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Amen TB, Dee EC, Jain B, Batter S, Jain U, Bajaj SS, Varady NH, Amen LJ, Goodman SM. Contemporary Patterns of Financial Toxicity Among Patients With Rheumatologic Disease in the United States. J Clin Rheumatol 2024; 30:223-228. [PMID: 38976618 DOI: 10.1097/rhu.0000000000002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND/OBJECTIVE Rheumatologic diseases encompass a group of disabling conditions that often require expensive clinical treatments and limit an individual's ability to work and maintain a steady income. The purpose of this study was to evaluate contemporary patterns of financial toxicity among patients with rheumatologic disease and assess for any associated demographic factors. METHODS The cross-sectional National Health Interview Survey was queried from 2013 to 2018 for patients with rheumatologic disease. Patient demographics and self-reported financial metrics were collected or calculated including financial hardship from medical bills, financial distress, food insecurity, and cost-related medication (CRM) nonadherence. Multivariable logistic regressions were used to assess for factors associated with increased financial hardship. RESULTS During the study period, 20.2% of 41,502 patients with rheumatologic disease faced some degree of financial hardship due to medical bills, 55.0% of whom could not pay those bills. Rheumatologic disease was associated with higher odds of financial hardship from medical bills (adjusted odds ratio, 1.29; 95% confidence interval, 1.22-1.36; p < 0.001) with similar trends for patients suffering from financial distress, food insecurity, and CRM nonadherence (p < 0.001 for all). Financial hardship among patients with rheumatologic disease was associated with being younger, male, Black, and uninsured ( p < 0.001 for all). CONCLUSION In this nationally representative study, we found that a substantial proportion of adults with rheumatologic disease in the United States struggled with paying their medical bills and suffered from food insecurity and CRM nonadherence. National health care efforts and guided public policy should be pursued to help ease the burden of financial hardship for these patients.
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Affiliation(s)
| | | | - Bhav Jain
- Stanford University School of Medicine, Stanford, CA
| | - Stephen Batter
- Department of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Urvish Jain
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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Frankiewicz P, Sawe Y, Sakita F, Mmbaga BT, Staton C, Joiner AP, Smith ER. Financial toxicity and acute injury in the Kilimanjaro region: An application of the Three Delays Model. PLoS One 2024; 19:e0308539. [PMID: 39213278 PMCID: PMC11364231 DOI: 10.1371/journal.pone.0308539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Trauma and injury present a significant global burden-one that is exacerbated in low- and middle-income settings like Tanzania. Our study aimed to describe the landscape of acute injury care and financial toxicity in the Kilimanjaro region by leveraging the Three Delays Model. METHODS This cross-sectional study used an ongoing injury registry and financial questionnaires collected at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania from December 2022 until March 2023. Financial toxicity measures included catastrophic expenditure and impoverishment, in accordance with World Health Organization standards. Descriptive analysis was also performed. FINDINGS Most acute injury patients that presented to the KCMC Emergency Department experienced financial toxicity due to their out-of-pocket (OOP) hospital expenses (catastrophic health expenditure, CHE: 62.8%; impoverishment, IMP: 85.9%). Households within our same which experienced financial toxicity had more dependents (CHE: 18.4%; IMP: 17.9% with ≥6 dependents) and lower median monthly adult-equivalent incomes (CHE: 2.53 times smaller than non-CHE; IMP: 4.27 times smaller than non-IMP). Individuals experiencing financial toxicity also underwent more facility transfers with a higher surgical burden. INTERPRETATION Delay 1 (decision to seek care) and Delay 2 (reaching appropriate care facility) could be significant factors for those who will experience financial toxicity. In the Tanzanian healthcare system where national health insurance is present, systematic expansions are indicated to target those who are at higher risk for financial toxicity including those who live in rural areas, experience unemployment, and have many dependents.
