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Berghuijs KMVT, Kaddas HK, Trujillo G, Rouhani G, Chevrier A, Ose J, Shibata D, Toriola AT, Figueiredo JC, Peoples AR, Li CI, Hardikar S, Siegel EM, Gigic B, Schneider M, Ulrich CM, Kirchhoff AC. Age-related differences in employment, insurance, and financial hardship among colorectal cancer patients: a report from the ColoCare Study. J Cancer Surviv 2024; 18:1075-1084. [PMID: 36949233 DOI: 10.1007/s11764-023-01362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Employment and financial hardships are common issues for working-age colorectal cancer patients. We surveyed colorectal cancer survivors to investigate employment, insurance, and financial outcomes by age at diagnosis. METHODS Cross-sectional survey of six ColoCare Study sites regarding employment, insurance, and financial hardship outcomes. Eligible participants were 1 to 5 years from colorectal cancer diagnosis. Diagnosis age (18-49, 50-64, 65+ years) with outcomes of interest were compared using chi-square and t-tests. Multivariable logistic and Poisson regressions were fit to examine association of demographic factors with any material/psychological hardship (yes/no) and the count of hardships. RESULTS N = 202 participants completed the survey (age: 18-49 (n = 42, 20.8%), 50-64 (n = 79, 39.1%), 65+ (n = 81, 40.1%)). Most diagnosed age < 65 worked at diagnosis (18-49: 83%; 50-64: 64%; 65+ : 14%, p < 0.001) and continued working after diagnosis (18-49: 76%; 50-64: 59%; 65+ : 13%; p < 0.001). Participants age 18-49 reported cancer-related difficulties with mental (81.3%) and physical (89%) tasks at work more than those working in the older age groups (45%-61%). In regression models, among those reporting any hardship, the rates of material and psychological hardships were higher among those age 18-64 (Incidence Rate Ratios (IRR) range 1.5-2.3 vs. age 65+) and for those with < college (IRR range 1.3-1.6 vs. college +). CONCLUSIONS Younger colorectal cancer patients are more likely to work after a cancer diagnosis and during cancer treatment, but report higher levels of financial hardship than older patients. IMPLICATIONS FOR CANCER SURVIVORS Younger colorectal cancer patients may encounter financial hardship, thus may feel a need to work during and after treatment.
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Affiliation(s)
| | - Heydon K Kaddas
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Gillian Trujillo
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gazelle Rouhani
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Amy Chevrier
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Jennifer Ose
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - David Shibata
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adetunji T Toriola
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jane C Figueiredo
- Cedars-Sinai Medical Center Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA
| | - Anita R Peoples
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Sheetal Hardikar
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Erin M Siegel
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia M Ulrich
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Beauchemin MP, Solomon S, Michaels CL, McHenry K, Turi E, Khurana R, Sanabria G. Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective. Cancer Med 2024; 13:e7197. [PMID: 38659403 PMCID: PMC11043682 DOI: 10.1002/cam4.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. METHODS We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. RESULTS We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. CONCLUSION Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.
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Affiliation(s)
- Melissa P. Beauchemin
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Samrawit Solomon
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Claudia L. Michaels
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kathryn McHenry
- School of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Eleanor Turi
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rhea Khurana
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Bybee SG, Waters AR, Smith K, Warner EL. Misalignment of social support in the social media posts of young adult cancer caregivers. Cancer Rep (Hoboken) 2024; 7:e1998. [PMID: 38389399 PMCID: PMC10884617 DOI: 10.1002/cnr2.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Compared with older cancer caregivers, young adult cancer caregivers (YACC) experience greater stress and depression during the first 6 months of caregiving. Social support can buffer the negative psychological effects associated with cancer caregiving. However, the misalignment of social support is associated with increased distress and worse emotional well-being. As YACC are more likely to utilize social media (SM) to seek social support compared with older cancer caregivers, they may be at greater risk of experiencing the misalignment of social support and related negative outcomes. OBJECTIVE The purpose of this study was to identify ways that SM posts containing support for YACC's were potentially misaligned with the social support desired by YACC. METHODS In this secondary analysis, cancer-related SM posts (N = 760) from 34 YACC's SM accounts were extracted for 6 months following the day of cancer diagnosis and imported into NVivo qualitative analysis software. Open coding of posts from four YACC identified a pattern of SM posts containing responses that may misalign with social support requests, and could be perceived as dismissive of YACC's emotions. Similar posts were grouped together, forming categories which were used to create a codebook and applied in coding all posts from the remaining 30 YACC. RESULTS Content analysis identified three categories of social support misalignment originating from YACC's SM posts: supplications (n = 251, 33%), prevailing (n = 7, 10.1%), and consolations (n = 16, 2.1%). Supplications involved prayer or trust in god, prevailing posts compared dealing with cancer to a fight and suggested that the person would overcome cancer, and consolations used quotes, song lyrics, and or general reassurances in SM posts. CONCLUSIONS Findings suggest that when YACC use SM during cancer experiences, they may interpret SM posts as social support or as misalignment of social support requests, which in turn can lead to either improved quality of life or additional distress (respectively). This study adds to the body of knowledge regarding how YACC use social media for social support and may inform future interventions designed to match YACC's desired support with support offered.
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Affiliation(s)
- Sara G. Bybee
- College of Nursing, University of UtahSalt Lake CityUtahUSA
| | - Austin R. Waters
- Huntsman Cancer Institute at the University of UtahSalt Lake CityUtahUSA
| | - Keely Smith
- The University of Arizona, College of NursingTucsonArizonaUSA
| | - Echo L. Warner
- College of Nursing, University of UtahSalt Lake CityUtahUSA
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [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: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Kirchhoff AC, van Thiel Berghuijs KM, Waters AR, Kaddas HK, Warner EL, Vaca Lopez PL, Perez GK, Ray N, Chevrier A, Allen K, Fair DB, Tsukamoto T, Lewis MA, Haaland B, Park ER. Health Insurance Literacy Improvements Among Recently Diagnosed Adolescents and Young Adults With Cancer: Results From a Pilot Randomized Controlled Trial. JCO Oncol Pract 2024; 20:93-101. [PMID: 38060990 PMCID: PMC10827289 DOI: 10.1200/op.23.00171] [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: 03/22/2023] [Revised: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Adolescents and young adults (AYAs; age 18-39 years) with cancer report needing support with health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and acceptability of a virtual health insurance navigation intervention (HIAYA CHAT) to improve health insurance literacy (HIL), awareness of Affordable Care Act (ACA) protections, financial toxicity, and stress. MATERIALS AND METHODS HIAYA CHAT is a four-session navigator delivered program; it includes psychoeducation on insurance, navigating one's plan, insurance-related laws, and managing costs. Participants were eligible if they could access an internet-capable device, were <1 year from diagnosis, and received treatment from University of Utah Healthcare or Intermountain Health systems. We assessed the feasibility, acceptability, and preliminary efficacy of HIAYA CHAT compared with usual navigation care, including HIL (nine items), insurance knowledge (13 items), ACA protections (eight items), COmprehensive Score for financial Toxicity (COST; 11 items), and Perceived Stress Scale (PSS; four items), using t tests and Cohen's d. RESULTS From November 2020 to December 2021, N = 86 AYAs enrolled (44.6% participation) and 89.3% completed the 5-month follow-up survey; 68.6% were female, 72.1% were White, 23.3% were Hispanic, 65.1% were age 26-39 years, and 87.2% were privately insured. Of intervention participants (n = 45), 67.4% completed all four sessions; among an exit interview subset (n = 10), all endorsed the program (100%). At follow-up, compared with usual navigation care, intervention participants had greater improvements in HIL, insurance and ACA protections knowledge, and PSS; effect sizes ranged from moderate to large (0.42-0.77). COST did not differ. CONCLUSION The results support the feasibility and acceptability of HIAYA CHAT with related improvements in HIL.
