1
|
Xiao T, Zhong H, Xiao R, Chen T, Li L, Chen X. Profiles of financial toxicity and influencing factors among cancer patients: A latent profile analysis. Res Social Adm Pharm 2024; 20:137-144. [PMID: 37949721 DOI: 10.1016/j.sapharm.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
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.
Collapse
Affiliation(s)
- Tian Xiao
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan Province, China
| | - Hongyue Zhong
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan Province, China
| | - Ruihan Xiao
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan Province, China
| | - Ting Chen
- Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, 610083, Sichuan Province, China
| | - Li Li
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan Province, China
| | - Xiaoju Chen
- School of Nursing, Chengdu Medical College, Chengdu, 610083, Sichuan Province, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Pituskin E, Foulkes SJ, Cox-Kennett N, Driga A, Dimitry R, Thompson RB, Kirkham A, Prado C, Gyenes G, Haykowsky MJ. Cardio-oncology and Cancer Rehabilitation: Is an Integrated Approach Possible? Can J Cardiol 2023; 39:S315-S322. [PMID: 37758015 DOI: 10.1016/j.cjca.2023.09.024] [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: 06/20/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
With significant improvements in the understanding of cancer biology, improved detection, and the use of novel adjuvant therapies, each year more Canadians are surviving a cancer diagnosis. Despite their effectiveness these therapies often result in short- and long-term deleterious effects to major organ systems, particularly cardiovascular. Cardio-oncology is an emerging field of study with the aim to improve cardiovascular health across the oncology disease spectrum. International guidelines distinguish "cardio-oncology" rehabilitation from "cancer" rehabilitation, but how this is navigated is currently unknown. How such care should be assessed and integrated acutely or in the longer term remains unknown. Accordingly, the aim of this article is to consider the cancer patient's needs beyond the scope of cardio-oncology rehabilitation to holistically integrate cancer rehabilitation across the disease trajectory.
Collapse
Affiliation(s)
- Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Stephen J Foulkes
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy Driga
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | - Rebecca Dimitry
- Alberta Health Services, CancerCare Alberta, Edmonton, Alberta, Canada
| | | | - Amy Kirkham
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada
| | - Carla Prado
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Gabor Gyenes
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mark J Haykowsky
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
4
|
Politi MC, Forcino RC, Parrish K, Durand M, O'Malley AJ, Moses R, Cooksey K, Elwyn G. The impact of adding cost information to a conversation aid to support shared decision making about low-risk prostate cancer treatment: Results of a stepped-wedge cluster randomised trial. Health Expect 2023; 26:2023-2039. [PMID: 37394739 PMCID: PMC10485319 DOI: 10.1111/hex.13810] [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: 02/08/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND Decision aids help patients consider the benefits and drawbacks of care options but rarely include cost information. We assessed the impact of a conversation-based decision aid containing information about low-risk prostate cancer management options and their relative costs. METHODS We conducted a stepped-wedge cluster randomised trial in outpatient urology practices within a US-based academic medical center. We randomised five clinicians to four intervention sequences and enroled patients newly diagnosed with low-risk prostate cancer. Primary patient-reported outcomes collected postvisit included the frequency of cost conversations and referrals to address costs. Other patient-reported outcomes included: decisional conflict postvisit and at 3 months, decision regret at 3 months, shared decision-making postvisit, financial toxicity postvisit and at 3 months. Clinicians reported their attitudes about shared decision-making pre- and poststudy, and the intervention's feasibility and acceptability. We used hierarchical regression analysis to assess patient outcomes. The clinician was included as a random effect; fixed effects included education, employment, telehealth versus in-person visit, visit date, and enrolment period. RESULTS Between April 2020 and March 2022, we screened 513 patients, contacted 217 eligible patients, and enroled 117/217 (54%) (51 in usual care, 66 in the intervention group). In adjusted analyses, the intervention was not associated with cost conversations (β = .82, p = .27), referrals to cost-related resources (β = -0.36, p = .81), shared decision-making (β = -0.79, p = .32), decisional conflict postvisit (β = -0.34, p= .70), or at follow-up (β = -2.19, p = .16), decision regret at follow-up (β = -9.76, p = .11), or financial toxicity postvisit (β = -1.32, p = .63) or at follow-up (β = -2.41, p = .23). Most clinicians and patients had positive attitudes about the intervention and shared decision-making. In exploratory unadjusted analyses, patients in the intervention group experienced more transient indecision (p < .02) suggesting increased deliberation between visit and follow-up. DISCUSSION Despite enthusiasm from clinicians, the intervention was not significantly associated with hypothesised outcomes, though we were unable to robustly test outcomes due to recruitment challenges. Recruitment at the start of the COVID-19 pandemic impacted eligibility, sample size/power, study procedures, and increased telehealth visits and financial worry, independent of the intervention. Future work should explore ways to support shared decision-making, cost conversations, and choice deliberation with a larger sample. Such work could involve additional members of the care team, and consider the detail, quality, and timing of addressing these issues. PATIENT OR PUBLIC CONTRIBUTION Patients and clinicians were engaged as stakeholder advisors meeting monthly throughout the duration of the project to advise on the study design, measures selected, data interpretation, and dissemination of study findings.