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Affiliation(s)
- Parker Frankiewicz
- Global Emergency Medicine Innovation and Implementation Research Center, Duke Global Health Institute, Durham, NC, United States of America
| | - Yvonne Sawe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Catherine Staton
- Global Emergency Medicine Innovation and Implementation Research Center, Duke Global Health Institute, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Anjni P. Joiner
- Global Emergency Medicine Innovation and Implementation Research Center, Duke Global Health Institute, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Emily R. Smith
- Global Emergency Medicine Innovation and Implementation Research Center, Duke Global Health Institute, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
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Halpern MT, Thamm C, Knowles R, Chan RJ. Cancer Survivors' Experience of Care and Financial Toxicity: Results From a National Survey. JCO Oncol Pract 2024:OP2400370. [PMID: 39173093 DOI: 10.1200/op.24.00370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/20/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024] Open
Abstract
PURPOSE Financial toxicity (FT) can adversely affect quality of life, treatment adherence, and clinical outcomes. Patient experience of care (PEC) captures patient's perspectives on interactions with health care providers (HCPs) and systems, but the impact of PEC on FT is unknown. This study examined the relationship between PEC and FT. METHODS We used data from the 2016-2017 Medical Expenditure Panel Survey (MEPS) Experience with Cancer Survivorship Supplement. PEC was assessed by patient-reported frequencies of their HCPs providing explanations that were easy to understand, listening carefully, showing respect, and spending enough time with the patient. FT was assessed by nine items to measure material, psychological, and behavioral FT. Analyses were performed using multivariable logistic regression controlling for sociodemographic and clinical characteristics and weighted to produce nationally representative estimates and account for survey nonresponse. RESULTS Data from 1,068 individuals diagnosed with cancer at age >18 years were assessed. A total of 30% reported material FT, 35% reported psychological FT, and 27% reported behavioral FT. Examining PEC, 64% of respondents indicated that HCPs always explained things, 60% always listened, 66% always showed respect, and 57% always spent adequate time with them. Odds of psychological FT were significantly (P < .05) lower among patients reporting HCPs always (v never/sometimes) listened to them (odds ratio [OR], 0.37 [95% CI, 0.19 to 0.70]), showed them respect (OR, 0.36 [95% CI, 0.16 to 0.81]), and spent enough time with them (OR, 0.47 [95% CI, 0.26 to 0.86]). Significant associations with PEC were also found with MEPS psychological FT items on worry about paying medical bills, family's financial stability, and keeping job/income because of cancer. CONCLUSION Worry/anxiety regarding costs can be a major factor affecting individuals diagnosed with cancer. Improving patient-provider interactions to enhance patient experience of care may reduce psychological financial toxicity.
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Affiliation(s)
- Michael T Halpern
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Health Delivery Research Program, National Cancer Institute, Bethesda, MD
| | - Carla Thamm
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Reegan Knowles
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Su H, Thompson HJ, Figuracion KC, Patel MB, Needham DM. Comparative analysis of financial toxicity between SARS-CoV-2 infection and common comorbidities. PLoS One 2024; 19:e0309116. [PMID: 39146373 PMCID: PMC11326593 DOI: 10.1371/journal.pone.0309116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024] Open
Abstract
Financial toxicity is common in individuals with COVID-19 and Long COVID. However, the extent of financial toxicity experienced, in comparison to other common comorbidities, is uncertain. Contributing factors exacerbating financial challenges in Long COVID are also unclear. These knowledge gaps are addressed via a cross-sectional analysis utilizing data from the 2022 National Health Interview Survey (NHIS), a representative sample drawn from the United States. COVID-19 cases were identified through self-reported positive testing or physician diagnoses. Long COVID was defined as experiencing COVID-19-related symptoms for more than three months. Comorbidity was assessed based on self-reported diagnoses of ten doctor-diagnosed conditions (Yes/No). Financial toxicity was defined as having difficulty paying medical bills, cost-related medication nonadherence, delaying healthcare due to cost, and/or not obtained healthcare due to cost. A total of 27,492 NHIS 2022 respondents were included in our analysis, representing 253 million U.S. adults. In multivariable logistic regression models, adults with Long COVID (excluding respondents with COVID-19 but not Long COVID), showed increased financial toxicity compared to those with other comorbidities, such as epilepsy (OR [95% CI]: 1.69 [1.22, 2.33]), dementia (1.51 [1.01, 2.25]), cancer (1.43 [1.19, 1.71]) or respiratory/cardiovascular conditions (1.18 [1.00, 1.40]/1.23 [1.02, 1.47]). Long COVID-related financial toxicity was associated with female sex, age <65 years, lack of medical insurance, current paid employment, residence region, food insecurity, fatigue, mild to severe depression symptoms experienced during the survey completion, visits to hospital emergency rooms, presence of arthritis, cardiovascular or respiratory conditions, and social activity limitations. In conclusion, American adults with Long COVID, but not those who had prior COVID-19 infection without Long COVID, exhibited a higher prevalence of financial toxicity compared to individuals with common comorbidities. Vulnerable populations were at greater risk for financial toxicity. These findings emphasize the importance of evaluating strategies to reduce economic burden and increase awareness of the effect of Long COVID-related financial toxicity on patient's healthcare and health status.
