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Yabroff KR, Mittu K, Halpern MT. Cost-of-care discussions for individuals with advanced non-small cell lung cancer and melanoma: Findings from a large, population-based pilot study. Cancer 2024; 130:3364-3374. [PMID: 38869706 DOI: 10.1002/cncr.35380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/28/2024] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high-quality care. In this pilot study, the authors examined patient-provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non-small cell lung cancer (NSCLC) and melanoma-cancers with recently approved, high-cost treatment options. METHODS Individuals who were newly diagnosed in 2017-2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses. RESULTS Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37-0.80). Patients who did not receive systemic therapy or did not receive any cancer-directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19-0.81] and 0.46 [95% CI, 0.30-0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42-0.98). CONCLUSIONS Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost-of-care discussions and relevant referrals, as well as their documentation, are warranted.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Karen Mittu
- Information Management Services, Calverton, Maryland, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland, USA
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Conti RM, McCue S, Dockter T, Gunn HJ, Dusetzina SB, Bennett AV, Rapkin B, Gracia G, Jazowski S, Johnson M, Behrens R, Richardson P, Subbiah N, Chow S, Chang GJ, Neuman HB, Weiss ES. Self-Reported Financial Difficulties Among Patients with Multiple Myeloma and Chronic Lymphocytic Leukemia Treated at U.S. Community Oncology Clinics (Alliance A231602CD). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.13.24311098. [PMID: 39371185 PMCID: PMC11451638 DOI: 10.1101/2024.09.13.24311098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
Objectives To estimate the proportion and correlates of self-reported financial difficulty among patients with multiple myeloma (MM) or chronic lymphocytic leukemia (CLL). Setting 23 U.S. community and minority oncology practice sites affiliated with the National Cancer Institute Community Oncology Research Program (NCORP). Participants 521 patients (≥18 years) with MM or CLL were consented and 416 responded to a survey (completion rate=79.8%). Respondents had a MM diagnosis (74.0%), an associate degree or higher (53.4%), were White (89.2%), insured (100%) and treated with clinician-administered drugs (68.0%). Interventions Observational, prospective, protocol-based survey administered in 2019-2020. Primary and secondary outcome measures Financial difficulty was assessed using a single-item standard measure, the EORTC QLQC30: "Has your physical condition or medical treatment caused you financial difficulties in the past year?" and using an 'any-or-none' composite measure of 22 items assessing financial difficulty, worries and the use of cost-coping strategies. Multivariable logistic regression models assessed the association between financial difficulty, diagnosis, and socioeconomic and treatment characteristics. Results 16.8% reported experiencing financial difficulty using the single-item measure and 60.3% using the composite measure. Most frequently endorsed items in the composite measure were financial worry about having to pay large medical bills related to cancer and difficulty paying medical bills. Financial difficulty using the single-item measure was associated with having MM versus CLL (adjusted odds ratio [aOR], 0.34; 95% CI, 0.13-0.84; P =.02), having insurance other than Medicare (aOR, 2.53; 95% CI, 1.37-4.66; P =.003), being non-White (aOR, 2.21; 95% CI, 1.04-4.72; P =.04), and having a high school education or below (aOR, 0.36; 95% CI, 0.21-0.64; P =.001). Financial difficulty using the composite measure was associated with having a high school education or below (aOR, 0.62; 95% CI, 0.41-0.94; P =.03). Conclusions U.S. patients with blood cancer report financial difficulty, especially those with low socio-economic status. Evidence-based and targeted interventions are needed. Study Strengths and Limitations Strengths: NCORP, a program of the National Cancer Institute (NCI), is a national network for cancer clinical trials and care delivery studies that is comprised of 7 research bases and 46 community sites across the U.S., 14 of which are designated as Minority/Underserved community sites. The study had strong engagement and participation across diverse NCORP Sites across the country and their affiliates. Strong site engagement resulted in high patient recruitment and retention rates for this study (79.8%), despite coincident timing with the initial stages of the COVID-19 pandemic.The survey tool was composed of previously validated items that were modified for this population and new questions that were evaluated for comprehension, which facilitates comparison of our findings to others previously published. Patients targeted for recruitment were treated in the community and recruitment aimed to represent the socioeconomic characteristics of the prevalent patient population. The study relied on both self-report and medical chart abstraction to establish key dependent and independent variables.The primary outcome variable was a previously developed, and empirically tested measure, supporting study internal and external validity. We also used a secondary composite measure of financial difficulty to present a more holistic picture of how cancer diagnosis and treatment impact patients' daily lives and inform decisions to delay or forego care and use cost-coping strategies. By capturing specific worries, decisions and strategies, the composite measure indicates areas where there is a need for greater patient engagement and resource provision at the site of care.Limitations: Among 105 participants who were not included in the final sample, the majority (n=66) were excluded from analysis because they could not be contacted within the 8-week period due to unexpectedly high recruitment volumes across sites.While NCORP sites from across the country participated in the study, 60% of patients recruited to the study were from the Midwest. Although this is the most representative study of financial difficulty in U.S. blood cancer patients to date, our findings may not be fully generalizable to the national CLL and MM communities due to these limitations.
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Fiala MA, Leblanc MR, Coccia KW, Bandaru S, Silberstein AE, Coles T, Vij R. Mixed-Methods Study on the Responsiveness of the Comprehensive Score for Financial Toxicity Among People With Multiple Myeloma. JCO Oncol Pract 2024; 20:835-842. [PMID: 38447085 DOI: 10.1200/op.23.00645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/12/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
PURPOSE Financial toxicity is a contributor to the psychosocial burden of cancer care. There is no consensus measure of financial toxicity; however, recent studies have adopted the Comprehensive Score for Financial Toxicity (COST). Despite its growing popularity, data on the responsiveness to change of the COST instrument are lacking. To address this gap in the literature, we performed a sequential mixed-methods study of people with multiple myeloma. MATERIALS AND METHODS In the quantitative phase of the study, we collected COST scores at two time points approximately 8 weeks apart from 72 patients. In the qualitative phase, we conducted semistructured interviews with a subset of 12 patients who reported the largest changes in scores. The qualitative data were analyzed using a deductive coding scheme developed using the Framework Method in the context of a commonly cited conceptual model of financial toxicity. RESULTS The median absolute change in COST scores was four points (IQR, 2-6). Only 13% of the sample had the same COST scores at both assessments; 38% had an improved score and 50% had a worsened score. Only, seven of the 12 patients (58%) interviewed reported changes to one or more of the constructs in the conceptual model of financial toxicity. Most commonly, changes to out-of-pocket medical costs were reported (5/12). Changes to nonmedical expenses (n = 2) and subjective financial distress without changes to objective financial burden (n = 2) were also reported. CONCLUSION Additional research is needed to explicate changes in COST scores over time.
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Affiliation(s)
- Mark A Fiala
- Division of Oncology, Washington University School of Medicine, St Louis, MO
- School of Social Work, Saint Louis University, St Louis, MO
| | - Matthew R Leblanc
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Ravi Vij
- Division of Oncology, Washington University School of Medicine, St Louis, MO
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Thomson MD, Wilson-Genderson M, Siminoff LA. Cancer patient and caregiver communication about economic concerns and the effect on patient and caregiver partners' perceptions of family functioning. J Cancer Surviv 2024; 18:941-949. [PMID: 36808388 PMCID: PMC10445289 DOI: 10.1007/s11764-023-01341-0] [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] [Received: 11/29/2022] [Accepted: 01/21/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Financial strain and stressful life events can constrain open communication within families. A cancer diagnosis can bring heightened emotional stress and financial strain for most cancer patients and their families. We evaluated how level of comfort and willingness to discuss important but sensitive economic topics affected longitudinal assessments of family relationships, exploring both within-person and between partner effects over 2 years after a cancer diagnosis. METHODS A case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Multi-level models were developed to examine the associations between comfort discussing economic aspects of cancer care and family functioning. RESULTS Broadly, caregivers and patients who were comfortable discussing economic topics reported higher family cohesion and lower family conflict. Dyads' assessments of family functioning were influenced both by their own and their partners level of communication comfort. Overtime, caregiver but not patients perceived a significant decrease in family cohesion. CONCLUSIONS Efforts to address financial toxicity in cancer care should include examination of how patients and families communicate as unaddressed difficulties can have detrimental effects on family functioning in the long term. Future studies should also examine whether the prominence of specific economic topics, such as employment status, varies depending on where the patient is in their cancer journey. IMPLICATIONS FOR CANCER SURVIVORS In this sample, cancer patients did not perceive the decline in family cohesion that was reported by their family caregiver. This is an important finding for future work that aims to identify the timing and nature to best intervene with caregiver supports to mitigate caregiver burden that may negatively impact long-term patient care and QoL.
