorter in the naldemedine group compared with the control group (12 days [interquartile range, 6-23] vs 14 days [6-26]; P=0.001). The median hospital costs were also significantly lower in the naldemedine group compared with the control group (US $6179 [3351-10,026] vs US $6576 [3436-11,107]; P<0.001). No significant differences were found for in-hospital mortality or incidence of ileus between the groups. CONCLUSIONS Our findings suggest that the use of naldemedine may have benefits in preventing hyperactive delirium, shortening hospital stay, and decreasing hospital costs in cancer patients receiving chemotherapy and opioid therapy.
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Affiliation(s)
- Hiroaki Abe
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Reo Inoue
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Al-Aqeel S, Alnaim L, Alghaith J, Almosabhi L. Cancer Impacts on Out-of-Pocket Expenses, Income Loss, and Informal (Unpaid) Care: A Cross-Sectional Study of Patient Perspective. J Patient Exp 2021; 8:23743735211049651. [PMID: 34676289 PMCID: PMC8524680 DOI: 10.1177/23743735211049651] [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] [Indexed: 12/04/2022] Open
Abstract
A paper-based questionnaire was used to measure out-of-pocket expenses, income
loss, and informal (unpaid) care from the cancer patient’s perspective. A total
of 181 adult solid cancer patients on chemotherapy for at least 3 months were
recruited from 1 teaching hospital in Riyadh, Saudi Arabia. The majority were
female (66%) and 41% were 60 years of age or older. A total of 107 respondents
used their own car for transport to and from the hospital to receive
chemotherapy (median distance 42 km). Over the last 4 weeks, 21% purchased
medications, 18% visited a physician, and 8% visited a physiotherapist, spending
a median amount of $47, $220, and $793, respectively. A total of 47 participants
were employed at the time of their cancer diagnoses, and 32% of them reported
some loss of income. A total of 85% of respondents were escorted by a carer
during chemotherapy sessions. Approximately 64%, 31%, 61%, 43%, and 28% reported
getting help from a carer for housework, child care, shopping, medicine taking,
and personal care, respectively. The carer spent on average 50 h per week
looking after the patient.
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Affiliation(s)
- Sinaa Al-Aqeel
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lamya Alnaim
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Jeelan Alghaith
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Latifa Almosabhi
- 1 Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Cox SR, Daniel CL. Racial and Ethnic Disparities in Laryngeal Cancer Care. J Racial Ethn Health Disparities 2021; 9:800-811. [PMID: 33733426 DOI: 10.1007/s40615-021-01018-3] [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: 11/04/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
There is a long history of racial and ethnic disparities in healthcare and they continue to persist in contemporary society. These disparities have the potential to negatively affect morbidity and mortality in racial and ethnic minorities diagnosed with laryngeal cancer. Diagnosis, medical treatment, and rehabilitation for laryngeal cancer have improved considerably, leading to improvements in overall survival rates and physical, social, and psychological functioning. Yet members of minority and underrepresented groups are at an increased risk for experiencing reduced access to quality care and delays between diagnosis and treatment, and as a result have lower survival rates. Increasing health providers' awareness of racial and ethnic disparities in laryngeal cancer is necessary to facilitate changes in patient and provider education, clinical practice, and health policies. The purpose of this review is to summarize current literature on disparities in laryngeal cancer diagnosis, treatment, and rehabilitation among Black and Hispanic patients. We present recent data from the Surveillance, Epidemiology, and End Results database to examine trends in laryngeal cancer and patient, provider, and health systems factors that may perpetuate these disparities. In addition, we offer interventions to address racism and other racial and ethnic biases in laryngeal cancer care and describe research and legislative actions that are needed to reduce disparities in this area.
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Affiliation(s)
- Steven R Cox
- Department of Communication Sciences and Disorders, Adelphi University, Garden City, NY, 11530, USA.
| | - Carolann L Daniel
- School of Social Work, Adelphi University, Garden City, NY, 11530, USA
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Joshi S, Joshi U, Bahl A, Arya D, Anand AK, Arora RS. Exploring the Financial Toxicities of Patients with Locally Advanced Head and Neck Malignancies, Being Treated in a Private Sector Hospital in North India: A Thematic Analysis. Indian J Palliat Care 2021; 27:118-125. [PMID: 34035629 PMCID: PMC8121222 DOI: 10.4103/ijpc.ijpc_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/24/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022] Open
Abstract
Background: The high cost of cancer diagnosis and treatment is a global concern. Evidence derived, mostly from high-income countries, shows how it gradually impacts the personal and household financial condition causing the increased psychosocial burden of the patient and their families (termed “financial toxicity”). Aim: To qualitatively explore the financial toxicities in patients with advanced head and neck malignancies in India, and to consider how it impacts the patient and his family. Methods: Interviewing a purposive sample of 8 patients using semi-structured interviews face to face. Interviews were transcribed verbatim, and a thematic content analysis was carried out. Results: Four major themes were identified: burden and amplifying factors, impact, rescue and relieving factors, and learning and innovation. The burden of cost relates to diagnosis, treatment and non-medical costs which gets amplified while navigating the healthcare labyrinth. Emerging themes describe financial journey of cancer patients, the issues faced by them and the ways they tackle these issues during their treatment. Healthcare system factors like limited availability of adequate/comprehensive/meaningful insurance and reimbursements potentiate the toxicity. The financial toxicity leads to a significant adverse financial, psychological and social impact on the patient and the family. While moving through the process of care, there were a few learnings and innovations which patients proposed. Conclusion: This study provides qualitative evidence of the considerable and pervasive nature of financial toxicity in head and neck cancer patients in India. The findings have implications for all cancer patients and highlight the unmet need of psychosocial support for these patients.