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Affiliation(s)
- Han Su
- School of Nursing, Vanderbilt University, Nashville, TN, United States of America
| | - Hilaire J Thompson
- School of Nursing, University of Washington, Seattle, WA, United States of America
| | - Karl Cristie Figuracion
- Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Mayur Bipin Patel
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Critical Illness, Brain Dysfunction and Survivorship Center, Vanderbilt University Medical, Nashville, TN, United States of America
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, United States of America
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
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5
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Kicken MP, Deenen MJ, Moes DJAR, Hendrikx JJMA, van den Borne BEEM, Dumoulin DW, van der Wekken AJ, van den Heuvel MM, Ter Heine R. An Evidence-Based Rationale for Dose De-escalation of Subcutaneous Atezolizumab. Target Oncol 2024:10.1007/s11523-024-01087-4. [PMID: 39085452 DOI: 10.1007/s11523-024-01087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Atezolizumab is a programmed death-ligand 1 (PD-L1) checkpoint inhibitor for the treatment of different forms of cancer. The subcutaneous formulation of atezolizumab has recently received approval. However, treatment with atezolizumab continues to be expensive, and the number of patients needing treatment with this drug continues to increase. OBJECTIVE We propose two alternative dosing regimens for subcutaneous atezolizumab to reduce drug expenses while ensuring effective exposure; one may be directly implemented in the clinic. PATIENTS AND METHODS We developed two alternative dose interval prolongation strategies based on pharmacokinetic modeling and simulation. The first dosing regimen was based on patients' weight while maintaining equivalent systemic drug exposure by adhering to Food and Drug Administration (FDA) guidelines for in silico dose adjustments. The second dosing regimen aimed to have a minimum atezolizumab concentration above the 6 µg/mL threshold, associated with 95% intratumoral PD-L1 receptor saturation for at least 95% of all patients. RESULTS We found that, for the weight-based dosing regimen, the approved 3-week dosing interval could be extended to 5 weeks for patients < 50 kg and 4 weeks for patients weighing 50-65 kg. Besides improving patient convenience, these alternative dosing intervals led to a predicted 7% and 12% cost reduction for either the USA or European population. For the second dosing regimen, we predicted that a 6-week dosing interval would result in 95% of the patients above the 6 µg/mL threshold while reducing costs by 50%. CONCLUSIONS We have developed and evaluated two alternative dosing regimens that resulted in a cost reduction. Our weight-based dosing regimen can be directly implemented and complies with FDA guidelines for alternative dosing regimens of PD-L1 inhibitors. For the more progressive alternative dosing regimen aimed at the intratumoral PD-L1 receptor threshold, further evidence on efficacy and safety is needed before implementation.