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Affiliation(s)
- Maria D Thomson
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University/Massey Cancer Center, Richmond, VA, USA.
| | - Maureen Wilson-Genderson
- College of Public Health, Social and Behavioral Sciences, Temple University, Suite 370, 1101 W. Montgomery Ave. Philadelphia, Bell Building, PA, 19122, USA
| | - Laura A Siminoff
- College of Public Health, Social and Behavioral Sciences, Temple University, Suite 370, 1101 W. Montgomery Ave. Philadelphia, Bell Building, PA, 19122, USA
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Fauer AJ, Qiu W, Huang IC, Ganz PA, Casillas JN, Yabroff KR, Armstrong GT, Leisenring W, Howell R, Howell CR, Kirchhoff AC, Yasui Y, Nathan PC. Financial hardship and neighborhood socioeconomic disadvantage in long-term childhood cancer survivors. JNCI Cancer Spectr 2024; 8:pkae033. [PMID: 38676662 PMCID: PMC11126153 DOI: 10.1093/jncics/pkae033] [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: 04/11/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships. METHODS We performed a cross-sectional analysis of data from the Childhood Cancer Survivor Study between 1970 and 1999 and self-reported financial information from 2017 to 2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material and financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status. RESULTS Analysis was restricted to 3475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 years (interquartile range [IQR] = 33-46 years and 47 years (IQR = 39-59 years), respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings; P < .001). One quintile increases in deprivation were associated with small increases in behavioral (second quintile, P = .017) and psychological financial hardship (second quintile, P = .009; third quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income (≥$60 000 income, P < .001) and being single (P = .048). CONCLUSIONS Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Neighborhood-level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships.
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Affiliation(s)
- Alex J Fauer
- Family Caregiving Institute, Betty Irene Moore School of Nursing, Sacramento, CA, USA
- Comprehensive Cancer Center, University of California, Davis, Sacramento, CA, USA
| | - Weiyu Qiu
- University of Alberta, University of Alberta, School of Public Health, Edmonton, AB, Canada
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Patricia A Ganz
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline N Casillas
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Wendy Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rebecca Howell
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Carrie R Howell
- Nutrition Obesity Research Center, Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada
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Edward J, Northrip KD, Rayens MK, Welker A, O’Farrell R, Knuf J, Fariduddin H, Costich J, D’Orazio J. Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers. JNCI Cancer Spectr 2024; 8:pkae025. [PMID: 38552323 PMCID: PMC11087728 DOI: 10.1093/jncics/pkae025] [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: 02/15/2024] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. METHODS We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. RESULTS In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. CONCLUSIONS Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. CLINICALTRIALS.GOV REGISTRATION NCT05876325.
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Affiliation(s)
- Jean Edward
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kimberly D Northrip
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Andrea Welker
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Rachel O’Farrell
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Jennifer Knuf
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Haafsah Fariduddin
- Markey STRONG, Markey Cancer Center, University of Kentucky HealthCare, Lexington, Kentucky, USA
| | - Julia Costich
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - John D’Orazio
- Department of Pediatrics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington, Kentucky, USA
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Wu VS, Shen X, de Moor J, Chino F, Klein J. Financial Toxicity in Radiation Oncology: Impact for Our Patients and for Practicing Radiation Oncologists. Adv Radiat Oncol 2024; 9:101419. [PMID: 38379894 PMCID: PMC10876607 DOI: 10.1016/j.adro.2023.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/16/2023] [Indexed: 02/22/2024] Open
Abstract
With rising costs of diagnosis, treatment, and survivorship, financial burdens on patients with cancer and negative effects from high costs, called financial toxicity (FT), are growing. Research suggests that FT may be experienced by more than half of working-age cancer survivors and a similar proportion may incur debt or avoid recommended prescription medications due to treatment costs. As FT can lead to worse physical, psychological, financial, and survival outcomes, there is a discrete need to identify research gaps around this issue that constrain the development and implementation of effective screening and innovative care delivery interventions. Prior research, including within a radiation oncology-specific context, has sought to identify the scope of FT among patients with cancer, develop assessment tools to evaluate patient risk, quantify financial sacrifices, and qualify care compromises that occur when cancer care is unaffordable. FT is a multifactorial problem and potential solutions should be pursued at all levels of the health care system (patient-provider, institutional, and systemic) with specific regard for patients' individual/local contexts. Solutions may include selecting alternative treatment schedules, discussing financial concerns with patients, providing financial navigation services, low-cost transportation options, and system-wide health policy shifts. This review summarizes existing FT research, describes tools developed to measure FT, and suggests areas for intervention and study to help improve FT and outcomes for radiation oncology patients.
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Affiliation(s)
- Victoria S. Wu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Medical Center, Kansas City, Kansas
| | - Janet de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Klein
- Department of Radiation Oncology, Maimonides Medical Center and State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
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Alacevich C, Abi Nehme AM, Lee JH, Li D, Mobley EM, Close JL, George TJ, LeLaurin JH, Hong YR, Shenkman EA, Gutter MS, Salloum RG. A point-of-care pilot randomized intervention to connect patients with cancer-induced financial toxicity to telehealth financial counseling. Cancer Causes Control 2024; 35:393-403. [PMID: 37794203 PMCID: PMC10872295 DOI: 10.1007/s10552-023-01794-9] [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: 04/12/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Elevated costs of cancer treatment can result in economic and psychological "financial toxicity" distress. This pilot study assessed the feasibility of a point-of-care intervention to connect adult patients with cancer-induced financial toxicity to telehealth-delivered financial counseling. METHODS We conducted a three-armed parallel randomized pilot study, allocating newly referred patients with cancer and financial toxicity to individual, group accredited telehealth financial counseling, or usual care with educational material (1:1:1). We assessed the feasibility of recruitment, randomization, retention, baseline and post-intervention COmprehensive Score for Financial Toxicity (COST), and Telehealth Usability Questionnaire (TUQ) scores. RESULTS Of 382 patients screened, 121 were eligible and enrolled. 58 (48%) completed the intervention (9 individual, 9 group counseling, 40 educational booklet). 29 completed follow-up surveys: 45% female, 17% African American, 79% white, 7% Hispanic, 55% 45-64 years old, 31% over 64, 34% lived in rural areas, 24% had cancer stage I, 21% II, 7% III, 31% IV. Baseline characteristics were balanced across arms, retention status, surveys completion. Mean (SD) COST was 12.4 (6.1) at baseline and 16.0 (8.4) post-intervention. Mean (SD) COST score differences were 6.3 (11.6) after individual counseling, 5.8 (8.5) after group counseling, and 2.5 (6.4) after usual care. Mean TUQ score among nine counseling participants was 5.5 (0.9) over 7.0. Non-parametric comparisons were not statistically meaningful. CONCLUSION Recruitment and randomization were feasible, while study retention presented challenges. Nine participants reported good usability and satisfaction with telehealth counseling. Larger-scale trials focused on improving participation, retention, and impact of financial counseling among patients with cancer are justified.