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Affiliation(s)
- Saurabh Joshi
- Consultant Palliative and Pain Medicine, Hospice India, New Delhi, India
| | - Upkar Joshi
- Senior Finance and Economics Expert, Founder Ascent Wealth Desk, Visiting Faculty- Delhi University, New Delhi, India
| | - Ankur Bahl
- Senior Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - Devavrat Arya
- Principal Consultant Medical Oncology, Max Super Specialty Hospital, New Delhi, India
| | - A K Anand
- Chief Radiation Oncology and Senior Director, Max Super Specialty Hospital, New Delhi, India
| | - Ramandeep Singh Arora
- Senior Consultant, Paediatric Oncology, Max Super Speciality Hospital, New Delhi, India
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Seol KH, Bong SH, Kang DH, Kim JW. Factors Associated with the Quality of Life of Patients with Cancer Undergoing Radiotherapy. Psychiatry Investig 2021; 18:80-87. [PMID: 33460533 PMCID: PMC7897871 DOI: 10.30773/pi.2020.0286] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/01/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Approximately half of patients with cancer have comorbidities, such as adjustment disorder, major depressive disorder, and delirium. Radiotherapy can cause psychological problems, e.g., the fear of treatment and its side effects, anxiety, depression, and social isolation. Health-related quality of life (QoL) must be determined to evaluate the effectiveness of cancer treatment. We analyzed the clinical, psychological, and sociodemographic factors influencing the QoL of patients with cancer who were undergoing radiotherapy. METHODS Twenty-six patients undergoing radiotherapy (10 male, 16 female) were included. Sociodemographic and clinical data were collected prior to radiotherapy. Psychosocial factors were assessed by self-reported questionnaires before, immediately after, and 3 months after radiotherapy. A multivariate regression analysis identified factors affecting QoL at each time point. RESULTS Patients' diagnoses were breast, cervical, prostate, endometrial, rectal, hypopharyngeal, laryngeal, liver, gallbladder, esophageal, ovarian, lung, and skin cancers. Before radiotherapy, better resilience was significantly associated with a higher QoL score (R2=0.199, p=0.033). Immediately after radiotherapy, financial difficulty was significantly associated with a lower QoL score (R2=0.274, p=0.010). Three months after radiotherapy, the presence of chronic disease (R2=0.398, p=0.002) and the severity of nausea and vomiting were significantly associated with a lower QoL score (R2=0.278, p=0.014). CONCLUSION Resilience, financial difficulty, the presence of chronic diseases, and the severity of nausea and vomiting significantly influenced the QoL of patients with cancer who were undergoing radiotherapy. Factors affecting QoL varied at each time point. Thus, patients with cancer should undergo regular mental health assessments, including assessments of QoL. Multidimensional (physical, psychological, and social) approaches and individualized time-based interventions are needed to improve the QoL of cancer patients undergoing radiotherapy.
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Affiliation(s)
- Ki Ho Seol
- Department of Radiation Oncology, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Su Hyun Bong
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Dae Hun Kang
- Department of Psychiatry, The Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Dinesh TA, Nair P, Abhijath V, Jha V, Aarthy K. Economics of cancer care: A community-based cross-sectional study in Kerala, India. South Asian J Cancer 2020; 9:7-12. [PMID: 31956610 PMCID: PMC6956579 DOI: 10.4103/sajc.sajc_382_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: The estimated incidence of cancer cases in Kerala for 2014 was 31,400 and the mortality associated with it was 13,816. Although the treatment of cancer has shown remarkable advances, it has come with increasing costs. Objective: The objective of this study is to estimate the economic burden of cancer in Vypin Block Panchayat at Ernakulam by analyzing the average total direct and indirect cost of cancer care, socioeconomic status, and cost of cancer care between government and private hospitals. Materials and Methods: A cross-sectional study was conducted for 2 months from March to April 2018. The study was conducted by utilizing an annotated cost questionnaire for completion by patients. Total direct and indirect cost was estimated. Appropriate statistical tests were used. Results: Direct cost for cancer care contributed 75% toward the cost of illness and the remaining was found to be indirect cost. Loss of income (44%) contributed to the largest chunk of indirect cost. The average direct cost for cancer care was found to be Rs. 25,606 and the average indirect cost was Rs. 8772. The average total cost of cancer care was calculated to be Rs. 34,378. Significant statistical variation was found between the cost of cancer care in private and government hospitals. The economic burden of cancer in this Vypin Block Panchayat was found to be Rs. 218,256,977/- Conclusion: The ratio of average income to average cost in this study is skewed which indicates the lack of affordability for cancer care in this population. A very large gap, therefore, exits between income levels and cost of cancer care clearly indicating a vast gap between affordability and cost of treatment, which clearly necessitates the need for a definite policy and state intervention for a mass cancer care program.
