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Chelsea NN, Posever N, Hsieh TYJ, Patterson S, Sweeney C, Dalrymple JL, Dottino J, Wiechert AC, Garrett L, Hacker MR, Esselen KM. Implementation of a financial navigation program in gynecologic oncology. Gynecol Oncol 2024; 189:119-124. [PMID: 39096589 DOI: 10.1016/j.ygyno.2024.07.672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/11/2024] [Accepted: 07/18/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND "Financial Toxicity" (FT) is the financial burden imposed on patients due to disease and its treatment. Approximately 50% of gynecologic oncology patients experience FT. This study describes the implementation and outcomes of a novel financial navigation program (FNP) in gynecologic oncology. METHODS Patients presenting for initial consultation with a gynecologic oncologist from July 2022 to September 2023 were included. A FNP was launched inclusive of hiring a financial navigator (FN) in July 2022, and implementing FT screening in October 2022. We prospectively captured patient referrals to the FN, collecting clinical, demographic, financial and social needs information, along with FN interventions and institutional support service referrals. Referrals to the FN and support services were quantified before and after screening implementation. RESULTS There were 1029 patients with 21.6% seen before and 78.4% after screening initiation. Median age was 58 (IQR 46-68). The majority were non-Hispanic white (60%) with private insurance (61%). A total of 10.5% patients were referred to the FN. Transportation (32%), financial assistance (20.5%) and emotional support (15.4%) were the most common needs identified. A higher proportion of patients referred to the FN identified as Black, had government-funded insurance or diagnoses of uterine or cervical cancers (p < 0.05). Post-screening referrals to FN increased (5% vs. 12.9%, p < 0.001), while referrals to other support services decreased (9.5% vs. 2.9%, p < 0.001). CONCLUSIONS Implementation of the FNP was feasible, though presence of both a FN and FT screening maximized its effectiveness. Further investigation is needed to understand screening barriers and evaluate longer-term impact.
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Affiliation(s)
- Nadiha Noor Chelsea
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA
| | - Natalie Posever
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA
| | - Tina Yi Jin Hsieh
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street Suite 514, Boston, MA 02115, USA
| | - Sutania Patterson
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA
| | - Christine Sweeney
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA
| | - John L Dalrymple
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Joseph Dottino
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Andrew C Wiechert
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Leslie Garrett
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Kirstein 3, 330 Brookline Ave, Boston, MA 02215, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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O'Connor RM, Huang DS, Rimel BJ, Kim KH, Li AJ, Taylor KN, Liang MI. Unmet financial needs among patients crowdfunding to support gynecologic cancer care. Gynecol Oncol 2024; 186:199-203. [PMID: 38833852 DOI: 10.1016/j.ygyno.2024.05.017] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Patients may use crowdfunding to solicit donations, typically from multiple small donors using internet-based means, to offset the financial toxicity of cancer care. OBJECTIVE To describe crowdfunding campaigns by gynecologic cancer patients and to compare campaign characteristics and needs expressed between patients with cervical, uterine, and ovarian cancer. STUDY DESIGN We queried the public crowdfunding forum GoFundMe.com for "cervical cancer," "uterine cancer," and "ovarian cancer." The first 200 consecutive posts for each cancer type fundraising within the United States were analyzed. Data on campaign goals and needs expressed were manually extracted. Descriptive statistics and bivariate analyses were performed. RESULTS Among the 600 fundraising pages, the median campaign goal was $10,000 [IQR $5000-$23,000]. Campaigns raised a median of 28.6% of their goal with only 8.7% of campaigns reaching their goal after a median of 54 days online. On average, ovarian cancer campaigns had higher monetary goals, more donors, and larger donation amounts than cervical cancer campaigns and raised more money than both cervical and uterine cancer campaigns. Campaigns were fundraising to support medical costs (80-85%) followed by lost wages (36-56%) or living expenses (27-41%). Cervical cancer campaigns reported need for non-medical costs more frequently than uterine or ovarian cancer campaigns. States without Medicaid expansions (31% of the national population) were over-represented among cervical cancer and uterine cancer, but not ovarian cancer campaigns. CONCLUSIONS Crowdfunding pages reveal patients fundraising for out-of-pocket costs in the thousands of dollars and a wide range of unmet financial needs based on cancer type.