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Affiliation(s)
- Caterina Alacevich
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA.
| | - Anna Maria Abi Nehme
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, USA
| | - Derek Li
- Department of Biostatistics, University of Florida, Gainesville, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida, Jacksonville, USA
| | - Julia L Close
- Division of Hematology and Oncology, University of Florida, Gainesville, USA
| | - Thomas J George
- Division of Hematology and Oncology, University of Florida, Gainesville, USA
| | - Jennifer H LeLaurin
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Young-Rock Hong
- Health Services Research, Management and Policy, University of Florida, Gainesville, USA
| | - Elizabeth A Shenkman
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Michael S Gutter
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, USA
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, USA
| | - Ramzi G Salloum
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
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9
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Ciftci Y, Radomski SN, Johnston FM, Greer JB. Predictors of Financial Toxicity Risk Among Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). Ann Surg Oncol 2024; 31:1980-1989. [PMID: 38044348 DOI: 10.1245/s10434-023-14577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the preferred treatment for select patients with peritoneal malignancies. However, the procedure is resource intensive and costly. This study aimed to determine the risk of financial toxicity for patients undergoing CRS-HIPEC. PATIENTS AND METHODS We performed a retrospective cohort study of patients undergoing CRS-HIPEC at a single institution from 2016 to 2022. We utilized insurance status, out-of-pocket expenditures, and estimated post-subsistence income to determine risk of financial toxicity. A multivariable logistic regression was used to determine risk factors for financial toxicity. RESULTS Our final study cohort consisted of 163 patients. Average age was 58 [standard deviation 10] years, and 52.8% (n = 86) were male. A total of 52 patients (31.9%) were at risk of financial toxicity. A total of 36 patients (22.1%) were from the lower income quartiles (first or second) and 127 patients (77.9%) were from the higher income quartiles (third or fourth). A total of 47 patients (29%) were insured by Medicare, and 116 patients (71%) had private insurance. The median out-of-pocket expenditure across the study cohort was $3500, with a median of $5000 ($3341-$7350) for the at-risk group and $3341 ($2500-$4022) for the not at-risk group (p < 0.001). Risk factors for financial toxicity included high out-of-pocket expenditures and a lower income quartile. CONCLUSIONS An estimated one-third of patients undergoing CRS-HIPEC at our institution were at risk for financial toxicity. Several preoperative factors were associated with an increased risk and could be utilized to identify patients who might benefit from interventions.
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Affiliation(s)
- Yusuf Ciftci
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shannon N Radomski
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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10
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Su CT, Shankaran V. Digital symptom assessment tools: the next frontier in financial toxicity screening. Nat Rev Clin Oncol 2024; 21:85-86. [PMID: 37880408 DOI: 10.1038/s41571-023-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Christopher T Su
- Division of Hematology and Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
- Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, WA, USA.
| | - Veena Shankaran
- Division of Hematology and Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, WA, USA
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11
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Biddell CB, Spees LP, Trogdon JG, Kent EE, Rosenstein DL, Angove RS, Rogers CD, Wheeler SB. Economic Evaluation of a Nonmedical Financial Assistance Program on Missed Treatment Appointments Among Adults With Cancer. J Clin Oncol 2024; 42:300-311. [PMID: 37897261 PMCID: PMC10824376 DOI: 10.1200/jco.23.00993] [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: 05/09/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/30/2023] Open
Abstract
PURPOSE We retrospectively evaluated the clinical and economic impact of a program providing nonmedical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. MATERIALS AND METHODS We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or no-show) radiation therapy and infusion chemotherapy/immunotherapy appointments in the 180 days after treatment initiation. We used propensity weighting to estimate the effect of the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to conduct a cost-consequence analysis from the health system perspective in a hypothetical cohort over a 6-month time horizon. RESULTS Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (n = 715) had ≥1 no-shows and 28% (n = 378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI, 0.6 to 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 in US dollars per missed appointment averted, relative to not providing nonmedical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (n = 541) received program assistance, and only 14% (n = 223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. CONCLUSION This study used a novel approach to retrospectively evaluate a nonmedical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients' nonmedical financial needs, particularly for those undergoing intensive radiation therapy.
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Affiliation(s)
- Caitlin B. Biddell
- Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lisa P. Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Justin G. Trogdon
- Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Erin E. Kent
- Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Donald L. Rosenstein
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- Department of Psychiatry, UNC School of Medicine, Chapel Hill, NC
| | | | | | - Stephanie B. Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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12
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Williams C, Meyer L, Kawam O, Leventakos K, DeMartino ES. The Faces of Financial Toxicity: A Qualitative Interview Study of Financial Toxicity in Advanced Cancer Patients in Phase I Oncology Trials. Mayo Clin Proc Innov Qual Outcomes 2023; 7:524-533. [PMID: 38035050 PMCID: PMC10685144 DOI: 10.1016/j.mayocpiqo.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Objective To characterize the financial toxicity experienced by advanced cancer patients enrolled in phase I oncology trials. Patients and Methods We conducted structured interviews with cancer patients participating in phase I clinical trials. Using a thematic analysis approach, we identified recurring themes in patients' experiences of financial toxicity resulting from trial participation. Results Seven major themes emerged from the interviews: (1) the burden of travel, (2) a willingness to pursue treatment despite financial risk, (3) fear of destitution, (4) financial toxicity equaling physical toxicity, (5) changes in food spending, (6) reluctance to confide in the study investigator about financial toxicity, and (7) difficulty navigating financial aid. These themes highlight the multifaceted financial challenges faced by patients in early phase clinical trials and the need for targeted support services. Conclusion Our findings underscore the relevance of financial toxicity in the context of phase I clinical trials and provide insights into the diverse challenges faced by advanced cancer patients. These challenges likely augment the disparities seen in trial enrollment for historically marginalized populations. Addressing financial toxicity in this population is crucial for improving patient outcomes and quality of life. Future research should focus on developing effective interventions and support services tailored to the needs of patients in early phase clinical trials.
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Affiliation(s)
- Colt Williams
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Leigh Meyer
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | - Omar Kawam
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
| | | | - Erin S. DeMartino
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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13
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You W, Pilehvari A, Shi R, Cohn W, Sheffield C, Chow PI, Krukowski BA, Anderson R. A multi-dimensional assessment of financial hardship of cancer patients using existing health system data. Cancer Med 2023; 12:22263-22277. [PMID: 37987094 PMCID: PMC10757134 DOI: 10.1002/cam4.6731] [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: 05/20/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Existing financial hardship screening does not capture the multifaceted and dynamic nature of the problem. The use of existing health system data is a promising way to enable scalable and sustainable financial hardship screening. METHODS We used existing data from 303 adult patients with cancer at the University of Virginia Comprehensive Cancer Center (2016-2018). All received distress screening and had a valid financial assistance screening based solely on household size-adjusted income. We constructed a composite index that integrates multiple existing health system data (Epic, distress screening, and cancer registry) to assess comprehensive financial hardship (e.g., material conditions, psychological responses, and coping behaviors). We examined differences of at-risk patients identified by our composite index and by existing single-dimension criterion. Dynamics of financial hardship over time, by age, and cancer type, were examined by fractional probit models. RESULTS At-risk patients identified by the composite index were generally younger, better educated, and had a higher annual household income, though they had lower health insurance coverage. Identified periods to intervene for most patients are before formal diagnosis, 2 years, and 6 years after diagnosis. Within 2 years of diagnosis and more than 4 years after diagnosis appear critical for subgroups of patients who may suffer from financial hardship disparities. CONCLUSION Existing health system data provides opportunities to systematically measure and track financial hardship in a systematic, scalable and sustainable way. We find that the dimensions of financial hardship can exhibit different patterns over time and across patient subgroups, which can guide targeted interventions. The scalability of the algorithm is limited by existing data availability.
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Affiliation(s)
- Wen You
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Asal Pilehvari
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Ruoding Shi
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Wendy Cohn
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Christina Sheffield
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Philip I‐Fon Chow
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | | | - Roger Anderson
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
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14
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Grafova IB, Manne SL, Hudson SV, Elliott J, Llanos AAM, Saraiya B, Duberstein PR. Functional impairment is associated with medical debt in male cancer survivors and credit card debt in female cancer survivors. Support Care Cancer 2023; 31:605. [PMID: 37782442 DOI: 10.1007/s00520-023-08070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To examine the associations of functional limitations with medical and credit card debt among cancer survivor families and explore sex differences in these associations. METHODS This cross-sectional study used data from the 2019 wave of the Panel Study of Income Dynamics, a nationally representative, population-based survey of individuals and households in the US administered in both English and Spanish and includes all households where either the head of household or spouse/partner reported having been diagnosed with cancer. Participants reported on functional limitations in six instrumental activities of daily living (IADL) and seven activities of daily living (ADL). Functional impairment was categorized as 0, 1-2 and ≥ 3 limitations. Medical debt was defined as self-reported unpaid medical bills. Credit card debt was defined as revolving credit card debt. Multivariable logistic regression analyses were performed. RESULTS Credit card debt was more common than medical debt (39.8% vs. 7.6% of cancer survivor families). Families of male cancer survivors were 7.3 percentage points more likely to have medical debt and 16.0 percentage points less likely to have credit card debt compared to families of female cancer survivors. Whereas male cancer survivors with increasing levels of impairment were 24.7 percentage point (p-value = 0.006) more likely to have medical debt, female survivors with more functional impairment were 13.6 percentage points (p-value = 0.010) more likely to have credit card debt. CONCLUSIONS More research on medical and credit card debt burden among cancer survivors with functional limitations is needed.
