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Richardson DR, Zhou X, Reeder-Hayes K, Jensen CE, Islam J, Loh KP, Gupta A, Basch E, Bennett AV, Bridges JFP, Wheeler SB, Wood WA, Baggett CD, Lund JL. Home Time Among Older Adults With Acute Myeloid Leukemia Following Chemotherapy. JAMA Oncol 2024; 10:1038-1046. [PMID: 38869885 PMCID: PMC11177219 DOI: 10.1001/jamaoncol.2024.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 06/14/2024]
Abstract
Importance Patients with acute myeloid leukemia (AML) recognize days spent at home (home time) vs in a hospital or nursing facility as an important factor in treatment decision making. No study has adequately described home time among older adults with AML. Objective To describe home time among older adults with AML (aged ≥66 years) and compare home time between 2 common treatments: anthracycline-based chemotherapy and hypomethylating agents (HMAs). Design, Setting, and Participants A cohort of adults aged 66 years or older with a new diagnosis of AML from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 2004 to 2016 was identified. Individuals were stratified into anthracycline-based therapy, HMAs, or chemotherapy, not otherwise specified (NOS) using claims. Main Outcomes and Measures The primary outcome was home time, quantified by subtracting the total number of person-days spent in hospitals and nursing facilities from the number of person-days survived and dividing by total person-days. A weighted multinomial regression model with stabilized inverse probability of treatment weighting to estimate adjusted home time was used. Results The cohort included 7946 patients with AML: 2824 (35.5%) received anthracyclines, 2542 (32.0%) HMAs, and 2580 (32.5%) were classified as chemotherapy, NOS. Median (IQR) survival was 11.0 (5.0-27.0) months for those receiving anthracyclines and 8.0 (3.0-17.0) months for those receiving HMAs. Adjusted home time for all patients in the first year was 52.4%. Home time was highest among patients receiving HMAs (60.8%) followed by those receiving anthracyclines (51.9%). Despite having a shorter median survival, patients receiving HMAs had more total days at home and 33 more days at home in the first year on average than patients receiving anthracyclines (222 vs 189). Conclusions and Relevance This retrospective study of older adults with AML using SEER-Medicare data and propensity score weighting suggests that the additional survival afforded by receiving anthracycline-based therapy was entirely offset by admission to the hospital or to nursing facilities.
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Affiliation(s)
- Daniel R. Richardson
- University of North Carolina School of Medicine, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Xi Zhou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Katherine Reeder-Hayes
- University of North Carolina School of Medicine, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Christopher E. Jensen
- University of North Carolina School of Medicine, Chapel Hill
- Cecil B. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill
| | | | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
| | - Arjun Gupta
- University of Minnesota Masonic Cancer Center, Minneapolis
| | - Ethan Basch
- University of North Carolina School of Medicine, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Antonia V. Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- University of North Carolina Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill
| | | | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- University of North Carolina Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill
| | - William A. Wood
- University of North Carolina School of Medicine, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- University of North Carolina Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill
| | - Jennifer L. Lund
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
- University of North Carolina Department of Epidemiology, Gillings School of Global Public Health, Chapel Hill
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Gupta A, Chant ED, Mohile S, Vogel RI, Parsons HM, Blaes AH, Booth CM, Rocque GB, Dusetzina SB, Ganguli I. Health Care Contact Days Among Older Cancer Survivors. JCO Oncol Pract 2024; 20:943-952. [PMID: 38452315 PMCID: PMC11268556 DOI: 10.1200/op.23.00590] [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: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/13/2023] [Indexed: 03/09/2024] Open
Abstract
PURPOSE Health care contact days-days spent receiving health care outside the home-represent an intuitive, practical, and person-centered measure of time consumed by health care. METHODS We linked 2019 Medicare Current Beneficiary Survey and traditional Medicare claims data for community-dwelling older adults with a history of cancer. We identified contact days (ie, spent in a hospital, emergency department, skilled nursing facility, or inpatient hospice or receiving ambulatory care including an office visit, procedure, treatment, imaging, or test) and described patterns of total and ambulatory contact days. Using weighted Poisson regression models, we identified factors associated with contact days. RESULTS We included 1,168 older adults representing 4.51 million cancer survivors (median age, 76.4 years, 52.8% women). The median (IQR) time from cancer diagnosis was 65 (27-126) months. In 2019, these adults had mean (standard deviation) total contact days of 28.4 (27.6) and ambulatory contact days of 24.2 (23.6). These included days for tests (8.0 [8.8]), imaging (3.6 [4.1]), visits with any clinicians (12.4 [11.5]), and visits with primary care clinicians (4.4 [4.7]), and nononcology specialists (7.1 [9.4]) specifically. Sixty-four percent of days with a nonvisit ambulatory service (eg, a test) were not on the same day as a clinician visit. Factors associated with more total contact days included younger age, lower income, more chronic conditions, poor self-rated health, and tendency to "go to doctor as soon as feel bad." CONCLUSION Older adult cancer survivors spent nearly 1 month of the year receiving health care outside the home. This care was largely ambulatory, often delivered by nononcologists, and varied by factors beyond clinical characteristics. These results highlight the need to recognize patient burdens and improve survivorship care delivery, including through care coordination.