Collapse
Affiliation(s)
- Mary C. Politi
- Department of Surgery, Division of Public Health SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Rachel C. Forcino
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth CollegeLebanonNew HampshireUSA
| | - Katelyn Parrish
- Department of Surgery, Division of Public Health SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Marie‐Anne Durand
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth CollegeLebanonNew HampshireUSA
- Université Toulouse III Paul SabatierToulouseFrance
| | - A. James O'Malley
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth CollegeLebanonNew HampshireUSA
- Department of Biomedical Data ScienceGeisel School of Medicine at Dartmouth, Dartmouth CollegeLebanonNew HampshireUSA
| | - Rachel Moses
- Section of Urology, Department of SurgeryDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | - Krista Cooksey
- Department of Surgery, Division of Public Health SciencesWashington University School of MedicineSt. LouisMissouriUSA
| | - Glyn Elwyn
- Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical PracticeDartmouth CollegeLebanonNew HampshireUSA
| |
Collapse
|
5
|
Hammer MJ, Cooper BA, Chen LM, Wright AA, Pozzar R, Blank SV, Cohen B, Dunn L, Paul S, Conley YP, Levine JD, Miaskowski C. Identification of distinct symptom profiles in patients with gynecologic cancers using a pre-specified symptom cluster. Support Care Cancer 2023; 31:485. [PMID: 37480403 DOI: 10.1007/s00520-023-07954-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/17/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE Pain, fatigue, sleep disturbance, and depression are four of the most common symptoms in patients with gynecologic cancer. The purposes were to identify subgroups of patients with distinct co-occurring pain, fatigue, sleep disturbance, and depression profiles (i.e., pre-specified symptom cluster) in a sample of patients with gynecologic cancer receiving chemotherapy and assess for differences in demographic and clinical characteristics, as well as the severity of other common symptoms and QOL outcomes among these subgroups. METHODS Patients completed symptom questionnaires prior to their second or third cycle of chemotherapy. Latent profile analysis was used to identify subgroups of patients using the pre-specified symptom cluster. Parametric and nonparametric tests were used to evaluate for differences between the subgroups. RESULTS In the sample of 233 patients, two distinct latent classes were identified (i.e., low (64.8%) and high (35.2%)) indicating lower and higher levels of symptom burden. Patients in high class were younger, had child care responsibilities, were unemployed, and had a lower annual income. In addition, these women had a higher body mass index, a higher comorbidity burden, and a lower functional status. Patients in the high class reported higher levels of anxiety, as well as lower levels of energy and cognitive function and poorer quality of life scores. CONCLUSIONS This study identified a number of modifiable and non-modifiable risk factors associated with membership in the high class. Clinicians can use this information to refer patients to dieticians and physical therapists for tailored interventions.