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Affiliation(s)
- Irina B Grafova
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, New Brunswick, NJ, 08901, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Jennifer Elliott
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, New Brunswick, NJ, 08901, USA
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Paul R Duberstein
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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15
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Yeager KA, Zahnd WE, Eberth JM, Vanderpool RC, Rohweder C, Teal R, Vu M, Stradtman L, Frost EL, Trapl E, Gonzalez SK, Vu T, Ko LK, Cole A, Farris PE, Shannon J, Askelson N, Seegmiller L, White A, Edward J, Davis M, Petermann V, Wheeler SB. Financial navigation: Staff perspectives on patients' financial burden of cancer care. J Cancer Surviv 2023; 17:1461-1470. [PMID: 35080699 PMCID: PMC9314461 DOI: 10.1007/s11764-022-01175-2] [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: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe perceptions of financial navigation staff concerning patients' cancer-related financial burden. METHODS This qualitative descriptive study used a semi-structured interview guide to examine perceptions of financial navigation staff concerning patients' cancer-related financial burden. Staff who provided financial navigation support services to cancer patients were interviewed from different types of cancer programs across seven states representing rural, micropolitan, and urban settings. Interviews lasted approximately one hour, were audio recorded, and transcribed. Transcripts were double coded for thematic analysis. RESULTS Thirty-five staff from 29 cancer centers were interviewed. The first theme involved communication issues related to patient and financial navigation staff expectations, timing and the sensitive nature of financial discussions. The second theme involved the multi-faceted impact of financial burden on patients, including stress, difficulty adhering to treatments, and challenges meeting basic, non-medical needs. CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS: Cancer-related financial burden has a profound impact on cancer survivors' health and non-health outcomes. Discussions regarding cancer-related costs between cancer survivors and healthcare team members could help to normalize conversations and mitigate the multi-faceted determinants and effects of cancer-related financial burden. As treatment may span months and years and unexpected costs arise, having this discussion regularly and systematically is needed.
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Affiliation(s)
| | - Whitney E Zahnd
- University of Iowa, Iowa City, IA, USA
- University of South Carolina, Columbia, SC, USA
| | | | | | | | - Randall Teal
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Erika Trapl
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Thuy Vu
- University of Washington, Seattle, WA, USA
| | - Linda K Ko
- University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Arica White
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Melinda Davis
- Oregon Health & Science University, Portland, OR, USA
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16
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Reeder-Hayes KE, Biddell CB, Manning ML, Rosenstein DL, Samuel-Ryals CA, Spencer JC, Smith S, Deal A, Gellin M, Wheeler SB. Knowledge, Attitudes, and Resources of Frontline Oncology Support Personnel Regarding Financial Burden in Patients With Cancer. JCO Oncol Pract 2023; 19:654-661. [PMID: 37294912 DOI: 10.1200/op.22.00631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/16/2022] [Accepted: 03/03/2023] [Indexed: 06/11/2023] Open
Abstract
PURPOSE Financial navigation services support patients with cancer and address the direct and indirect financial burden of cancer diagnosis and treatment. These services are commonly delivered through a variety of frontline oncology support personnel (FOSP) including navigators, social workers, supportive care providers, and other clinic staff, but the perspective of FOSPs is largely absent from current literature on financial burden in oncology. We surveyed a national sample of FOSPs to understand their perspectives on patient financial burden, resource availability, and barriers and facilitators to assisting patients with cancer-related financial burden. METHODS We used Qualtrics online survey software and recruited participants using multiple professional society and interest group mailing lists. Categorical responses were described using frequencies, distributions of numeric survey responses were described using the median and IQR, and two open-ended survey questions were categorized thematically using a priori themes, allowing additional emergent themes. RESULTS Two hundred fourteen FOSPs completed this national survey. Respondents reported a high awareness of patient financial burden and felt comfortable speaking to patients about financial concerns. Patient assistance resources were commonly available, but only 15% described resources as sufficient for the observed needs. A substantial portion of respondents reported moral distress related to this lack of resources. CONCLUSION FOSPs, who already have requisite knowledge and comfort in discussing patient financial needs, are a critical resource for mitigating cancer-related financial burden. Interventions should leverage this resource but prioritize transparency and efficiency to reduce the administrative and emotional toll on the FOSP workforce and reduce the risk of burnout.
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Affiliation(s)
- Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michelle L Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald L Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cleo A Samuel-Ryals
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Current Address: Flatiron Health, New York, NY
| | - Jennifer C Spencer
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Current Address: Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX
| | | | - Allison Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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17
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Mudaranthakam DP, Hughes D, Johnson P, Mason T, Nollen N, Wick J, Welch DR, Calhoun E. Career disruption and limitation of financial earnings due to cancer. JNCI Cancer Spectr 2023; 7:pkad044. [PMID: 37326961 PMCID: PMC10359624 DOI: 10.1093/jncics/pkad044] [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: 01/25/2023] [Revised: 04/24/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE This study investigated how cancer diagnosis and treatment lead to career disruption and, consequently, loss of income and depletion of savings. DESIGN This study followed a qualitative descriptive design that allowed us to understand the characteristics and trends of the participants. METHOD Patients recruited (n = 20) for this study were part of the University of Kansas Cancer Center patient advocacy research group (Patient and Investigator Voices Organizing Together). The inclusion criteria were that participants must be cancer survivors or co-survivors, be aged 18 years or older, be either employed or a student at the time of cancer diagnosis, have completed their cancer treatment, and be in remission. The responses were transcribed and coded inductively to identify themes. A thematic network was constructed based on those themes, allowing us to explore and describe the intricacies of the various themes and their impacts. RESULTS Most patients had to quit their jobs or take extended absences from work to handle treatment challenges. Patients employed by the same employer for longer durations had the most flexibility to balance their time between cancer treatment and work. Essential, actionable items suggested by the cancer survivors included disseminating information about coping with financial burdens and ensuring that a nurse and financial navigator were assigned to every cancer patient. CONCLUSIONS Career disruption is common among cancer patients, and the financial burden due to their career trajectory is irreparable. The financial burden is more prominent in younger cancer patients and creates a cascading effect that financially affects close family members.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Dorothy Hughes
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peggy Johnson
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Tracy Mason
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Nicole Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Danny R Welch
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Population Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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18
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Doherty M, Jacoby J, Copeland A, Mangir C, Hodzic RK, Cadet TJ. Building Organizational Capacity to Deliver Oncology Financial Advocacy. JOURNAL OF ONCOLOGY NAVIGATION & SURVIVORSHIP 2023; 14:203-210. [PMID: 37614869 PMCID: PMC10443934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Background Cancer-related financial hardship is linked to poor health outcomes and early mortality. Oncology financial advocacy (OFA) aims to prevent cancer-related financial hardship in oncology settings by assessing patients' needs and connecting them to available financial resources. Despite promising evidence, OFA remains underutilized. Objectives Describe oncology financial advocates' perceptions about the challenges to and opportunities for implementing oncology financial advocacy (OFA) in community cancer centers. Methods Nine virtual focus groups were conducted with 45 oncology financial advocates. Focus group transcripts were analyzed using template-based thematic analysis informed by the Consolidated Framework for Implementation Research (CFIR); two study team members coded each transcript and all six team members identified emergent themes. Results Salient themes were identified across all five domains of the CFIR framework: (1) intervention characteristics: participants described challenges of adapting OFA to meet the needs of the medical system instead of needs of the patients; (2) outer setting: growing awareness of health and cancer disparities could bring more attention to and investment in OFA; (3) inner setting: programs are under-resourced to assist all at-risk patients, staffing, technology integration, and network/communication workflows are needed; (4) characteristics of individuals: advocates believe strongly in the effectiveness and would like to see their credibility enhanced with professional certification; (5) process: implementation strategies that target the engagement of leadership, key stakeholders, and patients to increase program reach are needed. Conclusions OFA cannot reach all at-risk patients because of understaffing, poor communication between departments, and a lack of understanding OFA as an intervention among colleagues, key stakeholders, and patients. To reach full implementation, advocates need assistance in making the case for more resources, research on patient outcomes, professional certification, and the use of policy to incentivize financial advocacy as a standard of care in medicine.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania
| | - Jessica Jacoby
- School of Social Policy and Practice, University of Pennsylvania
| | | | | | | | - Tamara J. Cadet
- School of Social Policy and Practice, University of Pennsylvania
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19