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Affiliation(s)
| | - Emma D. Chant
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
| | - Supriya Mohile
- Department of Medicine, University of Rochester, Rochester, NY
| | | | | | | | | | | | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Ishani Ganguli
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA
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Yabroff KR, Doran JF, Zhao J, Chino F, Shih YCT, Han X, Zheng Z, Bradley CJ, Bryant MF. Cancer diagnosis and treatment in working-age adults: Implications for employment, health insurance coverage, and financial hardship in the United States. CA Cancer J Clin 2024; 74:341-358. [PMID: 38652221 DOI: 10.3322/caac.21837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 04/25/2024] Open
Abstract
The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working-age adults not yet age-eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working-age adults with a history of cancer and compare them with estimates among working-age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019-2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | | | - Jingxuan Zhao
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ya-Chen Tina Shih
- Department of Radiation Oncology, University of California-Los Angeles Jonsson Comprehensive Cancer Center, School of Medicine, Los Angeles, California, USA
| | - Xuesong Han
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, Georgia, USA
| | - Cathy J Bradley
- University of Colorado Comprehensive Cancer Center and Colorado School of Public Health, Aurora, Colorado, USA
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Atre SY, Soulos PR, Kuderer NM, Gross CP, Baum LVM, Dinan MA, Lustberg MB. Characterization of time toxicity in older patients with metastatic breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07379-7. [PMID: 38816556 DOI: 10.1007/s10549-024-07379-7] [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: 03/17/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Recognizing that receiving healthcare can be time intensive and burdensome, time toxicity has been conceptualized as the time spent by patients seeking healthcare. This study investigates the association between age at diagnosis and time toxicity for patients with Metastatic Breast Cancer (MBC) and identifies major components of care that confer the greatest time toxicity. METHODS We conducted a retrospective cohort study among patients with MBC aged 67 or older using the SEER-Medicare database. We assessed time toxicity using the number of encounter days patients interacted with the healthcare system per 100 days, within the first year of starting cancer treatment. We used a Poisson model to analyze the association between age and encounter days, adjusting for clinical and sociodemographic factors. We stratified the mean encounter days for each age cohort by treatment types. FINDINGS The final sample included 2949 patients; 51.4% were between 70 and 79 years old, and 81.3% were white. Although unadjusted analysis showed an association between older age and more encounter days (Rate Ratio (RR) 1.12; 95% CI 1.02, 1.22), there was no significant association after adjusting for comorbidities and treatment type. Patients with more than three comorbidities had significantly higher encounter days compared to those without comorbidities [RR 1.36 (95% CI 1.26, 1.46)]. Receipt of radiotherapy [RR: 1.45 95% CI (1.37, 1.54)] was associated with more encounter days compared to not receiving radiotherapy, while receipt of bone-modifying agents was associated with fewer encounter days compared to not using Bone modifying agents [RR 0.75 (95% CI 0.70, 0.79)]. CONCLUSION Our study identified comorbidities and cancer treatment modality, including radiotherapy, as the factors affecting time toxicity in older patients with MBC. Assessment of an individual's comorbid medical conditions and types of treatment planned are crucial to understanding age-related impacts on encounter days and to support shared decision making in older patients.
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Affiliation(s)
- Swarali Y Atre
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Pamela R Soulos
- Associate Director, COPPER Center, Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | | | - Cary P Gross
- Section of General Medicine, Department of Medicine and Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Laura V M Baum
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michaela A Dinan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Maryam B Lustberg
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Dona AC, Jewett PI, Hwee S, Brown K, Solomon M, Gupta A, Teoh D, Yang G, Wolfson J, Fan Y, Blaes AH, Vogel RI. Logistic burdens of cancer care: A qualitative study. PLoS One 2024; 19:e0300852. [PMID: 38573993 PMCID: PMC10994350 DOI: 10.1371/journal.pone.0300852] [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: 07/17/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Cancer treatment often creates logistic conflicts with everyday life priorities; however, these challenges and how they are subjectively experienced have been largely unaddressed in cancer care. Our goal was to describe time and logistic requirements of cancer care and whether and how they interfered with daily life and well-being. We conducted interviews with 20 adults receiving cancer-directed treatment at a single academic cancer center. We focused on participants' perception of the time, effort, and energy-intensiveness of cancer care activities, organization of care requirements, and preferences in how to manage the logistic burdens of their cancer care. Participant interview transcripts were analyzed using an inductive thematic analysis approach. Burdens related to travel, appointment schedules, healthcare system navigation, and consequences for relationships had roots both at the system-level (e.g. labs that were chronically delayed, protocol-centered rather than patient-centered bureaucratic requirements) and in individual circumstances (e.g. greater stressors among those working and/or have young children versus those who are retired) that determined subjective burdensomeness, which was highest among patients who experienced multiple sources of burdens simultaneously. Our study illustrates how objective burdens of cancer care translate into subjective burden depending on patient circumstances, emphasizing that to study burdens of care, an exclusive focus on objective measures does not capture the complexity of these issues. The complex interplay between healthcare system factors and individual circumstances points to clinical opportunities, for example helping patients to find ways to meet work and childcare requirements while receiving care.