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Affiliation(s)
- Reed M O'Connor
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dandi S Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B J Rimel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kenneth H Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Li
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kristin N Taylor
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Alismail S, Kober KM, Miaskowski C. Multidimensional Model of Energy in Patients With Cancer. Semin Oncol Nurs 2024; 40:151644. [PMID: 38692969 DOI: 10.1016/j.soncn.2024.151644] [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: 09/06/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Evidence suggests that energy is a distinct symptom from fatigue in patients with cancer. The purpose of this paper is to present the Multidimensional Model of Energy in Patients with Cancer (MMEPC) that is based on emerging evidence and to make recommendations for clinical practice and future research. METHODS The literature was reviewed to determine various factors associated with variations in energy in patients with cancer. In addition, some of the emerging evidence in the model is supported by studies of energy in the general population and in patients with other chronic conditions. RESULTS Based on a review of the literature, specific concepts in the MMEPC include: person factors, clinical factors, cancer-related factors, biological factors, factors associated with energy balance, and co-occurring symptoms. The evidence to support the association between each of these factors and variations in energy levels in patients with cancer is described and synthesized. CONCLUSION This article provides emerging evidence on factors that influence variations in energy levels in patients with cancer. While the fundamental biobehavioral and biologic mechanisms that underlie variations in energy levels are not well understood, the model can be used to design pre-clinical and clinical studies of energy in patients with cancer. In addition, while emerging evidence supports the hypothesis that fatigue and energy are distinct symptoms, additional research on common and distinct risk factors and underlying mechanisms is warranted to be able to develop and test precision interventions for one or both symptoms. IMPLICATIONS FOR NURSING PRACTICE The risk factors (eg, being female, sleep quality) associated with variations in energy levels in patients with cancer identified in this paper have important clinical implications. Clinicians can use the identified risk factors to guide their assessments; identify high-risk patients with decrements in energy decrement; and develop targeted energy conservation interventions for the patients.
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Affiliation(s)
| | | | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco; School of Medicine, University of California, San Francisco
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Andring LM, Corrigan KL, Reeve B, Meyer L, Wang XS, Smith G, Bailard N, Domingo M, Fellman B, Varkey J, Foster-Mills T, Lin L, Jhingran A, Colbert L, Eifel P, Klopp AH, Joyner M. The Value of Patient-Reported Outcomes to Predict Symptom Burden and Health-Related Quality of Life After Chemoradiation for Cervical Cancer: A Prospective Study. Pract Radiat Oncol 2024:S1879-8500(24)00135-8. [PMID: 38825227 DOI: 10.1016/j.prro.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE Patients with cervical cancer undergoing chemoradiation have high symptom burden. We performed an analysis of prospectively collected data on patient-reported outcomes to determine characteristics predictive of poor treatment experience. METHODS AND MATERIALS Between 2021 and 2023, we prospectively collected data on patient-reported outcomes from patients with cervical cancer undergoing definitive chemoradiation. The European Organization for Research and Treatment of Cancer (EORTC)-Quality of Life Question-Core 30 and the EORTC-Quality of Life Question-Cervical Cancer module were completed at baseline (BL) and at the end of treatment (EOT). Poor treatment experience was defined as EOT poor health-related quality of life (HRQOL), low physical function, or significant overall symptom burden. Predictive factors analyzed included demographic, clinical, and disease-specific factors and BL financial toxicity, depression, social function, and emotional function. Receiver operating characteristic analysis provided appropriate predictive cutoff values. Univariable and multivariable (MVA) linear regression analyses were performed. RESULTS Forty-nine patients completed BL and EOT questionnaires. Median age was 43 years (range, 18-85 years). Most patients (59%) had stage III disease. BL financial toxicity ≥66.7, depression ≥66.7, social function ≤50, and emotional function ≤58 on the EORTC linear transformed scale of 0 to 100 were significant predictors for poor treatment experience (p ≤ .04) based on receiver operating characteristic analysis. On MVA, poor BL social function was associated with reduced EOT HRQOL (β, -9.3; 95% CI, -16.1 to -2.6; p < .008), decreased physical function (β, -24.4; 95% CI, -36.3 to -12.6; p < .001), and high symptom burden (β, 26.9; 95% CI, 17.5-36.3; p < .001). Earlier disease stage predicted decreased symptom burden (β, -6.7; 95% CI, -13.1 to -0.3; p = .039). BL financial toxicity was a significant predictor in univariable analysis (p = .001-.044) and showed a significant interaction term on MVA (p = .024-.041) for all 3 domains of poor treatment experience. Demographic and treatment-related factors were not predictive. CONCLUSIONS Patients with cervical cancer with poor BL social function or high financial toxicity were at risk for increased symptom burden and poor HRQOL. Screening for these factors provides an opportunity for early intervention to improve treatment experience.