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Doherty M, Heintz J, Leader A, Wittenburg D, Ben-Shalom Y, Jacoby J, Castro A, West S. Guaranteed Income and Financial Treatment Trial (GIFT Trial or GIFTT): a 12-month, randomized controlled trial to compare the effectiveness of monthly unconditional cash transfers to treatment as usual in reducing financial toxicity in people with cancer who have low incomes. Front Psychol 2023; 14:1179320. [PMID: 37275728 PMCID: PMC10234289 DOI: 10.3389/fpsyg.2023.1179320] [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: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Cancer-related financial hardship (i.e., financial toxicity) has been associated with anxiety and depression, greater pain and symptom burden, treatment nonadherence, and mortality. Out-of-pocket healthcare costs and lost income are primary drivers of financial toxicity, however, income loss is a pronounced risk factor for cancer patients with low incomes. There has been little progress in developing an income intervention to alleviate financial toxicity cancer patients with low incomes. Unconditional cash transfers (UCT), or guaranteed income, have produced positive health effects in experiments with general low-income populations, but have not yet been evaluated in people with cancer. The Guaranteed Income and Financial Treatment (GIFT) Trial will use a two-arm randomized controlled trial to compare the efficacy of a 12-month UCT intervention providing $1000/month to treatment as usual on financial toxicity, health-related quality of life and treatment adherence in people with cancer who have low-incomes. The study will recruit 250 Medicaid beneficiaries with advanced cancer from two comprehensive cancer centers in Philadelphia, obtain informed consent, and randomize patients to one of two conditions: (1) $1,000/month UCT or (2) treatment as usual. Both arms will receive information on financial toxicity and the contact information for their hospital social worker or financial advocate upon enrollment. Participants will complete online surveys at baseline, 3, 6, 9, and 12 months from enrollment to collect patient-reported data on primary (i.e., financial toxicity, health-related quality of life, and treatment adherence) and secondary outcomes (i.e., anxiety, depression, food insecurity, housing stability). Social security records will be used to explore the effect on mortality at 2, 3, and 5 years post-enrollment. Linear mixed-models will be used to analyze all primary and secondary continuous outcomes over time and general estimating equations with a logit link and binary distribution for all binary outcomes over time. Differences between treatment and control groups and treatment effects will be determined using models that control for age, gender, race, baseline food security, baseline housing stability, and baseline ECOG. Findings from this study will have significant implications for the development and implementation of programs and policies that address the financial burden of cancer and other serious illnesses.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Jonathan Heintz
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy Leader
- Sidney Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA, United States
| | | | | | - Jessica Jacoby
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Amy Castro
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, United States
| | - Stacia West
- College of Social Work, University of Tennessee, Knoxville, TN, United States
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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21
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Vu M, Boyd K, De Marchis EH, Garnache BG, Gottlieb LM, Gross CP, Lee NK, Lindau ST, Mun S, Winslow VA, Makelarski JA. Perceived Appropriateness of Assessing for Health-related Socioeconomic Risks Among Adult Patients with Cancer. CANCER RESEARCH COMMUNICATIONS 2023; 3:521-531. [PMID: 37020993 PMCID: PMC10069714 DOI: 10.1158/2767-9764.crc-22-0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/17/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
Cancer treatment can trigger or exacerbate health-related socioeconomic risks (HRSR; food/housing insecurity, transportation/utilities difficulties, and interpersonal violence). The American Cancer Society and National Cancer Institute recommend HRSR screening and referral, but little research has examined the perceptions of patients with cancer on the appropriateness of HRSR screening in healthcare settings. We examined whether HRSR status, desire for assistance with HRSRs, and sociodemographic and health care-related factors were associated with perceived appropriateness of HRSR screening in health care settings and comfort with HRSR documentation in electronic health records (EHR). A convenience sample of adult patients with cancer at two outpatient clinics completed self-administered surveys. We used χ 2 and Fisher exact tests to test for significant associations. The sample included 154 patients (72% female, 90% ages 45 years or older). Thirty-six percent reported ≥1 HRSRs and 27% desired assistance with HRSRs. Overall, 80% thought it was appropriate to assess for HRSRs in health care settings. The distributions of HRSR status and sociodemographic characteristics were similar among people who perceived screening to be appropriate and those who did not. Participants who perceived screening as appropriate were three times as likely to report prior experience with HRSR screening (31% vs. 10%, P = 0.01). Moreover, 60% felt comfortable having HRSRs documented in the EHR. Comfort with EHR documentation of HRSRs was significantly higher among patients desiring assistance with HRSRs (78%) compared with those who did not (53%, P < 0.01). While initiatives for HRSR screening are likely to be seen by patients with cancer as appropriate, concerns may remain over electronic documentation of HRSRs. Significance National organizations recommend addressing HRSRs such as food/housing insecurity, transportation/utilities difficulties, and interpersonal violence among patients with cancer. In our study, most patients with cancer perceived screening for HRSRs in clinical settings as appropriate. Meanwhile, concerns may remain over the documentation of HRSRs in EHRs.
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Affiliation(s)
- Milkie Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kelly Boyd
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Emilia H. De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Bridgette G. Garnache
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Laura M. Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- National Clinician Scholars Program, Yale University, New Haven, Connecticut
| | - Nita K. Lee
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- Department of Medicine-Geriatrics, The University of Chicago Medicine, Chicago, Illinois
- Comprehensive Cancer Center, The University of Chicago Medicine, Chicago, Illinois
| | - Sophia Mun
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago Medicine, Chicago, Illinois
- College of Education and Health Services, Benedictine University, Lisle, Illinois
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22
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Nguyen OT, Donato U, McCormick R, Reblin M, Kim L, Hume E, Otto AK, Alishahi Tabriz A, Islam JY, Hong Y, Turner K, Patel KB. Financial toxicity among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2023; 8:450-457. [PMID: 37090884 PMCID: PMC10116977 DOI: 10.1002/lio2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives Head and neck cancer (HNC) patients experience greater financial toxicity than other cancer patients. Research on financial toxicity has concentrated on patients despite many informal caregivers sharing finances and reducing work hours to provide patient care. Thus, our pilot study: (1) assessed the feasibility of financial toxicity screening of HNC patients and their caregivers, and (2) described financial toxicity levels of HNC patients and their caregivers. Methods We surveyed English-speaking adult HNC patients initiating treatment at a National Cancer Institute-designated Comprehensive Cancer Center and their informal caregivers. This survey assessed demographics and financial toxicity through the Comprehensive Score for Financial Toxicity (COST) measure (0-44 range; lower score indicates higher financial toxicity). Screening feasibility was defined as ≥50% consent rate and ≥60% data completion rate. Results Our sample included 27 HNC patients and 9 caregivers. They both had slightly lower consent and completion rates than our goals. Patients reported a median COST score of 27 while caregivers reported a median COST score of 16. Approximately 25.9% of patients and 44.4% of caregivers reported high financial toxicity (COST < 17.5). Caregivers reported high concerns about their future financial health and their ability to control the amount of their financial contributions to the patient's care. Conclusions Patients and caregivers may require additional outreach approaches beyond emailed questionnaires to screen for their financial toxicity systematically. Future research is needed to replicate our results to determine whether differences in financial toxicity occur between patients and caregivers and identify areas of focus for interventions. Level of evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Umberto Donato
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- College of Medicine, University of South FloridaTampaFloridaUSA
| | | | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA
- Cancer Control and Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Amy K. Otto
- Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Jessica Y. Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services, Research, and ManagementUniversity of FloridaGainesvilleFloridaUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
- Department of Oncologic SciencesUniversity of South FloridaTampaFloridaUSA
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
| | - Krupal B. Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaFloridaUSA
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23
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Paradis LJ, Chao A, Rimer BK, Sandler AB, Duncan K, Cira MK, Hanisch R. The US President's Cancer Panel: A Model For Gathering Country-Level Input to Inform Cancer Control Policy and Program Initiatives. JCO Glob Oncol 2023; 9:e2200410. [PMID: 36921241 PMCID: PMC10497262 DOI: 10.1200/go.22.00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/09/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE The President's Cancer Panel (Panel) is a federal advisory committee charged with monitoring the US National Cancer Program and reporting directly to the US President. Since its creation a half century ago, the Panel has gathered input from individuals and organizations across the US cancer community and beyond and recommended actions to accelerate progress against cancer. The Panel is unique in its structure and function, and merits examination for its potential applicability in other settings worldwide. METHODS We present an overview of the general President's Cancer Panel model and describe the noteworthy and unique characteristics of the Panel that help achieve its charge. We also detail the specific processes, outputs, and achievements of the Panel appointed by President Barack Obama, which served between 2012 and 2018. RESULTS From 2012 to 2018, the Panel focused on three topics that addressed timely issues in cancer prevention and control: (1) HPV vaccination for cancer prevention, (2) connected health and cancer, and (3) value and affordability of cancer drug treatment. The Panel held 11 meetings with 165 participants who provided diverse perspectives on these issues. Four reports were delivered to the president, which were cited about 270 times in the literature. Over 20 collaborator activities, including commitments of funding, can be linked to the recommendations published in these reports. CONCLUSION The US President's Cancer Panel highlights the importance of independent advisory bodies within a national cancer control program and of national leadership support for the cancer community. The structure and function of the Panel could be applicable in other settings worldwide.
