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Marzorati C, Masiero M, Pravettoni G. "Perspective: An integrated vision of the quality of life in breast cancer survivorship trajectory". Breast 2024; 77:103785. [PMID: 39208546 DOI: 10.1016/j.breast.2024.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Hu X, Grosse SD, Han X, Marchak JG, Ji X. Mental Health Care Utilization Among Parents of Children With Cancer. JAMA Netw Open 2024; 7:e244531. [PMID: 38564218 PMCID: PMC10988353 DOI: 10.1001/jamanetworkopen.2024.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Caring for children diagnosed with cancer may adversely affect the mental health (MH) of parents. Objective To characterize utilization of MH services among parents of children with vs without cancer using nationwide commercial claims data. Design, Setting, and Participants For this cross-sectional study, the Merative MarketScan Commercial Claims Database was used to identify continuously insured families of children treated for cancer (aged ≤21 years at diagnosis) during 2010 to 2018, compared with families who matched eligibility criteria but did not have a child with a cancer history. Parents were assessed from 18 months before to 12 months after their child's cancer diagnosis. Analyses were conducted from February 2022 to September 2023. Exposures Children's cancer diagnosis. Main Outcomes and Measures Outcomes included parents' MH-related visits during the first year following their child's cancer diagnosis. Logistic regressions compared outcomes between families of children with vs without cancer, adjusting for sociodemographic and clinical factors. Results This study included 4837 families of children with cancer (4210 mothers and 4016 fathers) and 24 185 families of children without cancer (21 444 mothers and 19 591 fathers) with continuous insurance enrollment. Most household leads were aged 35 to 54 years (3700 [76.5%] in families of children with cancer vs 17 812 [73.6%] in families of children without cancer) and resided in urban areas (4252 [87.9%] vs 21 156 [87.5%]). The probabilities of parents having anxiety-related visits (10.6% vs 7.0%), depression-related visits (8.4% vs 6.1%), and any MH-related visits (18.1% vs 13.3%) were higher in families of children with vs without cancer. Adjusted analyses showed absolute increases of 3.2 percentage points (95% CI, 2.3 to 4.0; 45.7% relative increase), 2.2 percentage points (95% CI, 1.4 to 3.0; 36.1% relative increase), and 4.2 percentage points (95% CI, 3.1 to 5.3; 31.3% relative increase) in the probabilities of 1 or both parents having anxiety-related visits, depression-related visits, and any MH-related visits, respectively, among families of children with vs without cancer. Such differences were greater in magnitude among mothers than fathers. Conclusions and Relevance In this cohort study of privately insured parents, those caring for children with cancer had a higher likelihood of utilizing MH care than other parents. These findings underline the importance of interventions toward targeted counseling and support to better meet MH care needs among parents and caregivers of children with cancer.
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Affiliation(s)
- Xin Hu
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Thom B, Friedman DN, Aviki EM, Benedict C, Watson SE, Zeitler MS, Chino F. The long-term financial experiences of adolescent and young adult cancer survivors. J Cancer Surviv 2023; 17:1813-1823. [PMID: 36472761 PMCID: PMC9734817 DOI: 10.1007/s11764-022-01280-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer-related financial hardship can negatively impact financial well-being and may prevent adolescent and young adult (AYA) cancer survivors (ages 15-39) from gaining financial independence. This analysis explored the financial experiences following diagnosis with cancer among AYA survivors. METHODS We conducted a cross-sectional, anonymous survey of a national sample of AYAs recruited online. The Comprehensive Score for Financial Toxicity (COST) and InCharge Financial Distress/Financial Well-Being Scale (IFDFW) assessed financial hardship (cancer-related and general, respectively), and respondents reported related financial consequences and financial coping behaviors (both medical and non-medical). RESULTS Two hundred sixty-seven AYA survivors completed the survey (mean 8.3 years from diagnosis). Financial hardship was high: mean COST score was 13.7 (moderate-to-severe financial toxicity); mean IFDFW score was 4.3 (high financial stress). Financial consequences included post-cancer credit score decrease (44%), debt collection contact (39%), spending more than 10% of income on medical expenses (39%), and lacking money for basic necessities (23%). Financial coping behaviors included taking money from savings (55%), taking on credit card debt (45%), putting off major purchases (45%), and borrowing money (42%). In logistic regression models, general financial distress was associated with increased odds of experiencing financial consequences and engaging in both medical- and non-medical-related financial coping behaviors. DISCUSSION AYA survivors face long-term financial hardship after cancer treatment, which impacts multiple domains, including their use of healthcare and their personal finances. Interventions are needed to provide AYAs with tools to navigate financial aspects of the healthcare system; connect them with resources; and create systems-level solutions to address healthcare affordability. IMPLICATIONS FOR CANCER SURVIVORS Survivorship care providers, particularly those who interact with AYA survivors, must be attuned to the unique risk for financial hardships facing this population and make efforts to increase access available interventions.