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Affiliation(s)
- Anne C. Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Austin R. Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Heydon K. Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Echo L. Warner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- University of Utah College of Nursing, Salt Lake City, UT
| | | | | | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amy Chevrier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karlie Allen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Douglas B. Fair
- Department of Pediatrics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | | | | | - Ben Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Thom B, Arora N, Benedict C, Aviki EM, Chino F, Friedman DN, Watson SE, Zeitler MS. Using Real-World Data to Explore the Impact of One-Time Financial Grants Among Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:912-917. [PMID: 37852000 PMCID: PMC10739788 DOI: 10.1089/jayao.2022.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Young adult (YA) cancer survivors experience worse financial outcomes than older survivors. This analysis used data from Expect Miracles Foundation to explore the impact of one-time financial grants on financial well-being and access to health care. Among 300 respondents, the average grant was $1526 (standard deviation = $587; range $300-$3000). Respondents reported improved ability to pay expenses (t = 4.45, p < 0.001), increased financial decision-making power (t = 2.79, p = 0.06), decreased medical debt impact (t = 2.1, p = 0.04), improved transportation access (t = 2.38, p = 0.02), and fewer challenges in accessing care (t = 3.0, p = 0.005) 6 months after receiving a financial grant. Financial assistance offers YAs an opportunity to meet medical and nonmedical expenses.
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Affiliation(s)
- Bridgette Thom
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Arora
- Texas A&M School of Medicine, College Station, Texas, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, California, USA
| | - Emeline M. Aviki
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fumiko Chino
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danielle N. Friedman
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Waters AR, Kaddas HK, van Thiel Berghuijs KM, Vaca Lopez PL, Warner EL, Ou JY, Ramsay JM, Palmer A, Ray N, Tsukamoto T, Fair DB, Lewis MA, Linder L, Gill D, Kirchhoff AC. COVID-19-Related Employment Disruptions and Increased Financial Burden Among Survivors of Adolescent and Young Adult Cancer. J Adolesc Young Adult Oncol 2023; 12:744-751. [PMID: 36951664 PMCID: PMC10623459 DOI: 10.1089/jayao.2022.0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background: Financial burden is a major concern for survivors of adolescent and young adult (AYA) cancers. We identified if employment disruptions during the COVID-19 pandemic affected AYA survivors' financial burden. Methods: AYAs who were enrolled in a cancer patient navigation program were e-mailed a survey in fall 2020. Survey items included sociodemographics, employment disruption, and two measures of financial burden: COmprehensive Score for Financial Toxicity (COST) and material and behavioral financial hardship items (for any reason, COVID-19 induced, cancer induced). Financial burden outcomes were dichotomized at the median (COST = 21; financial hardship = 3). The association of employment disruptions and sociodemographics with financial burden was assessed using multivariable logistic regression models. Results: Reduced hours/job loss was reported by 24.0% of 341 participants. Survivors with a high school education or less (odds ratio [OR]: 2.70; 95% confidence interval [CI]: 1.21-6.03) or who had decreased hours or job loss (OR: 3.97; 95% CI: 2.01-7.84) had greater odds for high financial toxicity. Reduced hours/job loss was the only factor associated with high material and behavioral financial hardship for both any reason (OR: 2.75; 95% CI: 1.41-5.33) and owing to COVID-19 (OR: 4.98; 95% CI: 2.28-10.92). Cancer treatment since March 2020 was associated with cancer-induced high material and behavioral financial hardship (OR: 3.31; 95% CI: 1.96-5.58). Conclusion: Employment disruptions owing to the COVID-19 pandemic, lower education levels, and cancer treatment were associated with high financial burden among AYA cancer survivors. Our findings suggest the need for multilevel interventions to identify and address financial burden among vulnerable cancer survivors.
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Affiliation(s)
- Austin R. Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Heydon K. Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Perla L. Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Echo L. Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Judy Y. Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Cancer Biostatistics Shared Resource, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Joemy M. Ramsay
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Alexandra Palmer
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Nicole Ray
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Douglas B. Fair
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | | | - Lauri Linder
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - David Gill
- Intermountain Health, Salt Lake City, Utah, USA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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Jackson Levin N, Tan CY, Stelmak D, Iannarino NT, Zhang A, Ellman E, Herrel LA, Walling EB, Moravek MB, Chugh R, Haymart MR, Zebrack B. Banking on Fertility Preservation: Financial Concern for Adolescent and Young Adult Cancer Patients Considering Oncofertility Services. J Adolesc Young Adult Oncol 2023; 12:710-717. [PMID: 36603107 PMCID: PMC10611956 DOI: 10.1089/jayao.2022.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: Financial concern is a major issue for adolescent and young adult (AYA) cancer patients. Furthermore, unaddressed oncofertility challenges (e.g., infertility) are linked to psychological distress and decreased overall quality of life. Little is known about how financial concern in terms of oncofertility (i.e., concern regarding affording fertility preservation [FP] services) impacts AYAs' decision making and experiences. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred risk of infertility were recruited through electronic health record query. Participants completed semi-structured interviews, which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to financial concern were identified. The Institutional Review Board at the University of Michigan approved this study (HUM#00157267). Results: Financial concern was a dominant theme across the qualitative data. Emergent themes included (1) varied access to health insurance, (2) presence of parental/guardian support, (3) reliance upon financial aid, (4) negotiating infertility risk, and (5) lack of preparation for long-term costs. AYAs relied heavily upon parents for out-of-pocket and insurance coverage support. Some participants sought financial aid when guided by providers. Several participants indicated that no financial support existed for their circumstance. Conclusions: Financial consequences in terms of oncofertility are a major issue affecting AYA cancer patients. The incidence and gravity of financial concern surrounding affording oncofertility services merits attention in future research (measuring financial resources of AYAs' parental/support networks), clinical practice (strategically addressing short- and long-term costs; tailored psychosocial support), and health care policy (promoting legislation to mandate pre- and post-treatment FP coverage).
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Affiliation(s)
- Nina Jackson Levin
- Department of Anthropology, School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Chiu Yi Tan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Daria Stelmak
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas T. Iannarino
- Department of Language, Culture, and the Arts at University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Ellman
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey A. Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily B. Walling
- Department of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Molly B. Moravek
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rashmi Chugh
- Department of Internal Medicine, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R. Haymart
- Department of Metabolism, Endocrinology & Diabetes Clinic, University of Michigan, Ann Arbor, Michigan, USA
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Wu VS, Benedict C, Friedman DN, Watson SE, Anglade E, Zeitler MS, Chino F, Thom B. Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors? Support Care Cancer 2023; 31:434. [PMID: 37395811 DOI: 10.1007/s00520-023-07822-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15-39 years old) cancer survivors. METHODS Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients' levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses. RESULTS Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (β = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (β = - 1.40; p = 0.002). Key qualitative themes included survivors' frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help. CONCLUSION AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.
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Affiliation(s)
- Victoria S Wu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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10
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Benedict C, Thom B, Diefenbach M, Schapira L, Simon P, Ford JS. The Impact of Cancer-Related Financial Toxicity on Reproductive Concerns and Family-Building Decision-Making in Post-Treatment Survivorship. J Adolesc Young Adult Oncol 2023; 12:408-415. [PMID: 36169520 PMCID: PMC10282808 DOI: 10.1089/jayao.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) survivors are at-risk for cancer-related financial difficulties (i.e., financial toxicity [FT]). Family building after cancer often requires reproductive medicine or adoption with high costs; AYAs experience financial barriers to family building. This study evaluated the relationships among cancer FT, reproductive concerns, and decision-making processes about family building after cancer. Methods: AYA female (AYA-F) cancer survivors completed a cross-sectional survey including measures of FT, reproductive concerns, decisional conflict about family building, and decision-making self-efficacy. Differences across FT subgroups (i.e., no/mild, moderate, and severe FT) were tested. Linear regression evaluated the relationships between FT and reproductive concerns and decision-making processes. Results: Participants (N = 111) averaged 31.0 years (standard deviation [SD] = 5.49), 90% were nulliparous, and 84% were employed full/part-time. The overall FT levels were in the "moderate" range (M = 20.44, SD = 9.83); 48% worried quite a bit or very much about financial problems because of cancer. AYA-Fs reporting severe FT (24% of sample) experienced higher levels of reproductive concerns compared with those reporting no/mild and moderate FT. Those reporting moderate FT (46% of sample) reported greater decisional conflict about family-building options, compared with the no/mild FT subgroup. Both moderate and severe FT subgroups reported lower decision-making self-efficacy compared with the no/mild FT subgroup. In separate models controlling for covariates, greater FT related to higher levels of reproductive concerns (B = -0.39, p < 0.001), greater decisional conflict about family building (B = -0.56, p = 0.02), and lower decision-making self-efficacy (B = 0.60, p = 0.01). Conclusions: Given the high costs of reproductive medicine and adoption, fertility counseling pre- and post-treatment must address survivors' financial concerns and barriers.