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Affiliation(s)
- Lisa J. Paradis
- Former Employee of US National Cancer Institute (2011-2018), Rockville, MD
| | - Ann Chao
- US National Cancer Institute, Rockville, MD
| | - Barbara K. Rimer
- Former Employee of US National Cancer Institute (2011-2018), Rockville, MD
- UNC Gillings School of Global Public Health, Chapel Hill, NC
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24
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Beauchemin MP, DeStephano D, Raghunathan R, Harden E, Accordino M, Hillyer GC, Kahn JM, May BL, Mei B, Rosenblat T, Law C, Elkin EB, Kukafka R, Wright JD, Hershman DL. Implementation of Systematic Financial Screening in an Outpatient Breast Oncology Setting. JCO Clin Cancer Inform 2023; 7:e2200172. [PMID: 36944141 PMCID: PMC10530809 DOI: 10.1200/cci.22.00172] [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: 11/13/2022] [Accepted: 01/30/2023] [Indexed: 03/23/2023] Open
Abstract
PURPOSE Implementation of routine financial screening is a critical step toward mitigating financial toxicity. We evaluated the feasibility, sustainability, and acceptability of systematic financial screening in the outpatient breast oncology clinic at a large, urban cancer center. METHODS We developed and implemented a stakeholder-informed process to systematically screen for financial hardship and worry. A 2-item assessment in English or Spanish was administered to patients through the electronic medical record portal or using paper forms. We evaluated completion rates and mode of completion. Through feedback from patients, clinicians, and staff, we identified strategies to improve completion rates and acceptability. RESULTS From March, 2021, to February, 2022, 3,500 patients were seen in the breast oncology clinic. Of them, 39% (n = 1,349) responded to the screening items, either by paper or portal, 12% (n = 437) preferred not to answer, and the remaining 49% (n = 1,714) did not have data in their electronic health record, meaning they were not offered screening or did not complete the paper forms. Young adults (18-39 years) were more likely to respond compared with patients 70 years or older (61% v 30%, P < .01). English-preferring patients were more likely to complete the screening compared with those who preferred Spanish (46% v 28%, P < .01). Non-Hispanic White patients were more likely to respond compared with Non-Hispanic Black patients and with Hispanic patients (46% v 39% v 32%, P < .01). Strategies to improve completion rates included partnering with staff to facilitate paper form administration, optimizing patient engagement with the portal, and clearly communicating the purpose of the screening. CONCLUSION Systematic financial screening is feasible, and electronic data capture facilitates successful implementation. However, inclusive procedures that address language and technology preferences are needed to optimize screening.
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Affiliation(s)
- Melissa P. Beauchemin
- School of Nursing, Columbia University Irving Medical Center, New York, NY
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - David DeStephano
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Rohit Raghunathan
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Erik Harden
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Melissa Accordino
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Grace C. Hillyer
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Justine M. Kahn
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Benjamin L. May
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
| | - Billy Mei
- Clinical Information Technology Shared Resources, New York Presbyterian Hospital, New York, NY
| | - Todd Rosenblat
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Cynthia Law
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Elena B. Elkin
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY
| | - Rita Kukafka
- Department of Biomedical Informatics, Columbia University, New York, NY
| | - Jason D. Wright
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY
- Division of Hematology/Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, NY
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25
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Robien K, Clausen M, Sullo E, Ford YR, Griffith KA, Le D, Wickersham KE, Wallington SF. Prevalence of Food Insecurity Among Cancer Survivors in the United States: A Scoping Review. J Acad Nutr Diet 2023; 123:330-346. [PMID: 35840079 DOI: 10.1016/j.jand.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Medical financial hardship is an increasingly common consequence of cancer treatment and can lead to food insecurity. However, food security status is not routinely assessed in the health care setting, and the prevalence of food insecurity among cancer survivors is unknown. OBJECTIVE This scoping review aimed to identify the prevalence of food insecurity among cancer survivors in the United States before the COVID-19 pandemic. METHODS Five databases (PubMed, Scopus, CINAHL [Cumulative Index to Nursing and Allied Health Literature], Web of Science, and ProQuest Dissertations and Theses) were systematically searched for articles that reported on food security status among US patients receiving active cancer treatment or longer-term cancer survivors and were published between January 2015 and December 2020. RESULTS Among the 15 articles meeting the inclusion criteria, overall food insecurity prevalence ranged from 4.0% among women presenting to a gynecologic oncology clinic to 83.6% among patients at Federally Qualified Health Centers. Excluding studies focused specifically on Federally Qualified Health Center patients, prevalence of food insecurity ranged from 4.0% to 26.2%, which overlaps the food insecurity prevalence in the general US population during the same time period (range, 10.5% to 14.9%). Women were more likely than men to report being food insecure, and the prevalence of food insecurity was higher among Hispanic and Black patients compared with non-Hispanic White patients. CONCLUSIONS Given significant heterogeneity in study populations and sample sizes, it was not possible to estimate an overall food insecurity prevalence among cancer survivors in the United States. Routine surveillance of food security status and other social determinants of health is needed to better detect and address these issues.
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Affiliation(s)
- Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC; GW Cancer Center, George Washington University, Washington, DC.