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Affiliation(s)
- Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Danielle N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline M Aviki
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, CA, USA
| | | | | | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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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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5
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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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Ghazal LV, Wentzell K, Blanchette JE. Mobilizing Research to Understand the Impact of Financial Toxicity Among Adolescents and Young Adults Diagnosed With Chronic Diseases. J Adolesc Health 2023; 73:403-405. [PMID: 37389528 PMCID: PMC10697307 DOI: 10.1016/j.jadohealth.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Lauren V Ghazal
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan; Rogel Cancer Center, Ann Arbor, Michigan.
| | - Katherine Wentzell
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, Massachusetts
| | - Julia E Blanchette
- Center for Diabetes and Metabolic Care, Department of Medicine, University Hospitals, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
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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: 12] [Impact Index Per Article: 12.0] [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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Waters AR, van Thiel Berghuijs KM, Kaddas HK, Vaca Lopez PL, Chevrier A, Ray N, Tsukamoto T, Allen K, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC, Warner EL. Sources of informal financial support among adolescent and young adult cancer survivors: a mixed methods analysis from the HIAYA CHAT study. Support Care Cancer 2023; 31:159. [PMID: 36773110 PMCID: PMC10601020 DOI: 10.1007/s00520-023-07626-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE The purpose of this exploratory sequential mixed methods study was to describe the sources of informal financial support used by adolescent and young adult (AYA) cancer survivors and how financial toxicity and demographic factors were associated with different types and magnitudes of informal financial support. METHODS This analysis is part of a larger health insurance literacy study that included pre-trial interviews and a randomized controlled trial (RCT) for AYA cancer survivors. Eligible study participants were 18 years of age, diagnosed with cancer as an AYA (15-39 years), insured, and for the RCT sample less than 1 year from diagnosis. Interview audio was transcribed, quality checked, and thematically analyzed. RCT baseline and follow-up surveys captured informal financial support use. Chi-squared and Fisher's exact tests were used to assess differences in informal financial support type use and frequency by financial toxicity and AYA demographics. RESULTS A total of N = 24 and N = 86 AYAs participated in pre-trial interviews and the RCT respectively. Interview participants reported a variety of informal financial support sources including savings, community, family/friends, and fundraisers. However, only half of participants reported their informal financial support to be sufficient. High financial toxicity was associated with the most types of informal financial support and a higher magnitude of use. The lowest income group accessed informal financial supports less frequently than higher income groups. CONCLUSION Our study demonstrates that AYA survivors experiencing financial toxicity frequently turn to informal sources of financial support and the magnitude is associated with financial toxicity. However, low-income survivors, and other at-risk survivors, may not have access to informal sources of financial support potentially widening inequities.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA.
| | - Karely M van Thiel Berghuijs
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Perla L Vaca Lopez
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Amy Chevrier
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Tomoko Tsukamoto
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Karlie Allen
- Patient and Public Education, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
| | - Douglas B Fair
- Deparment of Pediatrics, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Medical Oncology, Intermountain Healthcare, Murray, UT, USA
| | - Giselle K Perez
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, USA
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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Ye ZM, Xu Z, Li H, Li Q. Cost-effectiveness analysis of durvalumab plus chemotherapy as first-line treatment for biliary tract cancer. Front Public Health 2023; 11:1046424. [PMID: 36844853 PMCID: PMC9950513 DOI: 10.3389/fpubh.2023.1046424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Objective The TOPAZ-1 trial reported a significant survival benefit of durvalumab in combination with chemotherapy for the first-line treatment of biliary tract cancer (BTC). However, no studies have evaluated the economics of this treatment option. The aim of this study was to assess the cost effectiveness of durvalumab plus chemotherapy compared to placebo plus chemotherapy from the perspective of US and Chinese payers. Methods Based on clinical data from the TOPAZ-1 trial, a Markov model was developed to simulate 10-year life expectancy and total healthcare costs for patients with BTC. The treatment group received durvalumab in combination with chemotherapy and the control group received placebo plus chemotherapy. The primary outcomes analyzed included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainty in the analysis results was assessed by sensitivity analysis. Results For US payers, the placebo plus chemotherapy group had a total cost of $56,157.05 and a utility of 1.10 QALYs, while the durvalumab plus chemotherapy group had a total cost of $217,069.25, a utility of 1.52 QALYs, resulting in an ICER of $381,864.39/QALY. For Chinese payers, the ICER of durvalumab plus chemotherapy group was $367,608.51/QALY. Sensitivity analysis showed that the analysis was most sensitive to the price of durvalumab. For US and Chinese payers, under the respective willing to pay thresholds, the likelihood of the durvalumab plus chemotherapy arm being cost-effective was 0%. Conclusions Both in China and in the US, durvalumab in combination with chemotherapy is not a cost-effective option for the first-line treatment of BTC compared with chemotherapy.