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Affiliation(s)
- Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, USA
- Stanford Cancer Institute, Stanford, California, USA
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | | | - Pam Simon
- Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
| | - Jennifer S. Ford
- Hunter College and The Graduate Center, City University of New York (CUNY), New York, New York, USA
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11
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Beauchemin MP, Roth ME, Parsons SK. Reducing Adolescent and Young Adult Cancer Outcome Disparities Through Optimized Care Delivery: A Blueprint from the Children's Oncology Group. J Adolesc Young Adult Oncol 2023; 12:314-323. [PMID: 36716260 PMCID: PMC10282820 DOI: 10.1089/jayao.2022.0136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Achieving equitable, high-quality cancer care delivery across socioeconomically and biologically diverse populations requires multilevel interventions, including those at the patient, provider, institution, and policy levels that influence cost, quality, and access to care. For adolescent and young adults (AYAs), who experience suboptimal health outcomes compared with younger and older people with cancer, cancer care delivery is influenced by additional contextual factors unique to the patients' developmental stage, psychosocial and economic status, and cancer subtype. In this review, we highlight the most pressing research needs in AYA cancer care delivery and opportunities to improve outcomes for this population.
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Affiliation(s)
- Melissa P. Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan K. Parsons
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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12
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Ghazal LV, Watson SE, Gentry B, Santacroce SJ. "Both a life saver and totally shameful": young adult cancer survivors' perceptions of medical crowdfunding. J Cancer Surviv 2023; 17:332-341. [PMID: 35169983 PMCID: PMC9378759 DOI: 10.1007/s11764-022-01188-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Young adults (YAs) diagnosed with cancer face high financial burden at a time in their lives when they are financially vulnerable. Some turn to medical crowdfunding, that is, using social media and other means to raise funds or resources to offset medical and usual life expenses. Major research gaps exist regarding the experiences of those who pursued crowdfunding. Thus, the study purpose was to describe the perceptions of, and experiences with, medical crowdfunding among a sample of YA cancer survivors. METHODS In February 2021, we distributed an online survey to YAs with a history of a cancer diagnosis, who had received grants from an organization that offers financial assistance. We calculated descriptive statistics on the crowdfunding sample and employed thematic analysis to analyze the open-ended questions. RESULTS In this sample (N = 113), 46 YA cancer survivors had engaged in medical crowdfunding and shared their perceptions and experiences. Our central theme, "The Crowdfunding Compromise" captures the trade-offs participants faced, which included subthemes of "crowdfunding as useful/helpful," "factors associated with crowdfunding success," and "questioning the why?". CONCLUSIONS Among YA cancer survivors, medical crowdfunding brings shame and stigma in addition to financial support. YA cancer survivors demonstrate resilience in their attempts to find individual solutions to financial problems created by unchecked health care costs, the US health insurance infrastructure, and lack of legislation. IMPLICATIONS FOR CANCER SURVIVORS This study fills an important gap in understanding individual-level crowdfunding experiences. Implications include system-level approaches to addressing cancer-related financial burden and potential worsening of existing disparities through medical crowdfunding.
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Affiliation(s)
- Lauren V Ghazal
- Center for Improving Patient and Population Health, School of Nursing, University of Michigan, Ann Arbor, MI, USA.
- Rogel Cancer Center, University of Michigan Ann, Arbor, MI, USA.
| | | | | | - Sheila J Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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13
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Di Giuseppe G, Pagalan L, Jetha A, Pechlivanoglou P, Pole JD. Financial toxicity among adolescent and young adult cancer survivors: A systematic review of educational attainment, employment, and income. Crit Rev Oncol Hematol 2023; 183:103914. [PMID: 36706969 DOI: 10.1016/j.critrevonc.2023.103914] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To identify, evaluate and summarize the evidence on educational attainment, employment status and income of AYAs surviving cancer. METHODS A search of six databases for articles published between 01/01/2010 and 03/31/2022 was performed. Articles with an AYA survivorship population, quantitative design and a cancer-free comparator group were included. Data extraction was conducted, and quality appraisal was completed using ROBINS-I. Results were summarized using a narrative synthesis. RESULTS A total of 2801 articles were identified, of which 12 were included. Among the limited evidence, educational attainment did not differ from cancer-free peers. Survivors were more likely to be unemployed, have lower incomes and require social security for income supplementation. Evidence suggested that females, diagnosis of brain cancer and the presence of late-effects were among the risk factors for severe outcomes. CONCLUSIONS Limited socioeconomic evidence exists for AYAs surviving cancer. Long-lasting financial toxicities occur and highlights a need for further investigation.
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Affiliation(s)
- Giancarlo Di Giuseppe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Lief Pagalan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arif Jetha
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Work & Health, Toronto, Ontario, Canada
| | | | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Health Sciences Research, University of Queensland, Brisbane, Australia
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14
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Keim-Malpass J, Callahan LB, Lindley LC, Templeman CA, Mooney-Doyle K. Perspectives on Access to Novel Therapeutics Through Clinical Trials Among Adolescents and Young Adults with Advanced Cancer: Implications for Patient-Centered Clinical Trials. J Adolesc Young Adult Oncol 2023; 12:53-58. [PMID: 35235445 DOI: 10.1089/jayao.2021.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescents and young adults (AYA) with advanced cancer have unequal access to and enrollment in clinical trials. Many AYA use online platforms to share their treatment experiences. The purpose of this analysis was to explore how AYA discuss clinical trials and their access to novel therapeutics through their blogs. Methods: We studied illness blogs from 22 AYA (ages 16-38 years old) with advanced cancer who specifically discussed experiences enrolling in a clinical trial. Nearly 500 excerpts were abstracted from their blogs, and we used qualitative descriptive methodology and thematic analysis to explore their longitudinal perspectives. Results: We describe three themes: (1) "Blinded", which represents the uncertainty in treatment pathway and underrepresentation of AYA in clinical trials, (2) "Totally healthy except for the damn cancer", which represents the numerous challenges associated with meeting eligibility criteria and lack of available clinical trials, and (3) "Go ahead and send me the bill!", which represents the precarious financial challenges associated with participating with clinical trials (both direct costs and indirect costs associated with travel, time away from work) as well as the costs of novel therapeutics. Conclusions: By studying AYA online narratives, we can outline several gaps in accessing clinical trials and generate future research priorities. AYA with advanced cancer are known to have aggressive trajectories, and there are opportunities to integrate patient-reported outcomes and supportive care frameworks embedded within clinical trial study design.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA.,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Linda B Callahan
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Lisa C Lindley
- Department of Nursing, University of Tennessee-Knoxville College of Nursing, Knoxville, Tennessee, USA
| | - Claire A Templeman
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Kim Mooney-Doyle
- Department of Nursing, University of Maryland School of Nursing, Baltimore, Maryland, USA
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15
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Abstract
PURPOSE OF REVIEW There is a growing population of adolescent and young adult (AYA, ages 15-39 years) cancer patients and survivors, and the field of AYA oncology is rapidly evolving. Despite an increased focus on survival and quality of life for AYAs, gaps in knowledge remain. The current review focuses on what is known across several domains unique to AYA cancer care as well as areas of improvement and future directions in research and intervention. RECENT FINDINGS Due to the developmental stages included in the AYA age range, a cancer diagnosis and treatment can affect relationships, education and employment, finances, and long-term health differently than diagnoses in younger or older populations. Recent studies that have focused on these unique aspects of AYA cancer care, including health-related quality of life (HRQoL), fertility, financial toxicity, barriers to clinical trial enrollment, genetic predisposition, and survivorship care are included in the current review. SUMMARY Although studies have described many of the challenges faced by AYAs across the cancer continuum from diagnosis to survivorship, more work is needed, particularly in systematically measuring HRQoL, eliminating barriers to clinical trial enrollment, addressing financial toxicity, and increasing access to fertility preservation and high-quality survivorship care.
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16
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Skinner A, Buhlmann M, Fridley BL, Reed DR, Vicedo D, Mason NT. Pilot Study in Investigating Material Financial Toxicity Markers by Age in Cancer Patients. J Adolesc Young Adult Oncol 2023; 12:34-42. [PMID: 36094443 PMCID: PMC9968625 DOI: 10.1089/jayao.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Studies have shown that financial toxicity can reduce survival, decrease quality of life, and reduce compliance with treatments. The aim of this retrospective study was to investigate material markers of financial toxicity, including insurance coverage, financial assistance, and balances due among adolescent and young adult (AYA) (18-39), adult (40-64), and senior adult (>65) patients with a sarcoma diagnosis after the Affordable Care Act became effective. Methods: This study performed a retrospective analysis of possible indicators within the material domain of financial toxicity in sarcoma patients, a common diagnosis in young adult patients. Indicators of financial toxicity included: insurance status and number of insurances, charity care, accessing financing options, or having an unpaid balance referred to a collection's agency. Results: The cumulative charges per patient were similar between AYA, adult, and senior adult populations at an average of $194,329 (standard deviation [SD] = $321,425), $236,724 (SD = $368,345), and $188,030 (SD = $271,191), respectively. AYA patients were more likely than adult and senior adult patients to have Medicaid coverage (income-based government insurance) (22.1% vs. 8.4% vs. 1.2%), receive charity care (5.3% vs. 2.6% vs. 1.2%), or have a balance referred to a collection's agency (9.2% vs. 5.8% vs. 1.2%). Conclusions: This study suggests that younger cancer patients are more likely to suffer material financial strain and additional financial resources may need to be made available to ensure they can receive care without an increase of financial toxicity markers and undue financial stress.