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Affiliation(s)
- Lauren M Andring
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Kelsey L Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryce Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Larissa Meyer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil Bailard
- Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maliah Domingo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Fellman
- Department of Statistical Analysis, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jasmine Varkey
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tomar Foster-Mills
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lilie Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lauren Colbert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Melissa Joyner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Siligato R, Gembillo G, Di Simone E, Di Maria A, Nicoletti S, Scichilone LM, Capone M, Vinci FM, Bondanelli M, Malaventura C, Storari A, Santoro D, Di Muzio M, Dionisi S, Fabbian F. Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. Methods Protoc 2024; 7:34. [PMID: 38668141 PMCID: PMC11053909 DOI: 10.3390/mps7020034] [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: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.
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Affiliation(s)
- Rossella Siligato
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
| | - Guido Gembillo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Alessio Di Maria
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Simone Nicoletti
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Laura Maria Scichilone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Matteo Capone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Francesca Maria Vinci
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Cristina Malaventura
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Alda Storari
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Sara Dionisi
- Nursing, Technical and Rehabilitation, Department DATeR Azienda Unità Sanitaria Locale di Bologna, 40121 Bologna, Italy;
| | - Fabio Fabbian
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
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Miller MF, Olson JS, Doughtie K, Zaleta AK, Rogers KP. The interplay of financial toxicity, health care team communication, and psychosocial well-being among rural cancer patients and survivors. J Rural Health 2024; 40:128-137. [PMID: 37449966 DOI: 10.1111/jrh.12779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/15/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Financial toxicity contributes to psychosocial distress among cancer patients and survivors. Yet, contextual factors unique to rural settings affect patient experiences, and a deeper understanding is needed of the interplay between financial toxicity and health care team communication and its association with psychosocial well-being among rural oncology patients. PURPOSE We examined associations between financial toxicity and psychosocial well-being among rural cancer patients, exploring variability in these linkages by health care team communication. METHODS Using data from 273 rural cancer patients who participated in Cancer Support Community's Cancer Experience Registry, we estimated multivariable regression models predicting depression, anxiety, and social function by financial toxicity, health care team communication, and the interplay between them. RESULTS We demonstrate robust associations between financial toxicity and psychosocial outcomes among our sample of rural cancer patients and survivors. As financial toxicity increased, symptoms of depression and anxiety increased. Further, financial toxicity was linked with decreasing social function. Having health care team conversations about treatment costs and distress-related care reduced the negative impact of financial toxicity on depressive symptoms and social function, respectively, in rural cancer patients at greatest risk for financial burden. CONCLUSIONS Financial toxicity and psychosocial well-being are strongly linked, and these associations were confirmed in a rural sample. A theorized buffer to the detrimental impacts of financial toxicity-health care team communication-played a role in moderating these associations. Our findings suggest that health care providers in rural oncology settings may benefit from tools and resources to bolster communication with patients about costs, financial distress, and coordination of care.