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Affiliation(s)
- Zhuo-miao Ye
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhe Xu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qian Li
- The Affiliated Changsha Central Hospital, Department of Infection Diseases, Hengyang Medical School, University of South China, Hengyang, Hunan, China,*Correspondence: Qian Li ✉
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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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11
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Corrigan KL, Fu S, Chen YS, Kaiser K, Roth M, Peterson SK, Shih YCT, Jagsi R, Giordano SH, Volk RJ, Robin Yabroff K, Banegas MP, Acquati C, Conti RM, Ma HY, Ku K, Nancy You Y, Smith GL. Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery. Cancer 2022; 128:2455-2462. [PMID: 35417565 PMCID: PMC9177670 DOI: 10.1002/cncr.34220] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Young adults and other working-age adults with cancer are at risk for cancer-related financial toxicity (FT), including material hardships, depletion of coping resources, and psychological burden. This study compares FT domains in young adults (18-39 years old) (YAs), other working-age adults (40-64 years old), and older adults (≥65 years old) receiving cancer care. METHODS A total of 311 adults were surveyed using the multi-domain Economic Strain and Resilience in Cancer instrument measuring FT (0-10 score indicating least to greatest FT; score ≥5 severe FT). Participants were receiving ambulatory care from March-September 2019. Associations of age with overall FT and material hardship, coping resource depletion, and psychological burden FT domains were tested using Kruskal-Wallis and χ2 tests and multivariable generalized linear models with gamma distribution. RESULTS YAs (median age, 31.5 years) comprised 9.6% of the sample; other working-age adults comprised 56.9%. Overall, material, coping, and psychological FT scores were worse in younger age adults versus older adults (P < .001 in all multivariable models). Compared with older adults, younger age adults demonstrated worse material hardship (median scores, 3.70 vs 4.80 vs 1.30 for YAs, other working-age, and older adults, respectively; P < .001), coping resource depletion (4.50 vs 3.40 vs 0.80; P < .001), and psychological burden (6.50 vs 7.00 vs 1.00; P < .001). Fifty percent of YAs had severe overall FT versus 40.7% of other working-age adults and 9.6% of older adults (P < .001). CONCLUSIONS Younger age adults with cancer bore disproportionate FT. Interventions to address unmet needs are critical components for addressing FT in this population.
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Affiliation(s)
- Kelsey L. Corrigan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shuangshuang Fu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelsey Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Mathew P. Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rena M. Conti
- Department of Markets, Public Policy, and Law, Boston University School of Business, Boston, MA
| | - Hilary Y. Ma
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kimberly Ku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Y. Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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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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13
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Evaluating the Feasibility and Acceptability of an Artificial-Intelligence-Enabled and Speech-Based Distress Screening Mobile App for Adolescents and Young Adults Diagnosed with Cancer: A Study Protocol. Cancers (Basel) 2022; 14:cancers14040914. [PMID: 35205663 PMCID: PMC8870320 DOI: 10.3390/cancers14040914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/21/2022] [Accepted: 02/03/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Adolescent and young adult (AYA) patients diagnosed with cancer are at a higher risk of psychological distress, which requires regular monitoring throughout their cancer journeys. Paper-and-pencil or digital surveys for psychological stress are often cumbersome to complete during a patient’s visit, and many patients find completing the same survey multiple times repetitive and boring. Recent advances in mobile technology and speech science have enabled flexible and engaging ways of monitoring psychological distress. This paper describes the scientific process we will use to evaluate an artificial intelligence (AI)-enabled mobile app to monitor depression and anxiety among AYAs diagnosed with cancer. Abstract Adolescents and young adults (AYAs) diagnosed with cancer are an age-defined population, with studies reporting up to 45% of the population experiencing psychological distress. Although it is essential to screen and monitor for psychological distress throughout AYAs’ cancer journeys, many cancer centers fail to effectively implement distress screening protocols largely due to busy clinical workflow and survey fatigue. Recent advances in mobile technology and speech science have enabled flexible and engaging methods to monitor psychological distress. However, patient-centered research focusing on these methods’ feasibility and acceptability remains lacking. Therefore, in this project, we aim to evaluate the feasibility and acceptability of an artificial intelligence (AI)-enabled and speech-based mobile application to monitor psychological distress among AYAs diagnosed with cancer. We use a single-arm prospective cohort design with a stratified sampling strategy. We aim to recruit 60 AYAs diagnosed with cancer and to monitor their psychological distress using an AI-enabled speech-based distress monitoring tool over a 6 month period. The primary feasibility endpoint of this study is defined by the number of participants completing four out of six monthly distress assessments, and the acceptability endpoint is defined both quantitatively using the acceptability of intervention measure and qualitatively using semi-structured interviews.