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Affiliation(s)
- Amber Skinner
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Melanie Buhlmann
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Brooke L. Fridley
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Damon R. Reed
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Department of Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Cancer Biology and Evolution, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Deborah Vicedo
- Patient Financial Services, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Neil T. Mason
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Precision Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.,Address correspondence to: Neil Mason, MBA, Precision Medicine Program, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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17
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Greater financial toxicity correlates with increased psychological distress and lower quality of life among Turkish cancer patients. Support Care Cancer 2023; 31:137. [PMID: 36700998 DOI: 10.1007/s00520-023-07586-w] [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: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aims to investigate the factors that influence financial toxicity and its effects on both quality of life and psychological distress in Turkish cancer patients. METHODS Data from 400 cancer patients receiving chemotherapy at a public university in Turkey was analyzed. The Comprehensive Score for Financial Toxicity (COST), Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and Functional Assessment of Cancer Therapy-General (FACT-G) were used to measure financial toxicity, psychological distress, and health quality of life, respectively. RESULTS Patients' median COST score was 22 (SD = 10.1; range: 1-44) and was consistent with mild financial toxicity. Financial toxicity was associated with lower education level (p < 0.001), lower monthly income (p < 0.001), being a woman (p = 0.021), living in another city (p = 0.012), and previous cancer surgery (p = 0.02). A negative and statistically significant correlation was found between financial toxicity and quality of life (r = - 0.139; p = 0.005) and psychological distress (r = - 0.398; p < 0.001). CONCLUSION This investigation demonstrated that financial toxicity was a significant determinant of quality of life and psychological distress.
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18
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Wesevich A, Jiao MG, Santanam TS, Chung RJ, Uchitel J, Zhang Q, Brindis CD, Ford CA, Counts NZ, Wong CA. Adolescent and Young Adult Perspectives on Quality and Value in Health Care. Acad Pediatr 2022; 23:782-789. [PMID: 36288750 DOI: 10.1016/j.acap.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses. RESULTS Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality. CONCLUSIONS When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.
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Affiliation(s)
- Austin Wesevich
- Section of Hematology/Oncology, Department of Medicine, University of Chicago (A Wesevich), Chicago, Ill; Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Taruni S Santanam
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Richard J Chung
- Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Julie Uchitel
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Qintian Zhang
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Claire D Brindis
- Adolescent and Young Adult National Health Information Center and Philip R. Lee Institute for Health Policy Studies, University of California (CD Brindis), San Francisco, Calif
| | - Carol A Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia (CA Ford), Philadelphia, Pa
| | | | - Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC.
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19
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Warsame R, Cook J, Fruth B, Hubbard J, Croghan K, Price KA, Jatoi A, Kumar S, Thompson C, Buckner J, Dispenzieri A, Sloan J, Dueck AC. A prospective, randomized trial of patient-reported outcome measures to drive management decisions in hematology and oncology. Contemp Clin Trials Commun 2022; 29:100964. [PMID: 35928285 PMCID: PMC9344350 DOI: 10.1016/j.conctc.2022.100964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Clinicians have limited time during patient encounters which can result in patients' concerns not being addressed. This study's objective was to test whether an electronic patient-reported outcome quality of life tool (PROQOL) in which patients identify their primary concern during clinic visits improves cancer patient quality of life (QOL). Patients and methods This single center non-blinded prospective clinical trial randomized patients (2:1) to PROQOL versus usual care (UC). Two patient cohorts were enrolled: those with hematologic malignancies (multiple myeloma [MM] or light chain amyloidosis [AL]) and solid tumors (head and neck [H/N] or gynecologic [GYN] malignancies). Primary endpoint was patient-reported QOL at 12 months measured by a single-item Linear Analog Self-Assessment. Value to patients and impact on clinician workflow was measured using a "was it worth it" survey. The study was powered to detect a 0.5 standard deviation difference between groups. Results Overall 383 patients were enrolled, 171 with MM, 62 AL, 113 GYN, and 37 H/N between July 2016 and April 2018, with 12-month follow-up. There were 171 (44.6%) male patients and median age was 62 years (range 31-87). The most often selected concern was physical health (30.9%), and second was cancer diagnosis and treatment (29.1%). Mean QOL was 7.12 for PROQOL and 6.98 for UC (0-10 scale) at 12 months, with no between-group difference overall (p = 0.56) or within hematologic or solid tumor cohorts, respectively. Among patients, 74% thought the PROQOL tool was worthwhile, 86% would choose PROQOL again, and 81% would recommend it to others. Among clinicians, 95% responded that PROQOL was worthwhile and did not think that PROQOL negatively impacted their workflow. Conclusions Although we did not demonstrate a QOL difference between PROQOL and UC groups; the PROQOL tool held considerable value in identifying patients' main concerns over time and was worthwhile for patients and clinicians.
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Affiliation(s)
- Rahma Warsame
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Patricia and Robert Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joselle Cook
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Briant Fruth
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Joleen Hubbard
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Shaji Kumar
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Jan Buckner
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeff Sloan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Amylou C. Dueck
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA
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20
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Tan CJ, Ng KYJ, Goh WL, Poon E, Chan RJ, Chew L, Farid M, Chan A. Work Outcomes and Medical Costs Among Singaporean Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2022. [PMID: 36169562 DOI: 10.1089/jayao.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To quantify and evaluate trends of work outcomes and medical costs among Singaporean adolescent and young adult (AYA) cancer survivors. Methods: This cross-sectional study was conducted at the National Cancer Centre Singapore between July 2016 and October 2018. Cancer patients who were diagnosed between the age of 15 and 39 years and had completed treatment were eligible. Siblings of cancer patients were recruited as controls. Work outcomes were collected using an investigator-designed questionnaire, while cost data were extracted from the hospital database. Descriptive statistics were used to quantify work and cost outcomes. Mixed-effects logistic regression was used to compare employment rates between survivors and controls. Generalized linear models were used to characterize trends between medical costs and symptom burden. Results: A total of 29 cancer survivors and 23 sibling controls were analyzed. Approximately 80% of survivors and controls were employed at the time of survey; however, more than half of the employed survivors reported impaired work outcomes due to effects from cancer and cancer treatment, including work reallocation, absenteeism, and decreased work ability. Median productivity loss due to absenteeism in the past 3 months was estimated to be U.S. dollar (USD) 110. Total medical cost incurred within the first year after treatment completion remained high at a median of USD6592, with out-of-pocket expenditure between 17.2% and 100.0%. Conclusion: Despite their young age and having completed cancer treatment, Singaporean AYA cancer survivors may continue to experience poor work outcomes even after resuming work. High medical costs may also persist.
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Affiliation(s)
- Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore, Singapore
| | | | - Wei Lin Goh
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lita Chew
- Department of Pharmacy, National University of Singapore, Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Alexandre Chan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore, Singapore.,Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, California, USA
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21
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Smith GL, Banegas MP, Acquati C, Chang S, Chino F, Conti RM, Greenup RA, Kroll JL, Liang MI, Pisu M, Primm KM, Roth ME, Shankaran V, Yabroff KR. Navigating financial toxicity in patients with cancer: A multidisciplinary management approach. CA Cancer J Clin 2022; 72:437-453. [PMID: 35584404 DOI: 10.3322/caac.21730] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022] Open
Abstract
Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.