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Affiliation(s)
- T A Dinesh
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Prem Nair
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - V Abhijath
- Amrita Institute of Medical Sciences and Research Center, Department of Hospital Administration, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vidya Jha
- Amrita Institute of Medical Sciences and Research Center, Department of Hospital Administration, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K Aarthy
- Amrita Institute of Medical Sciences and Research Center, Department of Hospital Administration, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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LaRocca CJ, Li A, Lafaro K, Clark K, Loscalzo M, Melstrom LG, Warner SG. The impact of financial toxicity in gastrointestinal cancer patients. Surgery 2020; 168:167-172. [PMID: 32197785 DOI: 10.1016/j.surg.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biopsychosocial distress screening is a critical component of comprehensive cancer care. Financial issues are a common source of distress in this patient population. This study uses a biopsychosocial distress screening tool to determine the factors associated with financial toxicity and the impact of these stressors on gastrointestinal cancer patients. METHODS A 48-question, proprietary distress screening tool was administered to patients with gastrointestinal malignancies from 2009 to 2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a 5-point Likert scale from 1 (not a problem) to 5 (very severe problem), with responses rated at ≥3 indicative of distress. Univariate and multivariate logistic regressions were used to analyze the data. RESULTS Most of the 1,027 patients had colorectal (50%) or hepatobiliary (31%) malignancies. Additionally, 34% of all patients expressed a high level of financial toxicity. Age greater than 65 (odds ratio: 0.63, 95% confidence interval: 0.47-0.86, P < .01), college education (odds ratio: 0.53, 95% confidence interval: 0.38-0.73, P < .0001), being partnered (odds ratio: 0.61, 95% confidence interval: 0.44-0.84, P < .01), and annual income greater than $40,000 (odds ratio: 0.27, 95% confidence interval: 0.19-0.38, P < .0001) were all protective against financial toxicity on univariate analysis. Also, heavy tobacco use was associated significantly with increased distress on univariate analysis (odds ratio: 2.79, 95% confidence interval: 1.38-5.78, P < .01). With the exception of partnered status (odds ratio: 1.18, 95% confidence interval: 0.76-1.85, P = .46), all these variables retained their significant association with financial toxicity in the multivariate model. CONCLUSION Financial toxicity impacts a large number of cancer patients. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.
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Affiliation(s)
- Christopher J LaRocca
- Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Arthur Li
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Karen Clark
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Matthew Loscalzo
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA.
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Rijal A, Adhikari TB, Khan JAM, Berg-Beckhoff G. The economic impact of non-communicable diseases among households in South Asia and their coping strategy: A systematic review. PLoS One 2018; 13:e0205745. [PMID: 30462648 PMCID: PMC6248902 DOI: 10.1371/journal.pone.0205745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/01/2018] [Indexed: 12/31/2022] Open
Abstract
Background Out of pocket payment (OOPP), is the major health financing mechanism in South Asia region. With the rising burden of non-communicable diseases (NCDs), the region is facing a high financial burden. However, the extent and nature of economic impact caused by treatment and management of NCDs at the household level is yet unknown. Method We conducted a systematic review using Medline and Embase databases. Only peer-reviewed quantitative studies published between January 2000 to December 2016 assessing OOPP or catastrophic health expenditure or impoverishment or financial coping strategy due to at least one of the four major NCDs—cardiovascular diseases(CVDs), diabetes, cancer, chronic respiratory disease in South Asia region was included in the review. The review is registered in PROSPERO no: CRD42017059345. Results A total of 21 studies (of 2693 records identified) met the inclusion criteria. The economic impact was most frequently studied in CVDs and in terms of OOPP. The studies collectively indicated high OOPP, higher likelihood of catastrophic expenditure and impoverishment for inpatient care for these major NCDs which was visible in all income levels. Borrowing and selling off assets were the most common forms of coping strategies adopted and varied inconsistently between urban and rural households. The true extent of the economic impact, however, remains difficult to determine due to methodological heterogeneity regarding outcomes reported and measures employed for calculation of OOPP, catastrophic expenditure, and impoverishment across these four major NCDs and between nations. Conclusion The economic impact due to treatment and management of CVDs, diabetes, cancer and chronic respiratory diseases among households in South Asia seems dire. Given the lack of sufficient evidence the review stresses the need for further research in the region to develop evidence-informed nationally tailored prepayment mechanisms covering NCDs to reduce economic vulnerability and standardization of tools measuring the economic impact for generating comparable estimates.