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Affiliation(s)
- Mart P Kicken
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Department of Clinical Pharmacy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | - Maarten J Deenen
- Department of Clinical Pharmacy, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dirk J A R Moes
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J M A Hendrikx
- Department of Pharmacy and Pharmacology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | | | - Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus Medical Center Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Anthonie J van der Wekken
- Department of Pulmonology, University of Gronigen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Rob Ter Heine
- Department of Pharmacy, Radboud University Medical Center, Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Chan A, Ke Y, Tanay M, Dagsi M, Bergerot C, Dixit N, Eng L, Cardeña Gutiérrez A, Jiang C, Velázquez AI, Islami F, Soto-Perez-de-Celis E. Financial Toxicity in Cancer Supportive Care: An International Survey. JCO Glob Oncol 2024; 10:e2400043. [PMID: 38959449 DOI: 10.1200/go.24.00043] [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: 01/30/2024] [Revised: 04/07/2024] [Accepted: 05/20/2024] [Indexed: 07/05/2024] Open
Abstract
PURPOSE The study aims to explore unmet social needs and sources of financial toxicities in patients as noted by health care professionals and researchers in cancer supportive care, shedding light on potential health disparities. METHODS In this cross-sectional survey, we anonymously surveyed active members of the Multinational Association of Supportive Care in Cancer (MASCC). The survey, structured in three sections, included questions regarding the routine assessment of social needs during patient consultations, sociodemographic aspects, factors influencing financial toxicity (FT), perceived support for managing FT, and available/desirable resources. RESULTS A total of 218 MASCC members were included, predominantly from high-income countries (HIC, 73.4%), with many age 41-60 years (56.5%) and female (56.9%). Drug/treatment cost and insurance coverage were the main sources for FT among the HIC, whereas participants from low-middle-income countries (LMIC) considered transportation cost, loss of employment because of cancer diagnosis, and unavailability of return-to-work services as the top three sources of FT. Respondents from LMIC (adjusted odds ratio [aOR], 3.01 [95% CI, 1.15 to 7.93]) and physicians (aOR, 2.67 [95% CI, 1.15 to 6.21]) were more likely to routinely assess financial coverages. Socioeconomic status was consistently ranked as one of the top three sources of financial toxicities by participants from LMIC (34%), HIC excluding the United States (38%), those who do not self-identify as racial/ethnic minority (36%), and physicians (40%). CONCLUSION This global survey of health care professionals and researchers in HIC and LMIC revealed varying approaches to assessing financial coverage and social needs. Socioeconomic status emerged as a consistent concern across countries, affecting financial toxicities. The study highlights the need for tailored approaches and improved resource visibility while emphasizing clinicians' pivotal role in addressing financial aspects of cancer care.
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Affiliation(s)
- Alexandre Chan
- School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, CA
| | - Yu Ke
- National Cancer Centre Singapore, Singapore
| | - Mary Tanay
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Mary Dagsi
- School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, Irvine, CA
| | | | - Niharika Dixit
- University of California, San Francisco/Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Lawson Eng
- Division of Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Canada
| | - Ana Cardeña Gutiérrez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Changchuan Jiang
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ana I Velázquez
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics. Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Jimenez-Labaig P, Aymerich C, Braña I, Rullan A, Cacicedo J, González-Torres MÁ, Harrington KJ, Catalan A. A comprehensive examination of mental health in patients with head and neck cancer: systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae031. [PMID: 38702757 PMCID: PMC11149920 DOI: 10.1093/jncics/pkae031] [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: 01/16/2024] [Revised: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer present particularly considerable levels of emotional distress. However, the actual rates of clinically relevant mental health symptoms and disorders among this population remain unknown. METHODS A Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology-compliant systematic review and quantitative random-effects meta-analysis was performed to determine suicide incidence and the prevalence of depression, anxiety, distress, posttraumatic stress, and insomnia in this population. MEDLINE, Web of Science, Cochrane Central Register, KCI Korean Journal database, SciELO, Russian Science Citation Index, and Ovid-PsycINFO databases were searched from database inception to August 1, 2023 (PROSPERO: CRD42023441432). Subgroup analyses and meta-regressions were performed to investigate the effect of clinical, therapeutical, and methodological factors. RESULTS A total of 208 studies (n = 654 413; median age = 60.7 years; 25.5% women) were identified. Among the patients, 19.5% reported depressive symptoms (95% confidence interval [CI] = 17% to 21%), 17.8% anxiety symptoms (95% CI = 14% to 21%), 34.3% distress (95% CI = 29% to 39%), 17.7% posttraumatic symptoms (95% CI = 6% to 41%), and 43.8% insomnia symptoms (95% CI = 35% to 52%). Diagnostic criteria assessments revealed lower prevalence of disorders: 10.3% depression (95% CI = 7% to 13%), 5.6% anxiety (95% CI = 2% to 10%), 9.6% insomnia (95% CI = 1% to 40%), and 1% posttraumatic stress (95% CI = 0% to 84.5%). Suicide pooled incidence was 161.16 per 100 000 individuals per year (95% CI = 82 to 239). Meta-regressions found a statistically significant higher prevalence of anxiety in patients undergoing primary chemoradiation compared with surgery and increased distress in smokers and advanced tumor staging. European samples exhibited lower prevalence of distress. CONCLUSIONS Patients with head and neck cancer presented notable prevalence of mental health concerns in all domains. Suicide remains a highly relevant concern. The prevalence of criteria-meeting disorders is significantly lower than clinically relevant symptoms. Investigating the effectiveness of targeted assessments for disorders in highly symptomatic patients is essential.