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Affiliation(s)
- Grace L Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shine Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University School of Business, Boston, Massachusetts
| | - Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Juliet L Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Department of Internal Medicine, The University of Alabama, Birmingham, Alabama
| | - Kristin M Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Veena Shankaran
- Seattle Cancer Care Alliance/University of Washington Medicine and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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22
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Rajwa P, Hopen P, Wojnarowicz J, Kaletka J, Paszkiewicz I, Lach-Wojnarowicz O, Mostafaei H, Krajewski W, D’Andrea D, Małkiewicz B, Paradysz A, Ploussard G, Moschini M, Breyer BN, Pradere B, Shariat SF, Leapman MS. Online Crowdfunding for Urologic Cancer Care. Cancers (Basel) 2022; 14:cancers14174104. [PMID: 36077641 PMCID: PMC9454944 DOI: 10.3390/cancers14174104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/21/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: we aimed to characterize the financial needs expressed through online crowdfunding for urologic cancers. Methods: the data used in this study came from the online crowdfunding platform GoFundMe.com. Using an automated software method, we extracted data for campaigns related to urologic cancers. Subsequently, four independent investigators reviewed all extracted data on prostate, bladder, kidney and testicular cancer. We analyzed campaigns’ basic characteristics, goals, fundraising, type of treatment and factors associated with successful campaigns. Results: in total, we identified 2126 individual campaigns, which were related to direct treatment costs (34%), living expenses (17%) or both (48%). Median fundraising amounts were greatest for testicular cancer. Campaigns for both complementary and alternative medicine (CAM) (median $11,000) or CAM alone (median $8527) achieved higher fundraising totals compared with those for conventional treatments alone (median $5362) (p < 0.01). The number of social media shares was independently associated with campaign success and highest quartile of fundraising. Conclusions: using an automated web-based approach, we identified and characterized online crowdfunding for urologic cancer care. These findings indicated a diverse range of patient needs related to urologic care and factors related to campaigns’ success.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Philip Hopen
- Data Science & Clinical Analytics, New Century Health, Boston, MA 02481, USA
| | - Jakub Wojnarowicz
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Julia Kaletka
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Iga Paszkiewicz
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | | | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - David D’Andrea
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, 41-800 Zabrze, Poland
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France
| | - Marco Moschini
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
- Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY 10021, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 15006 Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, CT 06520, USA
- Correspondence: ; Tel.: +1-203-785-3128
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23
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Beauchemin MP, Raghunathan RR, Accordino MK, Cogan JC, Kahn JM, Wright JD, Hershman DL. New persistent opioid use among adolescents and young adults with sarcoma. Cancer 2022; 128:2777-2785. [PMID: 35599575 PMCID: PMC10664461 DOI: 10.1002/cncr.34238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adolescents and young adults (AYA) with sarcoma experience both acute and chronic pain related to their disease and treatment. Studies in older adults have reported a high risk of persistent opioid use after cancer therapy among previously opioid-naive patients; however, few studies have evaluated posttreatment opioid use among AYAs. This article describes patterns of new persistent opioid use among AYAs in the year after treatment for sarcoma. METHODS Opioid-naive patients who were 10 to 26 years old and diagnosed with sarcoma (2008-2016) were identified with the IBM Marketscan Database. Included subjects had an International Classification of Diseases code for sarcoma (ninth or tenth revision), received anticancer therapy (chemotherapy, surgery, and/or radiation) within 30 days of the first diagnosis code, and had continuous insurance coverage (commercial or Medicaid) for more than 12 months both before the diagnosis and after the last therapy. The primary outcome was new persistent opioid use, which was defined as at least 2 opioid prescriptions in the 12 months following treatment completion. Covariates included age, sex, insurance, tumor type, surgical procedure, mental health (MH) or substance use diagnoses before or during therapy, and concomitant lorazepam use. RESULTS In total, 938 patients met the inclusion criteria; 521 (56%) were male, and 578 (62%) were younger than 18 years. In total, 727 (78%) had commercial insurance, and 273 (29%) had an MH diagnosis either before or during the treatment period. Of the total group, 464 (49%) used opioids during treatment only. Of those who used opioids during treatment, 135 (23%) received at least 2 prescriptions in the year after therapy. In a multivariable analysis, Medicaid versus commercial insurance (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.15-2.64) and non-soft tissue sarcoma (OR for Ewing sarcoma, 3.23; 95% CI, 1.81-5.78; OR for osteosarcoma, 2.05; 95% CI, 1.36-3.09) conferred a higher likelihood of new persistent use. CONCLUSIONS In this cohort of AYAs treated for sarcoma, 64% of the patients received opioid prescriptions during treatment, and 23% of these patients became new persistent users. Because of the risks associated with persistent opioid use, studies of novel pain management strategies along with age-appropriate education and anticipatory guidance are urgently needed. LAY SUMMARY Using an insurance claims database, we conducted a study to determine the rate of new persistent opioid use among adolescents and young adults treated for sarcoma. We found that 64% of adolescents and young adults treated for sarcoma received opioid prescriptions during treatment, and 23% of these patients met the criteria for new persistent opioid use. These findings support the need for age-appropriate education and novel pain management strategies in this vulnerable population.
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Affiliation(s)
- Melissa P. Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, New York
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Rohit R. Raghunathan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Melissa K. Accordino
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jacob C. Cogan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Justine M. Kahn
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Jason D. Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Financial toxicity in female patients with breast cancer: a national cross-sectional study in China. Support Care Cancer 2022; 30:8231-8240. [PMID: 35819521 PMCID: PMC9512750 DOI: 10.1007/s00520-022-07264-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/27/2022] [Indexed: 10/29/2022]
Abstract
PURPOSE To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients' coping strategies. METHODS The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0-IV breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used. RESULTS The median age of patients was 48 years (range: 26-84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (interquartile range: 15-26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage IV cancer, and a history of targeted therapy were associated with higher financial toxicity (all P < 0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, and failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies. CONCLUSIONS Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help oncologists and policy-makers identify at-risk patients and develop targeted interventions.
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Waters AR, Bybee S, Warner EL, Kaddas HK, Kent EE, Kirchhoff AC. Financial Burden and Mental Health Among LGBTQIA+ Adolescent and Young Adult Cancer Survivors During the COVID-19 Pandemic. Front Oncol 2022; 12:832635. [PMID: 35785163 PMCID: PMC9245943 DOI: 10.3389/fonc.2022.832635] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background In the United States, the cost of cancer treatment can lead to severe financial burden for cancer survivors. The economic impacts of the COVID-19 pandemic compound cancer survivors' financial challenges. Financial burden may be particularly challenging for lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (LGBTQIA+) survivors. LGBTQIA+ survivors who are adolescent and young adults (AYA) may face elevated financial burden due to multiple, intersecting identities. Methods An explanatory sequential mixed methods design was applied, beginning with a survey of AYA cancer survivors in the Mountain West region of the United States. Survey measures included demographics, COVID-19 impacts, the COmprehensive Score for financial Toxicity (COST), Perceived Stress Scale-4 (PSS-4), and PROMIS anxiety and depression scales. Two-way t-tests were used to analyze differences in outcomes between LGBTQIA+ and non-LGBTQIA+ AYAs. All LGBTQIA+ survey participants were invited to complete an interview, and those who agreed participated in descriptive interviews about financial burden due to cancer, COVID-19, and LGBTQIA+ identity. Interviews were audio recorded, transcribed, and analyzed using Dedoose. Results Survey participants (N=325) were LGBTQIA+ (n=29, 8.9%), primarily female (n= 197, 60.6%), non-Hispanic White (n= 267, 82.2%), and received treatment during COVID-19 (n= 174, 54.0%). LGBTQIA+ interview participants (n=9, 100%) identified as a sexual minority and (n=2, 22.2%) identified as a gender minority. Most were non-Hispanic White (n=6, 66.7%) and had received treatment during COVID-19 (n=7, 77.8%). Statistical analyses revealed that LGBTQIA+ AYAs reported significantly worse COST scores than non-LGBTQIA+ AYAs (p=0.002). LGBTQIA+ AYAs also reported significantly higher PSS-4 (p=0.001), PROMIS anxiety (p=0.002) and depression scores (p<0.001) than non-LGBTQIA+ AYAs, reflecting worse mental health outcomes. High costs of cancer treatment and employment disruptions due to COVID-19 contributed to substantial financial stress, which exacerbated existing mental health challenges and introduced new ones. Conclusions LGBTQIA+ AYA survivors reported substantial financial burden and psychological distress exacerbated by cancer, the COVID-19 pandemic, and LGBTQIA+ stigma. Given their multiple intersecting identities and potential for marginalization, LGBTQIA+ AYA survivors deserve prioritization in research to reduce financial burden and poor mental health.