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Affiliation(s)
- Anupa Rijal
- Young Earth, Kathmandu, Nepal
- Nepal Development Society, Chitwan, Nepal
- * E-mail:
| | - Tara Ballav Adhikari
- Nepal Development Society, Chitwan, Nepal
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jahangir A. M. Khan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden
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Newton JC, Johnson CE, Hohnen H, Bulsara M, Ives A, McKiernan S, Platt V, McConigley R, Slavova-Azmanova NS, Saunders C. Out-of-pocket expenses experienced by rural Western Australians diagnosed with cancer. Support Care Cancer 2018; 26:3543-3552. [PMID: 29704109 DOI: 10.1007/s00520-018-4205-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Out-of-pocket expenses (OOPE) can have a significant impact on patients' experiences of cancer treatment. This cross-sectional study sought to quantify the OOPEs experienced by rural cancer patients in Western Australia (WA), and determine factors that contributed to higher OOPE. METHODS Four hundred people diagnosed with breast, lung, colorectal or prostate cancer who resided in selected rural regions of WA were recruited through the WA Cancer Registry and contacted at least 3 months after diagnosis to report the medical OOPE (such as surgery or chemotherapy, supportive care, medication and tests) and non-medical OOPE (such as travel costs, new clothing and utilities) they had experienced as a result of accessing and receiving treatment. Bootstrapped t tests identified demographic, financial and treatment-related factors to include in multivariate analysis, performed using log-linked generalised linear models with gamma distribution. RESULTS After a median 21 weeks post-diagnosis, participants experienced an average OOPE of AU$2179 (bootstrapped 95% confidence interval $1873-$2518), and 45 (11%) spent more than 10% of their household income on these expenses. Participants likely to experience higher total OOPE were younger than 65 years (p = 0.008), resided outside the South West region (p = 0.007) and had private health insurance (PHI) (p < 0.001). CONCLUSIONS Rural WA cancer patients experience significant OOPE following their diagnosis. The impact these expenses have on patient wellbeing and their treatment decisions need to be further explored.
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Affiliation(s)
- Jade C Newton
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, Australia.,Eastern Health, Melbourne, Australia
| | - Harry Hohnen
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Perth, Western Australia, Australia
| | - Angela Ives
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandy McKiernan
- Cancer Council Western Australia, Perth, Western Australia, Australia
| | - Violet Platt
- WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Ruth McConigley
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Neli S Slavova-Azmanova
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia.
| | - Christobel Saunders
- UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
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13
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Fashler SR, Weinrib AZ, Azam MA, Katz J. The Use of Acceptance and Commitment Therapy in Oncology Settings: A Narrative Review. Psychol Rep 2017; 121:229-252. [PMID: 28836916 DOI: 10.1177/0033294117726061] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Various psychotherapeutic approaches have been developed to address the psychosocial stressors and distress associated with cancer diagnosis and treatment. One such approach, Acceptance and Commitment Therapy (ACT), may be particularly well suited to people with cancer as it offers a model of healthy adaptation to difficult circumstances. This paper provides a description and theoretical rationale for using ACT in psychosocial oncology care that emphasizes emotional distress and cancer-related pain and provides a narrative review of the current state of evidence for this setting. Six studies met eligibility criteria for inclusion in the review. The research designs included one case study, three pre-post cohort studies, and two randomized controlled trials. Cancer diagnoses of patients included breast cancer, ovarian cancer, colorectal cancer, and mixed cancer populations at various stages of disease progression or recovery. ACT interventions demonstrated significant improvements in symptoms including quality of life and psychological flexibility as well as reductions in symptoms including distress, emotional disturbances, physical pain, and traumatic responses. Overall, although there is limited published research currently available, there is some evidence to support ACT as an effective psychotherapeutic approach for cancer patients. Further research is needed for different cancer populations across the illness trajectory. Barriers to implementation are discussed.
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Affiliation(s)
- Samantha R Fashler
- Department of Psychology, 7991 York University , Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, 33540 Toronto General Hospital , University Health Network, Toronto, Ontario, Canada
| | - Aliza Z Weinrib
- Department of Psychology, 7991 York University , Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, 33540 Toronto General Hospital , University Health Network, Toronto, Ontario, Canada
| | - Muhammad Abid Azam
- Department of Psychology, 7991 York University , Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, 33540 Toronto General Hospital , University Health Network, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Psychology, 7991 York University , Toronto, Ontario, Canada; Department of Anesthesia and Pain Management, 33540 Toronto General Hospital , University Health Network, Toronto, Ontario, Canada
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McGrath P. Financial Assistance for Patients Who Relocate for Specialist Care in Hematology: Practical Findings to Inform Nursing Supportive Care. Nurs Forum 2017; 52:55-61. [PMID: 28152210 DOI: 10.1111/nuf.12167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/16/2015] [Accepted: 02/28/2016] [Indexed: 11/28/2022]
Abstract
AIMS This article examines findings on the need for, awareness of, and critical time for referral to financial assistance for patients who have to relocate for specialist care for hematological malignancies. DESIGN The study involved descriptive qualitative research based on in-depth interviews that were audio-recorded, transcribed verbatim, coded, and thematically analyzed. PARTICIPANTS Forty-five hematology patients purposively selected from the client database of the Leukaemia Foundation of Queensland were interviewed for the study. RESULTS AND CONCLUSION The findings indicate that there is a critical period at the initial point of diagnosis and start of treatment when patients are experiencing shock, confusion, and a sense of being overwhelmed by stress, fear, and uncertainty about the future. The stress can be exacerbated by the loss of work and a period of waiting to access income (e.g., from superannuation or approval to receive a pension). For some patients, this is a critical period when individuals need support and advice to avoid long-term financial problems. However, at this point in time, many individuals do not know how to access financial advice or assistance from leading cancer supportive care organizations. The findings have practical implications to inform the work by many nurses who provide psychosocial care to hematology patients.