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Affiliation(s)
- Pablo Jimenez-Labaig
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Claudia Aymerich
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Irene Braña
- Lung and Head & Neck Tumors Unit. Medical Oncology Department, Vall d‘Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Antonio Rullan
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Jon Cacicedo
- Radiotherapy Department, Cruces University Hospital, Barakaldo, Spain
- Biobizkaia Health Research Institute, OSI Ezkerraldea Enkarterri Cruces, Barakaldo, Spain
- Faculty of Medicine, University of the Basque Country, Leioa, Spain
| | - Miguel Ángel González-Torres
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Kevin J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
- Department of Psychiatry, University of Oxford, Oxford, UK
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Gunn AH, Warraich HJ, Mentz RJ. Costs of care and financial hardship among patients with heart failure. Am Heart J 2024; 269:94-107. [PMID: 38065330 DOI: 10.1016/j.ahj.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 01/09/2024]
Abstract
With the implementation of new therapies, more patients are living with heart failure (HF) as a chronic condition. Alongside these advances, out-of-pocket (OOP) medical costs have increased, and patients experience significant financial burden. Despite increasing interest in understanding and mitigating financial burdens, there is a relative paucity of data specific to HF. Here, we explore financial hardship in HF from the patient perspective, including estimated OOP costs for guideline-directed medical therapy for HF with reduced ejection fraction, hospitalizations, and total direct medical costs, as well as the consequences of high OOP costs. Studies estimate that high OOP costs are common in HF, and a large proportion are related to prescription drugs. Subsequently, the effects on patients can lead to worsening adherence, delayed care, and poor outcomes, leading to a financial toxicity spiral. Further, we summarize patients' cost preferences and outline future research that is needed to develop evidence-based solutions to reduce costs in HF.
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Affiliation(s)
- Alexander H Gunn
- Department of Medicine, Duke University School of Medicine, Durham, NC.
| | - Haider J Warraich
- Department of Medicine, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Cayrol J, Wakefield CE, Ilbawi A, Donoghoe M, Hoffman R, Echodu M, Schilstra C, Ortiz R, Wiener L. The lived experience of people affected by cancer: A global cross-sectional survey protocol. PLoS One 2024; 19:e0294492. [PMID: 38394101 PMCID: PMC10889872 DOI: 10.1371/journal.pone.0294492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 02/25/2024] Open
Abstract
A diagnosis of cancer impacts the person's physical and mental health and the psychosocial and financial health of their caregivers. While data on the experience of living with cancer is available, there is a dearth of data from persons in low- and middle-income countries (LMICs). The perspectives of other impacted individuals also remain understudied (e.g., bereaved family members), as well as the impact on survivors and their families over time. The objective of this study is to describe the psychosocial and financial impact of cancer on people diagnosed with cancer as a child, adolescent or adult, their families/caregivers, and the family members of those who have died from cancer, in high-income countries (HICs) and LMICs. This study is an observational, descriptive, quantitative study. Data will be collected anonymously via a digital online cross-sectional survey distributed globally by the World Health Organization (WHO) via the LimeSurvey software. Participants will include (a) adults aged 18+ who have been diagnosed with cancer at any age, who are currently undergoing cancer treatment or who have completed cancer treatment; (b) adult family members of individuals of any age with a cancer diagnosis, who are currently undergoing cancer treatment or who have completed cancer treatment; and (c) bereaved family members. Participants will be anonymously recruited via convenience and snowball sampling through networks of organisations related to cancer. Survey results will be analysed quantitatively per respondent group, per time from diagnosis, per disease and country. Results will be disseminated in peer-reviewed journals and at scientific conferences; a summary of results will be available on the WHO website. This study will suggest public health interventions and policy responses to support people affected by cancer and may also lead to subsequent research focusing on the needs of people affected by cancer.