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Affiliation(s)
- Austin R. Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- Department of Health Policy & Management, Gilling’s School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Sara Bybee
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Echo L. Warner
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Heydon K. Kaddas
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Erin E. Kent
- Department of Health Policy & Management, Gilling’s School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
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26
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Waters AR, Mann K, Warner EL, Vaca Lopez PL, Kaddas HK, Ray N, Tsukamoto T, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC. "I thought there would be more I understood": health insurance literacy among adolescent and young adult cancer survivors. Support Care Cancer 2022; 30:4457-4464. [PMID: 35107600 PMCID: PMC10512194 DOI: 10.1007/s00520-022-06873-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health insurance literacy is crucial for navigating the US healthcare system. Low health insurance literacy may be especially concerning for adolescent and young adult (AYA) cancer survivors. To describe AYAs' health insurance literacy, we conducted semi-structured interviews with AYA survivors, on and off of treatment. METHODS We interviewed 24 AYA cancer survivors (aged 18-39 years) between November 2019 and March 2020. Interviews were recorded, transcribed, and quality-checked. Using two cycles of structured coding, we explored AYAs' health insurance literacy and examined thematic differences by policy holder status and age. RESULTS AYAs were 58.3% female, 79.2% non-Hispanic White, 91.7% heterosexual, and 62.5% receiving cancer treatment. Most participants had employer-sponsored health insurance (87.5%), and 41.7% were their own policy holder. Four themes emerged; in the first theme, most AYAs described beginning their cancer treatment with little to no understanding of their health insurance. This led to the three subsequent themes in which AYAs reported: unclear expectations of what their insurance would cover and their out-of-pocket costs; learning about insurance and costs by trial and error; and how their health insurance literacy negatively impacted their ability to navigate the healthcare system. CONCLUSIONS Our findings, while requiring confirmation in larger samples and in other health systems, suggest that the health insurance literacy needed to navigate insurance and cancer care is low among US AYA survivors and may have health and financial implications. As the burden of navigating insurance is often put on patients, health insurance education is an important supportive service for AYA survivors on and off of treatment.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Karely Mann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, AZ, USA
- University of Arizona College of Nursing, Tucson, AZ, USA
| | | | - Heydon K Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Douglas B Fair
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Healthcare, Salt Lake City, UT, USA
| | | | | | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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Blanchette JE, Allen NA, Litchman ML. The Feasibility and Acceptability of a Community-Developed Health Insurance and Financial Toolkit for Emerging Adults With Type 1 Diabetes. Sci Diabetes Self Manag Care 2022; 48:174-183. [DOI: 10.1177/26350106221087474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The purpose of the study was to assess the feasibility and acceptability of a financial stress and health insurance education toolkit developed by a community advisory board for emerging adults, ages 18 to 25, with type 1 diabetes. Methods: This study is a longitudinal, randomized controlled trial that enrolled 39 emerging adults with type 1 diabetes. Participants randomized to the intervention group were given access to the T1D Financial Toolkit, an online financial and health insurance education toolkit, over 30 days. For the present analysis, feasibility was assessed by enrollment and attrition. Optional, qualitative interviews were conducted upon the conclusion of the intervention to evaluate feasibility, acceptability, satisfaction, and key recommendations for improvement. Results: Of the 39 participants who enrolled, 36 completed the study. The intervention period had 100% completion in both the control and intervention groups. Eleven participants from the intervention group completed interviews. Participants described few challenges accessing the toolkit and were highly satisfied with the intervention aesthetics, display, and content. Key recommendations included integrating more applied problem-solving into the experience of watching the videos. Conclusions: The T1D Financial Toolkit is a financial and health insurance education intervention tailored to emerging adults with type 1 diabetes. This resource is feasible, acceptable, and satisfactory. Diabetes care and education specialists can utilize this tool in practice to provide relevant, developmentally tailored education to emerging adults with type 1 diabetes, prompt applied problem-solving, reduce barriers to self-management, and improve psychosocial outcomes.
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Affiliation(s)
| | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, Utah
| | - Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, Utah
- Utah Diabetes and Endocrinology Center, Salt Lake City, Utah
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Avutu V, Monga V, Mittal N, Saha A, Andolina JR, Bell DE, Fair DB, Flerlage JE, Frediani JN, Heath JL, Kahn JM, Reichek JL, Super L, Terao MA, Freyer DR, Roth ME. Use of Communication Technology to Improve Clinical Trial Participation in Adolescents and Young Adults With Cancer: Consensus Statement From the Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network. JCO Oncol Pract 2022; 18:224-231. [PMID: 34905405 PMCID: PMC8932547 DOI: 10.1200/op.21.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Adolescents and young adults (AYAs; age 15-39 years) with cancer are under-represented in cancer clinical trials because of patient, provider, and institutional barriers. Health care technology is increasingly available to and highly used among AYAs and has the potential to improve cancer care delivery. The COVID-19 pandemic forced institutions to rapidly adopt novel approaches for enrollment and monitoring of patients on cancer clinical trials, many of which have the potential for improving AYA trial participation overall. This consensus statement from the Children's Oncology Group AYA Oncology Discipline Committee reviews opportunities to use technology to optimize AYA trial enrollment and study conduct, as well as considerations for widespread implementation of these practices. The use of remote patient eligibility screening, electronic informed consent, virtual tumor boards, remote study visits, and remote patient monitoring are recommended to increase AYA access to trials and decrease the burden of participation. Widespread adoption of these strategies will require new policies focusing on reimbursement for telehealth, license portability, facile communication between electronic health record systems and advanced safeguards to maintain patient privacy and security. Studies are needed to determine optimal approaches to further incorporate technology at every stage of the clinical trial process, from enrollment through study completion.
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Affiliation(s)
- Viswatej Avutu
- Department of Medicine, Memorial Sloan Kettering Cancer Center; New York, NY,Viswatej Avutu, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 300 E 66th Floor 14, New York, NY 10065; e-mail:
| | - Varun Monga
- Division of Medical Oncology, Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Nupur Mittal
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Rush University Medical Center, Chicago, IL
| | - Aniket Saha
- Division of Pediatric Hematology-Oncology, University of South Carolina School of Medicine, Greenville, SC
| | - Jeffrey R. Andolina
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Danielle E. Bell
- Department of Pediatrics, Ascension St John Hospital, Detroit, MI
| | - Douglas B. Fair
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, UT
| | - Jamie E. Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Jessica L. Heath
- Departments of Pediatrics and Biochemistry, University of Vermont, Burlington, VT
| | - Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Irving Medical Center, New York, NY
| | - Jennifer L. Reichek
- Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Leanne Super
- Department of Paediatrics, School of Medicine, Monash University, Melbourne, Australia
| | - Michael A. Terao
- Division of Pediatric Adolescent and Young Adult Hematology and Oncology, Department of Pediatrics, Medstar Georgetown University Hospital, Washington, DC
| | - David R. Freyer
- Departments of Pediatrics, Medicine, and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
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29
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Salsman JM, Kircher SM. Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches. JCO Oncol Pract 2022; 18:173-176. [PMID: 34807736 PMCID: PMC8932498 DOI: 10.1200/op.21.00663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Affiliation(s)
- John M. Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine and the Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Sheetal M. Kircher
- Division of Hematology-Oncology, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
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30
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Grigorian EG, Litchman ML, Porter ME, Blanchette JE, Allen NA. Financial Barriers in Emerging Adults With Type 1 Diabetes: A Qualitative Analysis. Diabetes Spectr 2022; 35:190-197. [PMID: 35668888 PMCID: PMC9160559 DOI: 10.2337/ds21-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Emerging adulthood is a period fraught with challenging life transitions for many and is especially difficult for individuals with type 1 diabetes, as they encounter more obstacles to independently managing their diabetes. We examined the barriers faced by emerging adults and parents of emerging adults with type 1 diabetes and the impact these barriers had on their lives. Methods Emerging adults and parents of emerging adults with type 1 diabetes were recruited from primary care and specialty clinics and via social media posts. In the parent study, semi-structured interviews were conducted to understand what supported and did not support diabetes self-management. Interviews were transcribed, coded, and analyzed for common themes. This sub-analysis analyzed data related to financial challenges in accessing diabetes management equipment and supplies. Results This study included emerging adults with type 1 diabetes (n = 33; mean age 20 ± 2.9 years) and parents of emerging adults with type 1 diabetes (n = 17; mean age 47.5 ± 6.9 years). The majority of emerging adults used an insulin pump and continuous glucose monitoring system (n = 24 [73%]). Four main themes emerged related to access to care: 1) affordability of diabetes management tools, 2) managing insurance, 3) communication with pharmacies and health care providers, and 4) emotional consequences of financial stress. Conclusion The current health system is challenging for emerging adults with type 1 diabetes and parents and is causing substantial emotional and financial stress. Future research is needed to address interventions for helping emerging adults and their parents navigate the cost of living with diabetes.