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Affiliation(s)
- Melissa F Miller
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kara Doughtie
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kimberly P Rogers
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
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Wu Y, Liu X, Maculaitis MC, Li B, Berk A, Massa A, Weiss MC, McRoy L. Financial Toxicity among Patients with Breast Cancer during the COVID-19 Pandemic in the United States. Cancers (Basel) 2023; 16:62. [PMID: 38201491 PMCID: PMC10778054 DOI: 10.3390/cancers16010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
This study reported the prevalence of financial distress (financial toxicity (FT)) and COVID-19-related economic stress in patients with breast cancer (BC). Patients with BC were recruited from the Ciitizen platform, Breastcancer.org, and patient advocacy groups between 30 March and 6 July 2021. FT was assessed with the COmprehensive Score for financial Toxicity (COST) instrument. COVID-19-related economic stress was assessed with the COVID-19 Stress Scale. Among the 669 patients, the mean age was 51.6 years; 9.4% reported a COVID-19 diagnosis. The prevalence rates of mild and moderate/severe FT were 36.8% and 22.4%, respectively. FT was more prevalent in patients with metastatic versus early BC (p < 0.001). The factors associated with FT included income ≤ USD 49,999 (adjusted odds ratio (adj OR) 6.271, p < 0.0001) and USD 50,000-USD 149,999 (adj OR 2.722, p < 0.0001); aged <50 years (adj OR 3.061, p = 0.0012) and 50-64 years (adj OR 3.444, p = 0.0002); living alone (adj OR 1.603, p = 0.0476); and greater depression severity (adj OR 1.155, p < 0.0001). Black patients (adj OR 2.165, p = 0.0133), patients with income ≤ USD 49,999 (adj OR 1.921, p = 0.0432), or greater depression severity (adj OR 1.090, p < 0.0001) were more likely to experience COVID-19-related economic stress. FT was common in patients with BC, particularly metastatic disease, during COVID-19. Multiple factors, especially lower income and greater depression severity were associated with financial difficulties during COVID-19.
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Affiliation(s)
- Yan Wu
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 07103, USA;
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | - Xianchen Liu
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | | | - Benjamin Li
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | - Alexandra Berk
- Invitae Corporation, San Francisco, CA 94103, USA; (A.B.); (A.M.)
| | - Angelina Massa
- Invitae Corporation, San Francisco, CA 94103, USA; (A.B.); (A.M.)
| | | | - Lynn McRoy
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
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8
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Esselen KM, Baig RA, Gompers A, Stack-Dunnbier H, Hacker MR, Jang JW. Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer. Support Care Cancer 2023; 31:388. [PMID: 37300721 DOI: 10.1007/s00520-023-07849-6] [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: 01/11/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. METHODS Patients completed a survey 1 month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. RESULTS Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). CONCLUSION Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.
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Affiliation(s)
- Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
| | - Rasha A Baig
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hannah Stack-Dunnbier
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Shalowitz DI, Schroeder MC, Birken SA. An implementation science approach to the systematic study of access to gynecologic cancer care. Gynecol Oncol 2023; 172:78-81. [PMID: 36972637 DOI: 10.1016/j.ygyno.2023.03.012] [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: 02/24/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Barriers to access to cancer care are profoundly threatening to patients with gynecologic malignancies. Implementation science focuses on empirical investigation of factors influencing delivery of clinical best practices, as well as interventions designed to improve delivery of evidence-based care. We outline one prominent framework for conducting implementation research and discuss its application to improving access to gynecologic cancer care. METHODS Literature on the use of the Consolidated Framework for Implementation Research (CFIR) was reviewed. Delivery of cytoreductive surgery for advanced ovarian carcinoma was selected as an illustrative case of an evidence-based intervention (EBI) in gynecologic oncology. CFIR domains were applied to the context of cytoreductive surgical care, highlighting examples of empirically-assessable determinants of care delivery. RESULTS CFIR domains include Innovation, Inner Setting, Outer Setting, Individuals, and Implementation Process. "Innovation" relates to characteristics of the surgical intervention itself; "Inner Setting" relates to the environment in which surgery is delivered. "Outer Setting" refers to the broader care environment influencing the Inner Setting. "Individuals" highlights attributes of persons directly involved in care delivery, and "Implementation Process" focuses on integration of the Innovation within the Inner Setting. CONCLUSIONS Prioritization of implementation science methods in the study of access to gynecologic cancer care will help ensure that patients are able to utilize interventions with the greatest prospect of benefiting them.
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Affiliation(s)
- David I Shalowitz
- West Michigan Cancer Center, Kalamazoo, MI, United States of America; Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America.
| | - Mary C Schroeder
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America; Division of Health Services Research, College of Pharmacy, University of Iowa, Iowa City, IA, United States of America
| | - Sarah A Birken
- Collaborative on Equity in Rural Cancer Care, Kalamazoo, MI, United States of America; Department of Implementation Science, School of Medicine, Wake Forest University, Winston-Salem, USA
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