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14
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Riva S, Arenare L, Di Maio M, Efficace F, Montesarchio V, Frontini L, Giannarelli D, Bryce J, Del Campo L, De Lorenzo F, Iannelli E, Traclò F, Gitto L, Jommi C, Vaccaro CM, Barberio D, Cinieri S, Porta C, Del Mastro L, Zagonel V, Cogoni AA, Bordonaro R, Gimigliano A, Piccirillo MC, Guizzaro L, Gallo C, Perrone F. Cross-sectional study to develop and describe psychometric characteristics of a patient-reported instrument (PROFFIT) for measuring financial toxicity of cancer within a public healthcare system. BMJ Open 2021; 11:e049128. [PMID: 34670762 PMCID: PMC8529986 DOI: 10.1136/bmjopen-2021-049128] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To measure and explain financial toxicity (FT) of cancer in Italy, where a public healthcare system exists and patients with cancer are not expected (or only marginally) to pay out-of-pocket for healthcare. SETTING Ten clinical oncological centres, distributed across Italian macroregions (North, Centre, South and Islands), including hospitals, university hospitals and national research institutes. PARTICIPANTS From 8 October 2019 to 11 December 2019, 184 patients, aged 18 or more, who were receiving or had received within the previous 3 months active anticancer treatment were enrolled, 108 (59%) females and 76 (41%) males. INTERVENTION A 30-item prefinal questionnaire, previously developed within the qualitative tasks of the project, was administered, either electronically (n=115) or by paper sheet (n=69). PRIMARY AND SECONDARY OUTCOME MEASURES According to the protocol and the International Society for Pharmacoeconomics and Outcomes Research methodology, the final questionnaire was developed by mean of explanatory factor analysis and tested for reliability, internal consistency (Cronbach's α test and item-total correlation) and stability of measurements over time (test-retest reliability by intraclass correlation coefficient and weighted Cohen's kappa coefficient). RESULTS After exploratory factor analysis, a score measuring FT (FT score) was identified, made by seven items dealing with outcomes of FT. The Cronbach's alpha coefficient for the FT score was 0.87 and the item-total correlation coefficients ranged from 0.53 to 0.74. Further, nine single items representing possible determinants of FT were also retained in the final instrument. Test-retest analysis revealed a good internal validity of the FT score and of the 16 items retained in the final questionnaire. CONCLUSIONS The Patient-Reported Outcome for Fighting FInancial Toxicity (PROFFIT) instrument consists of 16 items and is the first reported instrument to assess FT of cancer developed in a country with a fully public healthcare system. TRIAL REGISTRATION NUMBER NCT03473379.
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Affiliation(s)
- Silvia Riva
- Psychology and Pedagogic Science, St Mary's University, Twickenham, London, UK
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University Hospital of Milan, Milano, Italy
| | - Laura Arenare
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Massimo Di Maio
- Dipartimento di Oncologia, AO Ordine Mauriziano, Università degli Studi di Torino, Torino, Italy
| | - Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano per le Malattie Ematologiche dell'Adulto (GIMEMA), Roma, Italy
| | | | - Luciano Frontini
- Federation of Italian Cooperative Oncology Groups (FICOG), Milano, Italy
| | - Diana Giannarelli
- Unità di Biostatistica, Istituto Nazionale per lo Studio e la Cura dei Tumori Regina Elena, IRCCS, Roma, Italy
| | - Jane Bryce
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata", Roma, Italy
- Clinical Research Institute, Ascension St. John Clinical Research Institute, Tulsa, Oklahoma, USA
| | - Laura Del Campo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | - Francesco De Lorenzo
- Associazione Italiana Malati di Cancro (AIMAC), Roma, Italy
- European Cancer Patient Coalition (ECPC), Brussels, Belgium
| | - Elisabetta Iannelli
- Federazione Italiana delle Associazioni di Volontariato in Oncologia (FAVO), Roma, Italy
| | | | - Lara Gitto
- Dipartimento di Economia, Università degli Studi di Messina, Messina, Italy
| | - Claudio Jommi
- CERGAS (Centre for Health and Social Care Management), Università Bocconi, Milano, Italy
| | | | - Daniela Barberio
- Psiconcologia Clinica, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Camillo Porta
- Oncologia Medica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Università degli Studi di Bari, Bari, Italy
| | - Lucia Del Mastro
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna e Medicina Specialistica (DIMI), Università di Genova, Genova, Italy
| | | | | | | | - Anna Gimigliano
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Maria Carmela Piccirillo
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Lorenzo Guizzaro
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Ciro Gallo
- Statistica Medica, Università degli Studi della Campania Luigi Vanvitelli, Napoli, Italy
| | - Francesco Perrone
- Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
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