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Affiliation(s)
- Pam McGrath
- Pam McGrath, BSocWk, MA, PhD, is, Associate Professor and Senior Research Fellow, Centre for Community Science, Griffith University, Meadowbrook Qld, Queensland, Australia
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McGuffin M, Merino T, Keller B, Pignol JP. Response to: ‘Reply to: Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer’. Clin Oncol (R Coll Radiol) 2017; 29:393-394. [DOI: 10.1016/j.clon.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 03/16/2017] [Accepted: 03/24/2017] [Indexed: 11/24/2022]
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16
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Ó Céilleachair A, Hanly P, Skally M, O'Leary E, O'Neill C, Fitzpatrick P, Kapur K, Staines A, Sharp L. Counting the cost of cancer: out-of-pocket payments made by colorectal cancer survivors. Support Care Cancer 2017; 25:2733-2741. [PMID: 28341973 DOI: 10.1007/s00520-017-3683-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 03/20/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Cancer places a significant cost burden on health services. There is increasing recognition that cancer also imposes a financial and economic burden on patients but this has rarely been quantified outside North America. We investigate out-of-pocket costs (OOPCs) incurred by colorectal (CRC) survivors in Ireland. METHODS CRC survivors (ICD10 C18-20) diagnosed 6-30 months previously were identified from the National Cancer Registry Ireland and invited to complete a postal questionnaire. Cancer-related OOPC for tests, procedures, drugs, allied medications and household management in approximately the year following diagnosis were calculated. Robust regression was used to identify predictors of OOPC; this was done for all survivors combined and stratified by age (<70 and ≥70 years) and employment status (working and not working) at diagnosis. RESULTS Four hundred ninety-seven CRC survivors completed questionnaires (response rate = 39%). Almost all (90%) respondents reported some cancer-related OOPC. The average total OOPC was €1589. Stage III at diagnosis was associated with significantly higher OOPCs than other stages in the all-survivor model, in those not working in the employment model and in those under 70 years in the age-stratified model. In all-survivor model, those under 70 also had higher OOPCs, as did those in employment. Having one or more children was associated with significantly lower OOPCs in those under 70 years. CONCLUSIONS Almost all CRC survivors incur cancer-related OOPCs; for some, these are not insignificant. Greater attention should be paid to the development of services to help survivors manage the financial and economic burden of cancer.
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Affiliation(s)
- Alan Ó Céilleachair
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
| | - Paul Hanly
- National College of Ireland, IFSC, Dublin 1, Ireland
| | - Máiréad Skally
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland
| | | | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin 4, Ireland
| | - Kanika Kapur
- School of Economics and Geary Institute, University College Dublin, Dublin 4, Ireland
| | - Anthony Staines
- School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, Newcastle, UK
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McGuffin M, Merino T, Keller B, Pignol JP. Who Should Bear the Cost of Convenience? A Cost-effectiveness Analysis Comparing External Beam and Brachytherapy Radiotherapy Techniques for Early Stage Breast Cancer. Clin Oncol (R Coll Radiol) 2017; 29:e57-e63. [DOI: 10.1016/j.clon.2016.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 10/27/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022]
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18
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Associations between neighbourhood support and financial burden with unmet needs of head and neck cancer survivors. Oral Oncol 2016; 65:57-64. [PMID: 28109469 DOI: 10.1016/j.oraloncology.2016.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/15/2016] [Accepted: 12/18/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the unmet needs of head and neck cancer survivors and investigate associated factors. In particular, to explore whether social support (family/friends and neighbours) and financial burden are associated with unmet needs of head and neck cancer (HNC) survivors. METHODS This was a cross-sectional study of HNC survivors, with 583 respondents included in the analysis. Information was collected on unmet supportive care needs as measured by the Supportive Care Needs Survey (SCNS-SF34). Poisson regression with robust standard errors was used to examine factors associated with having one or more needs in each of the five domains (physical; psychological; sexuality; patient care and support; and health system and information). RESULTS The mean age of respondents was 62.9years (standard deviation 11.3years) and one third of respondents were female. The top ten unmet needs was composed exclusively of items from the physical and psychological domains. Financial strain due to cancer and finding it difficult to obtain practical help from a neighbour were both associated with unmet needs in each of the five domains, in the adjusted analyses. CONCLUSION Whilst in each domain, a minority of respondents have unmet needs, approximately half of respondents reported at least one unmet need, with the commonest unmet needs in the psychological domain. Providing services to people with these needs should be a priority for healthcare providers. We suggest that studies, which identify risk factors for unmet needs, could be used to develop screening tools or aid in the targeting of support.