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Affiliation(s)
| | - Michelle L. Litchman
- University of Utah College of Nursing, Salt Lake City, UT
- Utah Diabetes and Endocrinology Center, Salt Lake City, UT
| | | | | | - Nancy A. Allen
- University of Utah College of Nursing, Salt Lake City, UT
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31
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Joffe L, Steinberg DM, Strohli T, Beauchemin M. Adolescents and Young Adults with Cancer: Survivorship and Special Considerations. Pediatr Ann 2022; 51:e27-e33. [PMID: 35020510 DOI: 10.3928/19382359-20211209-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adolescents and young adults (AYAs) who have cancer face a distinct set of challenges beginning during the initial diagnosis, extending throughout treatment, and continuing into survivorship. Owing to significant strides made in cancer therapy in recent decades, more than 80% of this group will go on to become long-term survivors. Despite these improvements, however, many AYAs continue to have poorer outcomes when compared with older and younger patients. The purpose of this article is to underscore the unique set of multifaceted obstacles that this vulnerable group encounters and to pinpoint critical areas of attention and intervention throughout the health care journey. Moreover, it aims to highlight the importance of the role of the primary care provider as a constant partner in safeguarding the long-term physical and mental health of this diverse population within a complex and, at times, trying health care system. [Pediatr Ann. 2022;51(1):e27-e33.].
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Qualitative inquiry of cancer caregiving during young adulthood: responsibilities, challenges, teamwork, and social support. ACTA ACUST UNITED AC 2021; 3. [PMID: 34746795 PMCID: PMC8570566 DOI: 10.1097/or9.0000000000000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Young adult cancer caregivers (YACC) may experience heightened caregiver burden because they take on caregiving during a dynamic time of life. The purpose of this study was to describe YACC experiences, burden, and social support while caregiving. Methods: Grounded by the Cancer Family Caregiving Experience Model and the Stress and Coping Social Support theory, semi-structured interviews were conducted with YACC. Inductive analysis was applied to YACC perceptions of caregiving, and deductive analysis to YACC social networks and social support. Results: YACC (N=34) were primarily between 25 to 29 years of age (38.2%), primarily female (70.6%), non-Hispanic White (91.2%), employed (85.3%), college graduates or higher (53.0%), and caring for a spouse/partner (52.9%). Qualitative analysis of interviews with YACC resulted in 2 themes: cancer caregiving during young adulthood and young adult cancer caregiver social support. In the first theme YACC often did not perceive themselves as caregivers, rather their caregiving responsibilities were viewed as an extension of their relationship with the patient. Further YACC reported developmental-specific responsibilities (eg, caring for young children, being unable to take time off while solidifying careers) which often conflicted with their caregiving responsibilities (eg, managing patient’s medication, attending appointments) and heightened burden. In response, YACC often formed caregiver teams consisting of family, friends, and community members to care for their loved one. In the second theme YACC most commonly reported receiving emotional and instrumental support from their social network. YACC specifically mentioned their appreciation for emotional support provided by other young adults and instrumental support in the form of financial support. Conclusions: YACC faced developmentally specific challenges during caregiving that older adult caregivers may not encounter. The conflict of young adult and caregiving responsibilities resulted in YACC forming caregiver teams. Thus, theoretical approaches to understand and improve caregiver health would benefit from the inclusion of the developmental context of young adulthood. Furthermore, it is crucial that cancer centers tailor supportive services to YACC as the number of young caregivers increases.
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Abstract
BACKGROUND A cancer diagnosis as an adolescent and young adult (AYA) poses exceptional challenges, including potential greater financial toxicity than older survivors experience who have had more time for career establishment and to build financial assets. Costs to patients have increased more than the past decade; prospects for AYA long-term survival have also increased. A better understanding of what financial toxicity is, how it presents, and the immediate and longer-term implications for AYAs is needed. OBJECTIVE The aim of this study was to analyze the concept financial toxicity in AYAs diagnosed with cancer. METHODS We used Rodgers' evolutionary method and articles published between January 2013 and December 2020. RESULTS We identified key antecedents, attributes, and consequences of financial toxicity in AYAs and review its related terms that have often been used as surrogate terms. Attributes were financial burden, financial distress, and competing financial pressures. Consequences were mostly adverse and persistent and included engaging in various financial problem-solving behaviors, material hardship and poor financial well-being, and deteriorated quality of life. CONCLUSIONS Results of this analysis clarify financial toxicity and provide guidance for a conceptual framework in the context of AYA cancer survivorship. Its consequences in AYAs with cancer are profound and will continue to evolve over time with changes in health systems and the economy. IMPLICATIONS FOR PRACTICE Oncology nurses should understand the attributes and consequences of financial toxicity for AYAs throughout the cancer trajectory. Future research on financial toxicity should extend across AYAs living with other chronic illnesses and cancer survivors in other age groups.
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Parikh DA, Ragavan M, Dutta R, Garnet Edwards J, Dickerson J, Maitra D, Aggarwal S, Lee FC, Patel MI. Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems. JCO Oncol Pract 2021; 17:e1450-e1459. [PMID: 33826366 PMCID: PMC9797228 DOI: 10.1200/op.20.00890] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. METHODS We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity. RESULTS Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI (P < .0001), high OOPCs (P = .003), and employment changes as a result of cancer diagnosis (P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS. CONCLUSION Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.
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Affiliation(s)
- Divya A. Parikh
- Department of Medicine, Stanford University, Stanford, CA,Department of Health Research and Policy, Stanford University, Stanford, CA,Divya A. Parikh, MD, 875 Blake Wilbur Drive, Stanford, CA 94305; e-mail:
| | - Meera Ragavan
- Department of Medicine, Stanford University, Stanford, CA
| | - Ritika Dutta
- Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Debeshi Maitra
- Department of Hematology/Oncology, Santa Clara Valley Medical Center, San Jose, CA
| | - Sangeeta Aggarwal
- Department of Hematology/Oncology, Santa Clara Valley Medical Center, San Jose, CA
| | - Fa-Chyi Lee
- Department of Hematology/Oncology, Santa Clara Valley Medical Center, San Jose, CA
| | - Manali I. Patel
- Department of Medicine, Stanford University, Stanford, CA,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA,Center for Primary Care Outcomes Research, Stanford University, Stanford, CA
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de Alcantara Nogueira L, Koller FJ, Marcondes L, de Fátima Mantovani M, Marcon SS, Guimarães PRB, Kalinke LP. Validation of the comprehensive score for financial toxicity for Brazilian culture. Ecancermedicalscience 2020; 14:1158. [PMID: 33574903 PMCID: PMC7864683 DOI: 10.3332/ecancer.2020.1158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 11/09/2022] Open
Abstract
Financial toxicity is a side effect of cancer treatment showing the financial burden experienced by cancer patients for funding their treatment. An instrument for its evaluation can contribute towards the creation of coping strategies. In Brazil, a developing country, cancer patients certainly feel the effects of this serious adverse event, however, the discussion on the theme and research concerning these issues is scarce and an instrument for evaluation can help in the promotion of coping strategies. Thus, the study objective was to: 1) translate and adapt the COmprehensive Score for financial Toxicity (COST) questionnaire to Brazilian culture and 2) evaluate the COST psychometric properties in Brazil. Thus, a methodological study was developed in two stages. In the first stage, the translation and cross-cultural adaptation were performed, and in the second stage, two groups of participants were recruited to evaluate the psychometric properties. In the first stage, 21 individuals participated, including translators and cancer patients, and in the second stage, 126 patients participated who were undergoing cancer treatment. For validation, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and Cronbach’s alpha coefficient were performed to verify internal consistency. For the first stage’s outcome, the pre-test Cronbach’s alpha was 0.83. The EFA and CFA carried out in the second stage of the study revealed that the COST Brazilian version measures a single construct with a value of—χ2/gl = 179.78, comparative fit index = 0.00, Parsimony goodness of fit index = 0.302, root mean square error of approximation = 1.196 and p-value of close fit = 0.000. When comparing the average of the COST score and the standard deviation of the two samples, the significance value was p = 0.001. Therefore, it is possible to confirm that the COST is a valid and reliable questionnaire to measure the financial toxicity of cancer patients in Brazil.