Collapse
Affiliation(s)
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Lee-May Chen
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Laura Dunn
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Steven Paul
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| |
Collapse
|
6
|
Metin T, Uğur Ö, Özdemir SÇ, Gönderen A, Sunu C. The unknown impact of multiple myeloma: assessing the impact of financial well-being on quality of life of caregivers. Support Care Cancer 2023; 31:288. [PMID: 37079098 DOI: 10.1007/s00520-023-07751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Patients with multiple myeloma and their caregivers are financially burdened, and their quality of life is significantly affected by treatment costs and care expenses. The aim of our study is to examine the impact of financial well-being of the caregiver on the life quality of patients with multiple myeloma. METHODS The study included 113 patients with multiple myeloma and 113 caregivers in two hospitals located in Western Turkey. This study evaluated the demographic characteristics of patients and their caregivers, financial status, financial well-being, and quality of life of caregivers. Simple linear regression analyses were used to examine the impact of financial well-being on caregiver quality of life. RESULTS The average age of multiple myeloma patients and caregivers is 64.00 ± 11.05 and 48.02 ± 11.4, respectively. Of patients, 50.4% and 62.8% of their caregivers were female. It is determined that 51.3% of the patients were diagnosed in 1-5 years, 85% received chemotherapy, and 80.5% had an ECOG performance status between 0 and 1. Caregivers' quality of life and financial well-being were found to be low. On one hand, while caregivers' financial well-being (β = - 1.003; t = - 3.831; p = .000) negatively affected the quality of their lives, their financial satisfaction (β = 2.507; t = 3.820; p = .000) positively affected the quality of their lives, on the other hand. CONCLUSIONS Caregivers' quality of life declined as their financial well-being got worse. Decreased quality of life of caregivers may affect the quality of care they provide to patients with MM. Hence, this study recommends the following. First, nurses who care for patients with MM should always assess the financial situation of patients and caregivers. Second, patient navigators, hospital billing specialists, and social workers should provide financial guidance to multiple myeloma patients and caregivers and provide help in solving their financial problems. Finally, policies that support the financial situation of patients and caregivers should be developed.
Collapse
Affiliation(s)
- Tuba Metin
- Simav Vocational School of Health Services, Kutahya Health Sciences University, Kutahya, Turkey.
| | - Özlem Uğur
- Department of Oncology Nursing, Faculty of Nursing, Dokuz Eylül University, İzmir, Turkey
| | | | - Aysun Gönderen
- Department of Hematology, Kutahya Health Sciences University Evliya Çelebi Training and Research Hospital, Kutahya, Turkey
| | - Cenk Sunu
- Department of Hematology, Faculty of Medicine, Sakarya University, Adapazarı, Sakarya, Turkey
| |
Collapse
|
7
|
Bazilainsky S, Cohen M, Holtmaat K, Erlich B, Verdonck-de Leeuw IM. The impact of cancer on psychosocial function and quality of life: A cross-sectional study in 18 pan-European countries. Psychooncology 2023; 32:383-392. [PMID: 36604583 DOI: 10.1002/pon.6083] [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: 10/18/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To improve psychosocial cancer care in Europe, more information is needed on psychosocial function and quality of life (QoL) among cancer patients in European countries. AIMS To investigate differences in psychosocial function between cancer survivors and the general population in Europe, in relation to national economic status and personal factors. METHOD Data were from the Survey of Health, Aging and Retirement in Europe (Wave 6). Main outcomes were psychosocial functioning: activity limitations, income adequacy, loneliness, depression, and QoL. Factors possibly associated with the main outcomes were ever having cancer, gross domestic product (GDP), and personal factors (age, gender, education, marriage status, employment status, number of children, number of chronic diseases). RESULTS The study sample featured 6238 cancer survivors and 60,961 individuals without cancer aged 50 or older in 17 European countries and Israel. Levels of depression were higher and QoL was lower among cancer survivors compared to individuals without cancer and worse in low GDP countries, whereas differences in income adequacy and loneliness were not statistically significant. The interaction of cancer groups and country groups indicated a significant interactional effect on activity limitations, loneliness, depression, and QoL. In a multivariate regression analysis, personal factors, GDP, and being a cancer survivor predicted the main outcome variables. CONCLUSIONS Cancer has a persistent negative effect on survivors that is related to a country's GDP. Cancer survivors in low-GDP countries are affected by the consequences of cancer intertwined with the hardships of living in a low-GDP country.