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Kowalski C, Ferencz J, Singer S, Weis I, Wesselmann S. Frequency of psycho-oncologic and social service counseling in cancer centers relative to center site and hospital characteristics: Findings from 879 center sites in Germany, Austria, Switzerland, and Italy. Cancer 2016; 122:3538-3545. [PMID: 27481151 DOI: 10.1002/cncr.30202] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Society's cancer center certification system include the routine provision of psycho-oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers. METHODS Data routinely collected during the certification process regarding the percentages of psychosocial care provision and characteristics of center sites and hospitals were matched with data with regard to size of the municipality, teaching hospital status, and institutional ownership. Linear multilevel regression analyses were performed to identify the characteristics of hospitals and center sites that were related to psychosocial care provision. RESULTS Substantial differences were found for different types of cancer (eg, a greater provision of psychosocial care in centers specializing in breast rather than prostate cancer). There was more POC provision in longer-certified centers and less in rural areas and university hospitals. Much of the variation between hospitals remains unexplained. CONCLUSIONS Although the implementation of mandatory psychosocial services generally provides patients with access to POC and social service counseling, the wide differences in the provision of counseling indicate that additional measures are needed to avoid inequalities resulting from the center at which a patient receives cancer treatment. Cancer 2016;122:3538-3545. © 2016 American Cancer Society.
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Affiliation(s)
| | - Julia Ferencz
- OnkoZert, Certification Institute of the German Cancer Society, Neu-Ulm, Germany
| | - Susanne Singer
- Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, Mainz University Medical Centre, Mainz, Germany
| | - Ilse Weis
- Association for Social Work in the Health-Care System, Berlin, Germany
| | - Simone Wesselmann
- Department for Certification, German Cancer Society, Berlin, Germany
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20
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Balfe M, Butow P, O'Sullivan E, Gooberman-Hill R, Timmons A, Sharp L. The financial impact of head and neck cancer caregiving: a qualitative study. Psychooncology 2016; 25:1441-1447. [DOI: 10.1002/pon.4079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/08/2015] [Accepted: 12/26/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Myles Balfe
- National Cancer Registry Ireland; Cork Ireland
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Decision-making; The University of Sydney; Sydney Australia
| | | | | | | | - Linda Sharp
- Newcastle University; Newcastle upon Tyne UK
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21
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Bestvina CM, Zullig LL, Yousuf Zafar S. The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature. Future Oncol 2015; 10:2189-99. [PMID: 25471033 DOI: 10.2217/fon.14.130] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Advances in cancer diagnosis and treatment have led to increased societal costs and out-of-pocket patient cost. We reviewed the literature on the impact of out-of-pocket cancer care costs on the patient experience, and described efforts made to address these costs. A critical appraisal of articles published in the USA from 2004 to 2014 was performed. The literature revealed that even insured patients receiving anticancer therapy are vulnerable to financial distress, which can impel patients to borrow money, deplete their savings, or engage in cost-coping strategies including nonadherence to prescribed treatment. Additional research is required to define financial distress risk factors, patient-physician communication of the costs of cancer care, and supportive care models for patients and survivors with substantial financial burdens.
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Affiliation(s)
- Christine M Bestvina
- Duke University Medical Center, 2301 Erwin Road, Room 8254, Durham, NC 27701, USA
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Fleming L, MacMahon K. ‘CBT-I in Cancer: We Know It Works, so Why Are We Waiting?’. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0021-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H, Chisholm G, Williams J, Frisbee-Hume S, Bruera E. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Oncologist 2015. [PMID: 26205738 DOI: 10.1634/theoncologist.2015-0026] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. PATIENTS AND METHODS We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). RESULTS The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%-93%) versus 65 of 72 at GPH (90%; 95% CI: 81%-96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1-7) versus 8 (IQR: 3-10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1-8). FD correlated (Spearman correlation) with FACT-G (r = -0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336). CONCLUSION FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. IMPLICATIONS FOR PRACTICE Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
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Affiliation(s)
- Marvin Delgado-Guay
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jeanette Ferrer
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alyssa G Rieber
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Wadih Rhondali
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Supakarn Tayjasanant
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jewel Ochoa
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Hilda Cantu
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gary Chisholm
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Janet Williams
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Susan Frisbee-Hume
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Eduardo Bruera
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Gott M, Allen R, Moeke-Maxwell T, Gardiner C, Robinson J. 'No matter what the cost': A qualitative study of the financial costs faced by family and whānau caregivers within a palliative care context. Palliat Med 2015; 29:518-28. [PMID: 25680378 PMCID: PMC4441882 DOI: 10.1177/0269216315569337] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND There has been significant attention paid in recent years to the economic costs of health service provision for people with palliative care needs. However, little is known about the costs incurred by family caregivers who typically provide the bulk of care for people at the end of life. AIM To explore the nature and range of financial costs incurred by family caregiving within a palliative care context. DESIGN In-depth qualitative interviews were conducted with 30 family/whānau caregivers who were currently caring for someone with a life-limiting illness or had done so within the preceding year. Narrative analysis was used to identify impacts and costs at the personal, interpersonal, sociocultural and structural levels. SETTING Auckland, New Zealand. FINDINGS Costs of caregiving were significant and, for participants, resulted in debt or even bankruptcy. A range of direct (transport, food and medication) and indirect costs (related to employment, cultural needs and own health) were reported. A multi-level qualitative analysis revealed how costs operated at a number of levels (personal, interpersonal, sociocultural and structural). The palliative care context increased costs, as meeting needs were prioritised over cost. In addition, support from statutory service providers to access sources of financial support was limited. CONCLUSION Families incur significant financial costs when caring for someone at the end of life. Research is now needed to quantify the financial contribution of family and whānau caregiving within a palliative care context, particularly given attempts in many countries to shift more palliative care provision into community settings.