| | | | - Elaine Sullo
- Himmelfarb Health Sciences Library, George Washington University, Washington, DC
| | - Yvonne R Ford
- School of Nursing, North Carolina A&T State University, Greensboro, NC
| | - Kathleen A Griffith
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | - Daisy Le
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
| | | | - Sherrie Flynt Wallington
- GW Cancer Center, George Washington University, Washington, DC; School of Nursing, George Washington University, Washington, DC
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26
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Doherty M, Jacoby J, Gany F. " I wish I knew about these programs before!" A brief report exploring barriers to financial assistance reported by gynecological oncology patients. J Psychosoc Oncol 2022; 41:493-501. [PMID: 36514954 PMCID: PMC10322634 DOI: 10.1080/07347332.2022.2149374] [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: 12/15/2022]
Abstract
PURPOSE Despite widespread reports of cancer-related financial hardship, hospital financial assistance programs are underutilized. APPROACH Rapid qualitative research. SAMPLE Gynecologic oncology patients with recurrent or metastatic disease, under 65 years old, and Comprehensive Score for Financial Toxicity of 26 or under. METHODS Semi-structured interviews to elicit (1) financial assistance awareness/knowledge, (2) barriers to accessing assistance, and (3) suggestions for improving access. We analyzed the transcripts using thematic analysis: open coding, consensus building/codebook, and identification of salient themes. FINDINGS We interviewed 25 patients and identified four barriers and three suggestions for improving access. Barriers: lack of awareness, perceptions of ineligibility, fear of negative consequences, and being overwhelmed. Suggestions: simplifying financial processes, providing individualized assistance, and being more proactive by intervening earlier. CONCLUSION Increase access by reducing stigma, misconceptions, and more proactively engaging at-risk patients. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Patients may be too afraid or overwhelmed to ask for help. A more proactive, psychosocial approach is needed.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jessica Jacoby
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francesca Gany
- Center for Immigrant Health and Cancer Disparities, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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27
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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28
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Nguyen OT, McCormick R, Patel K, Reblin M, Kim L, Hume E, Powers B, Otto A, Alishahi Tabriz A, Islam J, Hong Y, Kirchhoff AC, Turner K. Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1820-1829. [PMID: 36544972 PMCID: PMC9764792 DOI: 10.1002/lio2.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0-84). Objective health insurance literacy was measured through correct answers to a previously developed 10-question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10-item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out-of-pocket costs for out-of-network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Krupal Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA
- Cancer Control & Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Benjamin Powers
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amy Otto
- Department of Public Health SciencesUniversity of MiamiCoral GablesFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
| | - Jessica Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services Research and ManagementUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA
- Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
- Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
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29
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Wheeler SB, Birken SA, Wagi CR, Manning ML, Gellin M, Padilla N, Rogers C, Rodriguez J, Biddell CB, Strom C, Bell RA, Rosenstein DL. Core functions of a financial navigation intervention: An in-depth assessment of the Lessening the Impact of Financial Toxicity (LIFT) intervention to inform adaptation and scale-up in diverse oncology care settings. FRONTIERS IN HEALTH SERVICES 2022; 2:958831. [PMID: 36925862 PMCID: PMC10012722 DOI: 10.3389/frhs.2022.958831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
Background Lessening the Impact of Financial Toxicity (LIFT) is an intervention designed to address financial toxicity (FT) and improve cancer care access and outcomes through financial navigation (FN). FN identifies patients at risk for FT, assesses eligibility for financial support, and develops strategies to cope with those costs. LIFT successfully reduced FT and improved care access in a preliminary study among patients with high levels of FT in a single large academic cancer center. Adapting LIFT requires distinguishing between core functions (components that are key to its implementation and effectiveness) and forms (specific activities that carry out core functions). Our objective was to complete the first stage of adaptation, identifying LIFT core functions. Methods We reviewed LIFT's protocol and internal standard-operating procedures. We then conducted 45-90 min in-depth interviews, using Kirk's method of identifying core functions, with key LIFT staff (N = 8), including the principal investigators. Interviews focused on participant roles and intervention implementation. Recorded interviews were transcribed verbatim. Using ATLAS.ti and a codebook based on the Model for Adaptation Design and Impact, we coded interview transcripts. Through thematic analysis, we then identified themes related to LIFT's intervention and implementation core functions. Two report back sessions with interview participants were incorporated to further refine themes. Results Six intervention core functions (i.e., what makes LIFT effective) and five implementation core functions (i.e., what facilitated LIFT's implementation) were identified to be sufficient to reduce FT. Intervention core functions included systematically cataloging knowledge and tracking patient-specific information related to eligibility criteria for FT relief. Repeat contacts between the financial navigator and participant created an ongoing relationship, removing common barriers to accessing resources. Implementation core functions included having engaged sites with the resources and willingness necessary to implement FN. Developing navigators' capabilities to implement LIFT-through training, an established case management system, and connections to peer navigators-were also identified as implementation core functions. Conclusion This study adds to the growing evidence on FN by characterizing intervention and implementation core functions, a critical step toward promoting LIFT's implementation and effectiveness.
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Affiliation(s)
- Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah A. Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Cheyenne R. Wagi
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Michelle L. Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Neda Padilla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cindy Rogers
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julia Rodriguez
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin B. Biddell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carla Strom
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Ronny Antonio Bell
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
| | - Donald L. Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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30
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Wheeler SB, Biddell CB, Manning ML, Gellin MS, Padilla NR, Spees LP, Rogers CD, Rodriguez-O'Donnell J, Samuel-Ryals C, Birken SA, Reeder-Hayes KE, Petermann VM, Deal AM, Rosenstein DL. Lessening the Impact of Financial Toxicity (LIFT): a protocol for a multi-site, single-arm trial examining the effect of financial navigation on financial toxicity in adult patients with cancer in rural and non-rural settings. Trials 2022; 23:839. [PMID: 36192802 PMCID: PMC9527389 DOI: 10.1186/s13063-022-06745-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost half of the patients with cancer report cancer-related financial hardship, termed "financial toxicity" (FT), which affects health-related quality of life, care retention, and, in extreme cases, mortality. This increasingly prevalent hardship warrants urgent intervention. Financial navigation (FN) targets FT by systematically identifying patients at high risk, assessing eligibility for existing resources, clarifying treatment cost expectations, and working with patients and caregivers to develop a plan to cope with cancer costs. This trial seeks to (1) identify FN implementation determinants and implementation outcomes, and (2) evaluate the effectiveness of FN in improving patient outcomes. METHODS The Lessening the Impact of Financial Toxicity (LIFT) study is a multi-site Phase 2 clinical trial. We use a pre-/post- single-arm intervention to examine the effect of FN on FT in adults with cancer. The LIFT trial is being conducted at nine oncology care settings across North Carolina in the United States. Sites vary in geography (five rural, four non-rural), size (21-974 inpatient beds), and ownership structure (governmental, non-profit). The study will enroll 780 patients total over approximately 2 years. Eligible patients must be 18 years or older, have a confirmed cancer diagnosis (any type) within the past 5 years or be living with advanced disease, and screen positive for cancer-related financial distress. LIFT will be delivered by full- or part-time financial navigators and consists of 3 components: (1) systematic FT screening identification and comprehensive intake assessment; (2) connecting patients experiencing FT to financial support resources via trained oncology financial navigators; and (3) ongoing check-ins and electronic tracking of patients' progress and outcomes by financial navigators. We will measure intervention effectiveness by evaluating change in FT (via the validated Comprehensive Score of Financial Toxicity, or COST instrument) (primary outcome), as well as health-related quality of life (PROMIS Global Health Questionnaire), and patient-reported delayed or forgone care due to cost. We also assess patient- and stakeholder-reported implementation and service outcomes post-intervention, including uptake, fidelity, acceptability, cost, patient-centeredness, and timeliness. DISCUSSION This study adds to the growing evidence on FN by evaluating its implementation and effectiveness across diverse oncology care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04931251. Registered on June 18, 2021.
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Affiliation(s)
- Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Caitlin B Biddell
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mindy S Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neda R Padilla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa P Spees
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cynthia D Rogers
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Rodriguez-O'Donnell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cleo Samuel-Ryals
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, NC, USA.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Victoria M Petermann
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Departments of Psychiatry and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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31
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Nash SH, Dilley J, Siekaniec C, O'Brien D, Avila R, Quinn J. Needs assessment of cancer survivors in Alaska. Cancer Causes Control 2022; 33:1453-1463. [PMID: 36183311 PMCID: PMC9526813 DOI: 10.1007/s10552-022-01636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/25/2022]
Abstract
Purpose Little is known about cancer survivors’ needs in Alaska. To address this knowledge gap, the Alaska Cancer Partnership conducted a needs assessment survey; our objectives were to identify unmet needs of Alaska’s cancer survivors; identify survivor sub-populations that might benefit from targeted interventions or programming; and develop recommendations for public health and community organizations and healthcare providers for addressing cancer survivors’ unmet needs. Methods Cancer survivors were identified using data from the Alaska Cancer Registry. A random sample of 2,600 individuals was selected to receive the survey, which assessed unmet needs across the following domains: information needs and medical care issues; quality of life; emotional and relationship issues related to cancer diagnoses; and support services. We calculated descriptive statistics for survey responses and assessed demographic predictors of unmet needs using Poisson regression. Results We received 335 survey responses, for a response of 13.7%. Only 29.9% of cancer survivors expressed that all their needs were met. The most highly ranked unmet needs were as follows: help to reduce stress in life; to know doctors were coordinating care; and managing concerns about cancer coming back. After adjustment, men, adults younger than 65 at diagnosis, Alaska Native people, survivors still receiving or who had recently received care, and people who had to travel 50+ miles for most of their care had significantly greater unmet needs than their comparison groups. Conclusion This assessment provided some of the first information regarding the needs of Alaska’s cancer survivors. These results will be used by Alaska Cancer Partnership members across the state to inform healthcare delivery, programs, and public health messaging to support survivors.
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Affiliation(s)
- Sarah H Nash
- Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA.