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Affiliation(s)
- Julie Cayrol
- The Royal Children’s Hospital and Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - André Ilbawi
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Mark Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, NSW Sydney, Australia
| | - Ruth Hoffman
- American Childhood Cancer Organization, Beltsville, Maryland, United States of America
| | | | - Clarissa Schilstra
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Roberta Ortiz
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, Maryland, United States of America
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Romo Valenzuela A, Chervu NL, Roca Y, Sanaiha Y, Mallick S, Benharash P. Socioeconomic disparities in risk of financial toxicity following elective cardiac operations in the United States. PLoS One 2024; 19:e0292210. [PMID: 38295038 PMCID: PMC10830059 DOI: 10.1371/journal.pone.0292210] [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: 06/09/2023] [Accepted: 09/13/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND While insurance reimbursements allay a portion of costs associated with cardiac operations, uncovered and additional fees are absorbed by patients. An examination of financial toxicity (FT), defined as the burden of patient medical expenses on quality of life, is warranted. Therefore, the present study used a nationally representative database to demonstrate the association between insurance status and risk of financial toxicity (FT) among patients undergoing major cardiac operations. METHODS Adults admitted for elective coronary artery bypass grafting (CABG) and isolated or concomitant valve operations were assessed using the 2016-2019 National Inpatient Sample. FT risk was defined as out-of-pocket expenditure >40% of post-subsistence income. Regression models were developed to determine factors associated with FT risk in insured and uninsured populations. To demonstrate the association between insurance status and risk of FT among patients undergoing major cardiac operations. RESULTS Of an estimated 567,865 patients, 15.6% were at risk of FT. A greater proportion of uninsured patients were at risk of FT (81.3 vs. 14.8%, p<0.001), compared to insured. After adjustment, FT risk among insured patients was not affected by non-income factors. However, Hispanic race (Adjusted Odds Ratio [AOR] 1.60), length of stay (AOR 1.17/day), and combined CABG-valve operations (AOR 2.31, all p<0.05) were associated with increased risk of FT in the uninsured. CONCLUSION Uninsured patients demonstrated higher FT risk after undergoing major cardiac operation. Hispanic race, longer lengths of stay, and combined CABG-valve operations were independently associated with increased risk of FT amongst the uninsured. Conversely, non-income factors did not impact FT risk in the insured cohort. Culturally-informed reimbursement strategies are necessary to reduce disparities in already financially disadvantaged populations.