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Affiliation(s)
- Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Ruth Allen
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | | | - Clare Gardiner
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Pisu M, Kenzik KM, Oster RA, Drentea P, Ashing KT, Fouad M, Martin MY. Economic hardship of minority and non-minority cancer survivors 1 year after diagnosis: another long-term effect of cancer? Cancer 2015; 121:1257-64. [PMID: 25564986 DOI: 10.1002/cncr.29206] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Current literature suggests that racial/ethnic minority survivors may be more likely than whites to experience economic hardship after a cancer diagnosis; however, little is known about such hardship. METHODS Patients with lung cancer (LC) and colorectal cancer (CRC) participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium were surveyed approximately 4 months (baseline) and 12 months (follow-up) after diagnosis. Economic hardship at follow-up was present if participants 1) indicated difficulty living on household income; and/or 2) for the following 2 months, anticipated experiencing hardships (inadequate housing, food, or medical attention) or reducing living standards to the bare necessities of life. The authors tested whether African Americans (AAs) and Hispanics were more likely than whites to experience economic hardship controlling for sex, age, education, marital status, cancer stage, treatment, and economic status at baseline (income, prescription drug coverage). RESULTS Of 3432 survivors (39.7% with LC, 60.3% with CRC), 14% were AA, 7% were Hispanic, and 79% were white. AAs and Hispanics had lower education and income than whites. Approximately 68% of AAs, 58% of Hispanics, and 44.5% of whites reported economic hardship. In LC survivors, the Hispanic-white disparity was not significant in unadjusted or adjusted analyses, and the AA-white disparity was explained by baseline economic status. In CRC survivors, the Hispanic-white disparity was explained by baseline economic status, and the AA-white disparity was not explained by the variables that were included in the model. CONCLUSIONS Economic hardship was evident in almost 1 in 2 cancer survivors 1 year after diagnosis, especially AAs. Research should evaluate and address risk factors and their impact on survival and survivorship outcomes.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Kowalski C, Ferencz J, Weis I, Adolph H, Wesselmann S. Social service counseling in cancer centers certified by the German Cancer Society. SOCIAL WORK IN HEALTH CARE 2015; 54:307-319. [PMID: 25905764 DOI: 10.1080/00981389.2014.999980] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Social workers are an integral part of care provided in cancer centers that are certified according to the requirements of the German Cancer Society. This article reports on the tasks of social workers in German cancer care and on the proportion of patients that receives social service counseling (SSC) in breast, lung, colorectal, skin, gynecological, prostate, pancreas, neurological, and head and neck cancer centers based on data from 367,297 patients treated between 2009 and 2012. The highest proportions of patients (median >75%) are provided with SSC in breast and colorectal cancer centers, whereas the median is below 30% in skin cancer centers. Variation between centers and center types is high.
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Affiliation(s)
- Christoph Kowalski
- a Department for Certification , German Cancer Society , Berlin , Germany
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The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol 2014; 30:163-88. [PMID: 25527371 DOI: 10.1007/s10654-014-9983-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6-84% of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6-11% of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.
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Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, Hofstatter EW, Killelea BK, Knobf MT, Lannin DR, Abu-Khalaf M, Horowitz NR, Chagpar AB. Impact of Financial Burden of Cancer on Survivors' Quality of Life. J Oncol Pract 2014; 10:332-8. [DOI: 10.1200/jop.2013.001322] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Increased financial burden as a result of cancer care costs is the strongest independent predictor of poor quality of life among cancer survivors.
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Affiliation(s)
- Kathleen M. Fenn
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Suzanne B. Evans
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Ruth McCorkle
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | | | - Lajos Pusztai
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Tara Sanft
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | | | | | - M. Tish Knobf
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Donald R. Lannin
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Maysa Abu-Khalaf
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Nina R. Horowitz
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
| | - Anees B. Chagpar
- Yale School of Medicine; and Yale School of Nursing, New Haven, CT
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Kumthekar P, Stell BV, Jacobs DI, Helenowski IB, Rademaker AW, Grimm SA, Bennett CL, Raizer JJ. Financial burden experienced by patients undergoing treatment for malignant gliomas. Neurooncol Pract 2014; 1:71-76. [PMID: 26034619 DOI: 10.1093/nop/npu002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 01/23/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients undergoing treatment for malignant gliomas (MGs) can encounter medical costs beyond what their insurance covers. The magnitude and type of costs experienced by patients are unknown. The purpose of this study was to have patients or their families report on the medical costs incurred during the patients MG treatment. METHODS Patients with MG were eligible if they were within 6 months of diagnosis or tumor recurrence. Patients had to be ≥18 years of age, fluent in English, and not aphasic. Weekly logbooks were issued to patients for recording associated costs for ∼6 months or until tumor progression. "Out-of-pocket" (OOP) costs included medical and nonmedical expenses that were not reimbursed by insurance. Direct medical costs included hospital and physician bills. Direct nonmedical costs included transportation, parking, and other related items. Indirect medical costs included lost wages. Costs were analyzed to provide mean and medians with range of expenses. RESULTS Forty-three patients provided cost data for a median of 12 weeks. There were 25 men and 18 women with a median age of 57 years (range, 24y-73y); 79% were married, and 49% reported annual income >$75 000. Health insurance coverage was preferred provider organizations for 58% of patients, and median deductible was $1 500. Median monthly OOP cost was $1 342 (mean, $2 451; range, $333.41-$17 267.16). The highest OOP median costs were medication copayments ($710; range, $0-13 611.20), transportation ($327; range, $0-$1 927), and hospital bill copayments ($403; range, $0-$4 000). Median lost wages were $7 500, and median lost days of work were 12.8. CONCLUSIONS OOP costs for MG patients can be significant and comprise direct and indirect costs across several areas. Informing patients about expected costs could limit additional duress and allow financial support systems to be implemented.