Collapse
Affiliation(s)
| | - Miri Cohen
- School of Social Work, University of Haifa, Haifa, Israel
| | - Karen Holtmaat
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.,Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands
| | - Brach Erlich
- Braun School of Public Health, Hebrew University, Jerusalem, Israel
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, The Netherlands.,Department Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health, Mental Health, Amsterdam, The Netherlands.,Department Otolaryngology-Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Politi MC, Housten AJ, Forcino RC, Jansen J, Elwyn G. Discussing Cost and Value in Patient Decision Aids and Shared Decision Making: A Call to Action. MDM Policy Pract 2023; 8:23814683221148651. [PMID: 36643615 PMCID: PMC9834940 DOI: 10.1177/23814683221148651] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Direct and indirect costs of care influence patients' health choices and the ability to implement those choices. Despite the significant impact of care costs on patients' health and daily lives, patient decision aid (PtDA) and shared decision-making (SDM) guidelines almost never mention a discussion of costs of treatment options as part of minimum standards or quality criteria. Given the growing study of the impact of costs in health decisions and the rising costs of care more broadly, in fall 2021 we organized a symposium at the Society for Medical Decision Making's annual meeting. The focus was on the role of cost information in PtDAs and SDM. Panelists gave an overview of work in this space at this virtual meeting, and attendees engaged in rich discussion with the panelists about the state of the problem as well as ideas and challenges in incorporating cost-related issues into routine care. This article summarizes and extends our discussion based on the literature in this area and calls for action. We recommend that PtDA and SDM guidelines routinely include a discussion of direct and indirect care costs and that researchers measure the frequency, quality, and response to this information.
Collapse
Affiliation(s)
- Mary C. Politi
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Ashley J. Housten
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Rachel C. Forcino
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
| | - Jesse Jansen
- School for Public Health and Primary Care
CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
| |
Collapse
|
9
|
MacPhail C, Snow S. Not All Canadian Cancer Patients Are Equal—Disparities in Public Cancer Drug Funding across Canada. Curr Oncol 2022; 29:2064-2072. [PMID: 35323366 PMCID: PMC8947051 DOI: 10.3390/curroncol29030166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Canada lacks a national drug insurance plan. The home province or territory of a patient determines which cancer drugs are available on the public formulary, who is eligible for public coverage and what portion of the financial burden of cancer care falls to the individual. This narrative review describes the current interprovincial disparities in access to cancer drugs across Canada. Health technology assessment (HTA) of drugs at a provincial and territory level is a closed process, does not necessarily follow the recommendations of national HTA and leads to further delays in drug access. The public coverage of take-home cancer drugs (THCDs) in Ontario and the Atlantic provinces is often fragmented, unnecessarily complex and a barrier to cancer drug access. Policy solutions to address inter-provincial formulary variation and poor access to THCDs are discussed.
Collapse
|
10
|
Pituskin E. Cancer as a new chronic disease: Oncology nursing in the 21st Century. Can Oncol Nurs J 2022; 32:87-92. [PMID: 35280062 PMCID: PMC8849169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Edith Pituskin
- Associate Professor, Faculty of Nursing, Associate Clinical Professor, Dept of Oncology, Tier 2 Canada Research Chair, University of Alberta, P: 780-432-8221 | F: 780-492-2551
| |
Collapse
|
11
|
Pituskin E. [Not Available]. Can Oncol Nurs J 2022; 32:93-99. [PMID: 35280060 PMCID: PMC8849167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Affiliation(s)
- Edith Pituskin
- Professeure agrégée, Faculté des sciences infirmières, Professeure agrégée d'enseignement clinique, Département d'oncologie, Chaire de recherche du Canada de niveau 2, Université de l'Alberta, Tél. : 780-432-8221 | Téléc. : 780-492-2551
| |
Collapse
|