- Department of Epidemiology, University of Iowa, 145 N Riverside Drive, Iowa, IA, 52242, USA.
| | - Julia Dilley
- Multnomah County and Oregon Health Authority, Public Health Division, Program Design and Evaluation Services (PDES), Portland, OR, USA
| | - Claire Siekaniec
- Community Health Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - David O'Brien
- State of Alaska, Division of Public Health, Health Analytics and Vital Records Section, Anchorage, AK, USA
| | - Rosa Avila
- State of Alaska, Division of Public Health, Health Analytics and Vital Records Section, Anchorage, AK, USA
| | - Jessica Quinn
- State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Anchorage, AK, USA
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32
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Biddell CB, Spees LP, Petermann V, Rosenstein DL, Manning M, Gellin M, Padilla N, Samuel-Ryals CA, Birken SA, Reeder-Hayes K, Deal AM, Cabarrus K, Bell RA, Strom C, DeAntonio PA, Young TH, King S, Leutner B, Vestal D, Wheeler SB. Financial Assistance Processes and Mechanisms in Rural and Nonrural Oncology Care Settings. JCO Oncol Pract 2022; 18:e1392-e1406. [PMID: 35549521 PMCID: PMC9509146 DOI: 10.1200/op.21.00894] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer are at heightened risk of experiencing financial hardship. Financial navigation (FN) is an evidence-based approach for identifying and addressing patient and caregiver financial needs. In preparation for the implementation of a multisite FN intervention, we describe existing processes (ie, events and actions) and mechanisms (ie, how events work together) connecting patients to financial assistance, comparing rural and nonrural practices. METHODS We conducted in-depth, semistructured interviews with stakeholders (ie, administrators, providers, and staff) at each of the 10 oncology care sites across a single state (five rural and five nonrural practices). We developed process maps for each site and analyzed stakeholder perspectives using thematic analysis. After reporting findings back to stakeholders, we synthesized themes and process maps across rural and nonrural sites separately. RESULTS Eighty-three stakeholders were interviewed. We identified six core elements of existing financial assistance processes across all sites: distress screening (including financial concerns), referrals, resource connection points, and pharmaceutical, insurance, and community/foundation resources. Processes differed by rurality; however, facilitators and barriers to identifying and addressing patient financial needs were consistent. Open communication between staff, providers, patients, and caregivers was a primary facilitator. Barriers included insufficient staff resources, challenges in routinely identifying needs, inadequate preparation of patients for anticipated medical costs, and limited tracking of resource availability and eligibility. CONCLUSION This study identified a clear need for systematic implementation of oncology FN to equitably address patient and caregiver financial hardship. Results have informed our current efforts to implement a multisite FN intervention, which involves comprehensive financial toxicity screening and systematization of intake and referrals.
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Affiliation(s)
- Caitlin B. Biddell
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lisa P. Spees
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Victoria Petermann
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC
| | - Donald L. Rosenstein
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Michelle Manning
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mindy Gellin
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Neda Padilla
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Cleo A. Samuel-Ryals
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sarah A. Birken
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Katherine Reeder-Hayes
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Division of Oncology, Chapel Hill, NC
| | - Allison M. Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kendrel Cabarrus
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
| | - Ronny A. Bell
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Carla Strom
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Tiffany H. Young
- Novant Health Cancer Institute, Buddy Kemp Support Center, Charlotte, NC
| | - Sherry King
- Carteret Health Care Cancer Center, Morehead City, NC
| | | | | | - Stephanie B. Wheeler
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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33
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de Moor JS, Williams CP, Blinder VS. Cancer-Related Care Costs and Employment Disruption: Recommendations to Reduce Patient Economic Burden as Part of Cancer Care Delivery. J Natl Cancer Inst Monogr 2022; 2022:79-84. [PMID: 35788373 DOI: 10.1093/jncimonographs/lgac006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer survivors are frequently unprepared to manage the out-of-pocket (OOP) costs associated with undergoing cancer treatment and the potential for employment disruption. This commentary outlines a set of research recommendations stemming from the National Cancer Institute's Future of Health Economics Research Conference to better understand and reduce patient economic burden as part of cancer care delivery. Currently, there are a lack of detailed metrics and measures of survivors' OOP costs and employment disruption, and data on these costs are rarely available at the point of care to guide patient-centered treatment and survivorship care planning. Future research should improve the collection of data about survivors' OOP costs for medical care, other cancer-related expenses, and experiences of employment disruption. Methods such as microcosting and the prospective collection of patient-reported outcomes in cancer care are needed to understand the true sum of cancer-related costs taken on by survivors and caregivers. Better metrics and measures of survivors' costs must be coupled with interventions to incorporate that information into cancer care delivery and inform meaningful communication about OOP costs and employment disruption that is tailored to different clinical situations. Informing survivors about the anticipated costs of their cancer care supports informed decision making and proactive planning to mitigate financial hardship. Additionally, system-level infrastructure should be developed and tested to facilitate screening to identify survivors at risk for financial hardship, improve communication about OOP costs and employment disruption between survivors and their health-care providers, and support the delivery of appropriate financial navigation services.
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Affiliation(s)
- Janet S de Moor
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Courtney P Williams
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Corry J, Ng WT, Ma SJ, Singh AK, de Graeff P, Oosting SF. Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439036 DOI: 10.1200/edbk_359482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.
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Affiliation(s)
- June Corry
- Division Radiation Oncology, GenesisCare Radiation OncologySt Vincent's Hospital, Melbourne, Australia.,Department of MedicineThe University of Melbourne, Parkville, Australia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of MedicineThe University of Hong Kong, Hong Kong, China.,Clinical Oncology CentreThe University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pauline de Graeff
- University Center for Geriatric MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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35
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Offodile AC, Gallagher K, Angove R, Tucker-Seeley RD, Balch A, Shankaran V. Financial Navigation in Cancer Care Delivery: State of the Evidence, Opportunities for Research, and Future Directions. J Clin Oncol 2022; 40:2291-2294. [PMID: 35353552 DOI: 10.1200/jco.21.02184] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anaeze C Offodile
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.,Baker Institute for Public Policy, Rice University, Houston, TX
| | | | | | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alan Balch
- Patient Advocate Foundation, Hampton, VA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
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36
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Abrams HR, Durbin S, Huang CX, Johnson SF, Nayak RK, Zahner GJ, Peppercorn J. Financial toxicity in cancer care: origins, impact, and solutions. Transl Behav Med 2021; 11:2043-2054. [PMID: 34850932 DOI: 10.1093/tbm/ibab091] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term "financial toxicity" has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.
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Affiliation(s)
- Hannah R Abrams
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sienna Durbin
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cher X Huang
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rahul K Nayak
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg J Zahner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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37
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Bashkin O, Dopelt K, Asna N, Davidovitch N. Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System-A Mixed-Methods Study. Curr Oncol 2021; 28:2902-2913. [PMID: 34436020 PMCID: PMC8395438 DOI: 10.3390/curroncol28040254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022] Open
Abstract
Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians' perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient-physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients' financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician-patient discourse regarding all aspects of treatment.
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Affiliation(s)
- Osnat Bashkin
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel;
| | - Keren Dopelt
- Department of Public Health, Ashkelon Academic College, Ashkelon 78211, Israel;
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel;
| | - Noam Asna
- Oncology Institute, Ziv Medical Center, Safed 13100, Israel;
| | - Nadav Davidovitch
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 8410501, Israel;
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38
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Farrugia M, Yu H, Ma SJ, Iovoli AJ, Erickson K, Wendel E, Attwood K, Wooten KE, Gupta V, McSpadden RP, Kuriakose MA, Markiewicz MR, Chan JM, Hicks WL, Platek ME, Ray AD, Repasky EA, Singh AK. Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy. Cancers (Basel) 2021; 13:2516. [PMID: 34063890 PMCID: PMC8196601 DOI: 10.3390/cancers13112516] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. METHODS Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores. RESULTS Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre- and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = -0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC. CONCLUSIONS Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (H.Y.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (H.Y.); (K.A.)
| | - Kimberly E. Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Ryan P. McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Moni A. Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Michael R. Markiewicz
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Jon M. Chan
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Wesley L. Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
- Department of Dietetics, D’Youville College, 270 Porter Avenue, Buffalo, NY 14201, USA
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Elizabeth A. Repasky
- Department of Immunology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA;
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
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