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Affiliation(s)
- Priya Kumthekar
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Becky V Stell
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Daniel I Jacobs
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Irene B Helenowski
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Alfred W Rademaker
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Sean A Grimm
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Charles L Bennett
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
| | - Jeffrey J Raizer
- Departments of Neurology (B.V.S., P.K., D.I.J., S.A.G., J.J.R) and Preventive Medicine , Northwestern University , Chicago, Illinois (I.B.H., A.R.); Department of Clinical Pharmacy and Outcomes Sciences , University of South Carolina College of Pharmacy, Columbia, South Carolina (C.L.B)
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Witham G, Haigh C, Foy S. The challenges of health professionals in meeting the needs of vulnerable patients undergoing chemotherapy: a focus group study. J Clin Nurs 2014; 23:2844-53. [DOI: 10.1111/jocn.12583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Gary Witham
- Department of Nursing, Manchester Metropolitan University, Manchester, UK
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Timmons A, Gooberman-Hill R, Sharp L. "It's at a time in your life when you are most vulnerable": a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 2013; 8:e77549. [PMID: 24244279 PMCID: PMC3823871 DOI: 10.1371/journal.pone.0077549] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/10/2013] [Indexed: 11/19/2022] Open
Abstract
Although cancer patients may incur a wide range of cancer-related out-of-pocket costs and experience reduced income, the consequences of this financial burden are poorly understood. We investigated: financial adjustments needed to cope with the cancer-related financial burden; financial distress (defined as a reaction to the state of personal finances); and factors that increase risk of financial difficulties. Two sets of semi-structured face-to-face interviews were conducted with 20 patients with breast, lung and prostate cancer and 21 hospital-based oncology social workers (OSWs) in Ireland, which has a mixed public-private healthcare system. Participants were asked about: strategies to cope with the cancer-related financial burden; the impact of the financial burden on the family budget, other aspects of daily life, and wellbeing. OSWs were also asked about patient groups they thought were more likely to experience financial difficulties. The two interview sets were analysed separately using a thematic approach. Financial adjustments included: using savings; borrowing money; relying on family and friends for direct and indirect financial help; and cutting back on household spending. Financial distress was common. Financial difficulties were more likely for patients who were older or younger, working at diagnosis, lacked social support, had dependent children, had low income or had few savings. These issues often interacted with one another. As has been seen in predominantly publically and predominantly privately-funded healthcare settings, a complex mixed public-private healthcare system does not always provide adequate financial protection post-cancer. Our findings highlight the need for a broader set of metrics to measure the financial impact of cancer (and to assess financial protection in health more generally); these should include: out-of-pocket direct medical and non-medical costs; changes in income; financial adjustments (including financial coping strategies and household consumption patterns); and financial distress. In the interim, cancer patients require financial information and advice intermittently post diagnosis.
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Affiliation(s)
| | - Rachael Gooberman-Hill
- Orthopaedic Surgery Research Group, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
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Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH. Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 2013; 119:3710-7. [PMID: 23907958 DOI: 10.1002/cncr.28262] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 04/10/2013] [Accepted: 05/10/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. METHODS The authors identified cancer survivors diagnosed as adults (n=1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented. RESULTS Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%-34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all P<.05). CONCLUSIONS Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer.
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Affiliation(s)
- Erin E Kent
- Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
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Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: A systematic review. Maturitas 2013; 74:313-33. [DOI: 10.1016/j.maturitas.2013.01.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 01/21/2013] [Indexed: 11/21/2022]
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Timmons A, Gooberman-Hill R, Sharp L. The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public–private healthcare system. Support Care Cancer 2012; 21:107-17. [DOI: 10.1007/s00520-012-1498-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 05/09/2012] [Indexed: 11/30/2022]
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Sharp L, Carsin AE, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology 2012; 22:745-55. [PMID: 22411485 DOI: 10.1002/pon.3055] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 01/06/2012] [Accepted: 01/30/2012] [Indexed: 01/06/2023]
Affiliation(s)
| | - Anne-Elie Carsin
- National Cancer Registry; Cork Ireland
- Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
- Hospital del Mar Research Institute (IMIM); Barcelona Spain
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