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Affiliation(s)
- Alberto Romo Valenzuela
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Nikhil L. Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Yvonne Roca
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, United States of America
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Tran PB, Ali A, Ayesha R, Boehnke JR, Ddungu C, Lall D, Pinkney-Atkinson VJ, van Olmen J. An interpretative phenomenological analysis of the lived experience of people with multimorbidity in low- and middle-income countries. BMJ Glob Health 2024; 9:e013606. [PMID: 38262681 PMCID: PMC10823928 DOI: 10.1136/bmjgh-2023-013606] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/31/2023] [Indexed: 01/25/2024] Open
Abstract
People living with multimorbidity (PLWMM) have multiple needs and require long-term personalised care, which necessitates an integrated people-centred approach to healthcare. However, people-centred care may risk being a buzzword in global health and cannot be achieved unless we consider and prioritise the lived experience of the people themselves. This study captures the lived experiences of PLWMM in low- and middle-income countries (LMICs) by exploring their perspectives, experiences, and aspirations.We analysed 50 semi-structured interview responses from 10 LMICs across three regions-South Asia, Latin America, and Western Africa-using an interpretative phenomenological analysis approach.The bodily, social, and system experiences of illness by respondents were multidirectional and interactive, and largely captured the complexity of living with multimorbidity. Despite expensive treatments, many experienced little improvements in their conditions and felt that healthcare was not tailored to their needs. Disease management involved multiple and fragmented healthcare providers with lack of guidance, resulting in repetitive procedures, loss of time, confusion, and frustration. Financial burden was exacerbated by lost productivity and extreme finance coping strategies, creating a vicious cycle. Against the backdrop of uncertainty and disruption due to illness, many demonstrated an ability to cope with their conditions and navigate the healthcare system. Respondents' priorities were reflective of their desire to return to a pre-illness way of life-resuming work, caring for family, and maintaining a sense of independence and normalcy despite illness. Respondents had a wide range of needs that required financial, health education, integrated care, and mental health support.In discussion with respondents on outcomes, it appeared that many have complementary views about what is important and relevant, which may differ from the outcomes established by clinicians and researchers. This knowledge needs to complement and be incorporated into existing research and treatment models to ensure healthcare remains focused on the human and our evolving needs.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
| | - Ayaz Ali
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Rubab Ayesha
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, UK
- Department of Health Sciences, University of York, York, UK
| | - Charles Ddungu
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Dorothy Lall
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Wilrijk, Belgium
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12
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Jacobs MM, Evans E, Ellis C. Financial Well-Being Among US Adults with Vascular Conditions: Differential Impacts Among Blacks and Hispanics. Ethn Dis 2024; 34:41-48. [PMID: 38854787 PMCID: PMC11156161 DOI: 10.18865/ed.34.1.41] [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] [Indexed: 06/11/2024] Open
Abstract
Background The ability to meet current and ongoing financial obligations, known as financial well-being (FWB), is not only associated with the likelihood of adverse health events but is also affected by unexpected health care expenditures. However, the relationship between FWB and common health outcomes is not well understood. Using data available in the Financial Well-Being Scale from the Consumer Financial Protection Bureau, we evaluated the impact of four vascular conditions-cardiovascular disease (CVD), stroke, high blood pressure (BP), and high cholesterol-on FWB and how these impacts varied between racial and ethnic groups. Methods Using the Understanding America Survey-a nationally representative, longitudinal panel-we identified adults with self-reported diagnoses between 2014 and 2020 of high cholesterol, high BP, stroke, and CVD. We used stratified, longitudinal mixed regression models to assess the association between these diagnoses and FWB. Each condition was modeled separately and included sex, age, marital status, household size, income, education, race/ethnicity, insurance, body mass index, and an indicator of the condition. Racial and ethnic differentials were captured using group-condition interactions. Results On average, Whites had the highest FWB Scale score (69.0, SD=21.8), followed by other races (66.7, SD=21.0), Hispanics (59.3, SD=21.6), and Blacks (56.2, SD=21.4). In general, FWB of individuals with vascular conditions was lower than that of those without, but the impact varied between racial and ethnic groups. Compared with Whites (the reference group), Blacks with CVD (-7.4, SD=1.0), stroke (-8.1, SD=1.5), high cholesterol (-5.7, SD=0.7), and high BP (6.1, SD=0.7) had lower FWB. Similarly, Hispanics with high BP (-3.0, SD=0.6) and CVD (-6.3, SD=1.3) had lower FWB. Income, education, insurance, and marital status were also correlated with FWB. Conclusions These results indicated differences in the financial ramifications of vascular conditions among racial and ethnic groups. Findings suggest the need for interventions targeting FWB of individuals with vascular conditions, particularly those from minority groups.