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Affiliation(s)
- Luciana de Alcantara Nogueira
- Doctoral Students of the Nursing Graduate Program, Federal University of Paraná, Av Prof Lothário Meissner 632, Curitiba, PR 80210-170, Brazil
| | - Francisco José Koller
- Doctoral Students of the Nursing Graduate Program, Federal University of Paraná, Av Prof Lothário Meissner 632, Curitiba, PR 80210-170, Brazil
| | - Larissa Marcondes
- Doctoral Students of the Nursing Graduate Program, Federal University of Paraná, Av Prof Lothário Meissner 632, Curitiba, PR 80210-170, Brazil
| | - Maria de Fátima Mantovani
- Nursing Department, Federal University of Paraná, Av Prof Lothário Meissner 632, Curitiba, PR 80210-170, Paraná, Brazil
| | - Sonia Silva Marcon
- Nursing Department, State University of Maringá, Av Colombo, 5790, Jd Universitário, Maringá, Paraná, 87020-900, Brazil
| | | | - Luciana Puchalski Kalinke
- Nursing Department, Federal University of Paraná, Av Prof Lothário Meissner 632, Curitiba, PR 80210-170, Paraná, Brazil
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Siembida EJ, Reeve BB, Zebrack BJ, Snyder MA, Salsman JM. Measuring health-related quality of life in adolescent and young adult cancer survivors with the National Institutes of Health Patient-Reported Outcomes Measurement Information System ® : Comparing adolescent, emerging adult, and young adult survivor perspectives. Psychooncology 2020; 30:303-311. [PMID: 33073416 DOI: 10.1002/pon.5577] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our knowledge of symptom burden and functioning among adolescent and young adult (AYA; diagnosed ages 15-39) cancer survivors has been hindered by variability in health-related quality of life (HRQOL) measurement associated with developmental and disease heterogeneity among AYAs. We aimed to examine the variability in domain-specific aspects of HRQOL as a function of cancer type and developmental stage to clarify commonalities and differences using the NIH Patient-Reported Outcome Measurement Information System® . METHODS Five hundred seventy-two AYAs were recruited by an online research panel using stratified sampling (treatment status: on vs. off; developmental stage: adolescents, emerging adults, young adults). Participants completed questionnaires that included sociodemographic characteristics, clinical history, and the adult version of the Patient-Reported Outcomes Measurement Information System® -29 (PROMIS-29). Generalized linear models were run for each HRQOL domain and included treatment status, developmental stage, and cancer type (hematologic vs. solid tumor) and their interactions as independent variables. RESULTS There were no significant differences in any HRQOL domain by cancer type, and few significant differences were observed in PROMIS domains between developmental groups among on-treatment AYA survivors. In contrast, off-treatment emerging adults and young adults reported significantly higher symptoms and worse functioning compared to adolescents (all ps ≤ 0.003). CONCLUSIONS AYAs diagnosed in different developmental stages, particularly among off-treatment survivors, experienced diverse constellations of symptoms and functioning, and developmental stage was a more critical predictor of HRQOL than cancer type. These results suggest that supportive care interventions developed for AYA cancer survivors must be tailored and flexible by developmental stage and treatment status.
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Affiliation(s)
- Elizabeth J Siembida
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brad J Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Missouri, USA
| | - Mallory A Snyder
- Office of Research and National Laboratories, The University of Chicago, Illinois, Chicago, USA
| | - John M Salsman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine & the Wake Forest Baptist Comprehensive Cancer Center, North Carolina, Winston-Salem, USA
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Yap SL, Wong SSL, Chew KS, Kueh JSH, Siew KL. Assessing the Relationship between Socio-demographic, Clinical Profile and Financial Toxicity: Evidence from Cancer Survivors in Sarawak. Asian Pac J Cancer Prev 2020; 21:3077-3083. [PMID: 33112570 PMCID: PMC7798164 DOI: 10.31557/apjcp.2020.21.10.3077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient's financial ability is always the most critical imputes to treatment choice and adherence; as it translates into health outcomes such as survival rate and quality of life. Cancer care is likely to affect the patient's financial well-being, putting huge financial pressure to the families. Therefore, it is imperative to understand the confounding factors of financial toxicity among cancer survivors along the course of survivorship. METHODS This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors. RESULTS The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT. CONCLUSION Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.
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Affiliation(s)
- Shee-Ling Yap
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Shirly Siew-Ling Wong
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Keng-Sheng Chew
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Jerome Swee-Hui Kueh
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Ke-Lin Siew
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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Sisk BA, Fasciano K, Block SD, Mack JW. Impact of cancer on school, work, and financial independence among adolescents and young adults. Cancer 2020; 126:4400-4406. [PMID: 32658324 DOI: 10.1002/cncr.33081] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND For adolescents and young adults (AYAs), the diagnosis of cancer can impede social development, especially with respect to education, employment, and financial independence. However, there are limited quantitative data on the extent and trajectory of life disruptions during cancer treatment for AYA patients. METHODS This was a longitudinal, prospective, questionnaire-based cohort study of 145 AYA patients with cancer aged 15 to 29 years who were treated at a large academic cancer center. Questionnaires were administered shortly after diagnosis and 4 and 12 months after diagnosis. RESULTS Although half of the participants lived with their parents 6 months before diagnosis, 61% lived with their parents after diagnosis (P = .0002 vs 6 months before diagnosis), with a similar proportion reported to be living with their parents 4 months after diagnosis (61%; P = .001) and 55% doing so 12 months after diagnosis (P = .07). Before diagnosis, 38% of the patients were not attending school. After diagnosis, that proportion rose to 61% (P < .0001), with a similar proportion 4 months after diagnosis (61%; P < .0001); 54% were not in school at 12 months (P = .001). Patients experienced similar decrements in employment (30% not working before diagnosis vs 49% not working after diagnosis; P < .0001) and financial independence (37% with complete financial independence before diagnosis vs 31% after diagnosis; P = .02). Overall, 65% of the patients (94 of 145) had not returned to their precancer baseline in at least 1 of these 4 social domains by 12 months after diagnosis. CONCLUSIONS For many AYA patients, cancer leads to less engagement with school and work activities and decreased financial independence from parents. Clinicians should engage in early and ongoing discussions with patients about the potential impact of cancer on their lives.
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Affiliation(s)
- Bryan A Sisk
- Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Karen Fasciano
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan D Block
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts
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Perez GK, Salsman JM, Fladeboe K, Kirchhoff AC, Park ER, Rosenberg AR. Taboo Topics in Adolescent and Young Adult Oncology: Strategies for Managing Challenging but Important Conversations Central to Adolescent and Young Adult Cancer Survivorship. Am Soc Clin Oncol Educ Book 2020; 40:1-15. [PMID: 32324424 PMCID: PMC7328818 DOI: 10.1200/edbk_279787] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Research on adolescents and young adults (AYAs) with cancer has flourished over the past decade, underscoring the unique medical and psychosocial needs of this vulnerable group. A cancer diagnosis during adolescence and young adulthood intersects with the developmental trajectory of AYAs, derailing critical physical, social, and emotional development. AYAs face these abrupt life changes needing age-appropriate information and resources to offset these challenges. Greater attention is needed to address AYA-specific concerns on reproductive and sexual health, financial security and independence, emotional well-being, social support, and end-of-life care. If these unique needs are unaddressed, this can adversely affect AYAs' health care engagement and overall quality of life, increasing their risk for cancer-related morbidity and early mortality. In particular, health care decisions made during treatment have important implications for AYA patients' future health. Oncology clinicians are well positioned to address AYA patients' concerns by anticipating and addressing the challenges this age group is likely to face. In this paper, we explore several core topics that affect AYAs' quality of life and that can be challenging to address. Starting from the moment of diagnosis, through cancer treatment and post-treatment survivorship, and into end of life, each section highlights critical developmental-centric life domains that are affected by the cancer experience. Specifically, we discuss resources, tools, and strategies to navigate these challenging conversations. Taking a risk-reduction approach that invites two-way communication and facilitates referral to age-appropriate resources would help destigmatize these experiences and, in turn, would support the provision of compassionate and effective age-concordant care to this vulnerable group.
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Affiliation(s)
- Giselle K. Perez
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - John M. Salsman
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kaitlyn Fladeboe
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
| | - Anne C. Kirchhoff
- Huntsman Cancer Institute and Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elyse R. Park
- Harvard Medical School/Massachusetts General Hospital, Boston, MA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, MA
| | - Abby R. Rosenberg
- Seattle Children’s Research Institute, University of Washington, Seattle, WA
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