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Affiliation(s)
- Molly M. Jacobs
- Department of Health Services, Management and Policy, University of Florida, Gainesville, FL
| | - Elizabeth Evans
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
| | - Charles Ellis
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, FL
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13
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Montoya C, Spieler B, Welford SM, Kwon D, Pra AD, Lopes G, Mihaylov IB. Predicting response to immunotherapy in non-small cell lung cancer- from bench to bedside. Front Oncol 2023; 13:1225720. [PMID: 38033493 PMCID: PMC10686412 DOI: 10.3389/fonc.2023.1225720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background Immune checkpoint inhibitor (ICI) therapy is first-line treatment for many advanced non-small cell lung cancer (aNSCLC) patients. Predicting response could help guide selection of intensified or alternative anti-cancer regimens. We hypothesized that radiomics and laboratory variables predictive of ICI response in a murine model would also predict response in aNSCLC patients. Methods Fifteen mice with lung carcinoma tumors implanted in bilateral flanks received ICI. Pre-ICI laboratory and computed tomography (CT) data were evaluated for association with systemic ICI response. Baseline clinical and CT data for 117 aNSCLC patients treated with nivolumab were correlated with overall survival (OS). Models for predicting treatment response were created and subjected to internal cross-validation, with the human model further tested on 42 aNSCLC patients who received pembrolizumab. Results Models incorporating baseline NLR and identical radiomics (surface-to-mass ratio, average Gray, and 2D kurtosis) predicted ICI response in mice and OS in humans with AUCs of 0.91 and 0.75, respectively. The human model successfully sorted pembrolizumab patients by longer vs. shorter predicted OS (median 35 months vs. 6 months, p=0.026 by log-rank). Discussion This study advances precision oncology by non-invasively classifying aNSCLC patients according to ICI response using pre-treatment data only. Interestingly, identical radiomics features and NLR correlated with outcomes in the preclinical study and with ICI response in 2 independent patient cohorts, suggesting translatability of the findings. Future directions include using a radiogenomic approach to optimize modeling of ICI response.
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Affiliation(s)
- Chris Montoya
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
| | - Benjamin Spieler
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
| | - Scott M. Welford
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
| | - Deukwoo Kwon
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Health Science Center, Houston, TX, United States
| | - Alan Dal Pra
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
| | - Gilberto Lopes
- Department of Medical Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
| | - Ivaylo B. Mihaylov
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, Miami, FL, United States
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Doğramacı EJ, Rossi-Fedele G. Patient-related outcomes and Oral Health-Related Quality of Life in endodontics. Int Endod J 2023; 56 Suppl 2:169-187. [PMID: 36102371 DOI: 10.1111/iej.13830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
There is increased interest in outcome measures that complement the classic goal of endodontics, being the prevention and healing of apical periodontitis. Possible outcome measures can be subdivided into patient-centred outcomes (PCOs), encompassing data collected by nonpatients aiming to assess the effectiveness of an intervention and patient-reported outcomes (PROs), which are reported directly by the patient. PROs can be subsequently classed into PRO measures that ascertain patients' view of their symptoms, their functional status, and their health-related quality of life, and patient-reported experience measures that focus on aspects including the humanity of care, patient satisfaction, patient preference and adherence, personal costs, expectation fulfilment, and decision regrets. The present review aims to define various patient-related outcomes and discuss the literature available regarding PCOs and PROs in endodontics. This includes those proposed to assess the effectiveness of endodontic treatment for pulpitis and apical periodontitis for use in the development of European Society of Endodontology S3-level clinical practice guidelines that have been included by all working groups, except for the radiographic assessment of apical periodontitis. Based on limited evidence in the field, it can be summarized that after recall periods of various lengths, endodontic treatment is associated with a high likelihood of tooth survival and limited need for further intervention, including extraction and further restorative procedures. Oral Health-Related Quality of Life (OHRQoL) is likely to improve following the completion of treatment. Nonetheless, the literature assessing the association between OHRQoL and endodontics is hampered by the use of instruments that have not been previously validated. Amongst the remaining outcome measures discussed in the present review, it is worth highlighting that there is only one study assessing exacerbations in teeth with the presence of endodontic pathosis, which suggests a very low incidence of this adverse effect following endodontic treatment. Patients' expectation fulfilment, adherence, and satisfaction are closely inter-related and depend also on various nonclinical factors. Further studies assessing PCOs and PROs, in association with healing and prevention of apical periodontitis, are required to better understand endodontic treatment from the perspective of patients.
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Affiliation(s)
- Esma J Doğramacı
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Giampiero Rossi-Fedele
- Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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