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Affiliation(s)
- Allison C. Dona
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Patricia I. Jewett
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon Hwee
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matia Solomon
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arjun Gupta
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Guang Yang
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
| | - Julian Wolfson
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Yingling Fan
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rachel I. Vogel
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Kim DD. Accounting for Nonhealth and Future Costs in Cost-Effectiveness Analysis: Distributional Impacts of a US Cancer Prevention Strategy. PHARMACOECONOMICS 2023; 41:1151-1164. [PMID: 37195368 PMCID: PMC10189225 DOI: 10.1007/s40273-023-01275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To provide up-to-date and comprehensive US data tables to estimate future net resource use, including nonlabor market production, and examine distributional impacts of including nonhealth and future costs in cost-effectiveness results. METHODS Using a published US cancer prevention simulation model, the paper evaluated the lifetime cost effectiveness of implementing a 10% excise tax on processed meats across age- and sex-specific population subgroups. The model examined multiple scenarios accounting for cancer-related healthcare expenditure (HCE) only, cancer-related and unrelated background HCE, adding productivity benefits (i.e., patient time, cancer-related productivity loss, and background labor and nonlabor market production), and with nonhealth consumption costs, adjusted for household economies of scale. Additional analyses include using population-average versus age-sex-specific estimates for quantifying production and consumption value, as well as comparing direct model estimation versus postcorrections with Meltzer's approximation for incorporating future resource use. RESULTS Accounting for nonhealth and future costs impacted cost-effectiveness results across population subgroups, often leading to changes in "cost-saving" determination. Including nonlabor market production had a noticeable impact on estimating future resource use and reduced the bias toward undervaluing productivity among females and older populations. The use of age-sex-specific estimates resulted in less favorable cost-effectiveness results compared with population-average estimates. Meltzer's approximation provided reasonable corrections among the middle-aged population for re-engineering cost-effectiveness ratios from a healthcare sector to a societal perspective. CONCLUSION With updated US data tables, this paper can help researchers conduct a comprehensive value assessment to reflect net resource use (health and nonhealth resource use minus production value) from a societal perspective.
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Affiliation(s)
- David D Kim
- Department of Medicine, Section of Hospital Medicine, The University of Chicago, 5841 South Maryland Ave., MC 5000, Chicago, IL, 60637, USA.
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7
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Du M, Griecci CF, Cudhea F, Eom H, Wong JB, Wilde P, Kim DD, Michaud DS, Wang YC, Mozaffarian D, Zhang FF. What is the cost-effectiveness of menu calorie labelling on reducing obesity-associated cancer burdens? An economic evaluation of a federal policy intervention among 235 million adults in the USA. BMJ Open 2023; 13:e063614. [PMID: 37072239 DOI: 10.1136/bmjopen-2022-063614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To assess the impact of menu calorie labelling on reducing obesity-associated cancer burdens in the USA. DESIGN Cost-effectiveness analysis using a Markov cohort state-transition model. SETTING Policy intervention. PARTICIPANTS A modelled population of 235 million adults aged ≥20 years in 2015-2016. INTERVENTIONS The impact of menu calorie labelling on reducing 13 obesity-associated cancers among US adults over a lifetime was evaluated for: (1) effects on consumer behaviours; and (2) additional effects on industry reformulation. The model integrated nationally representative demographics, calorie intake from restaurants, cancer statistics and estimates on associations of policy with calorie intake, dietary change with body mass index (BMI) change, BMI with cancer rates, and policy and healthcare costs from published literature. MAIN OUTCOME MEASURES Averted new cancer cases and cancer deaths and net costs (in 2015 US$) among the total population and demographic subgroups were determined. Incremental cost-effectiveness ratios from societal and healthcare perspectives were assessed and compared with the threshold of US$150 000 per quality-adjusted life year (QALY) gained. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). RESULTS Considering consumer behaviour alone, this policy was associated with 28 000 (95% UI 16 300 to 39 100) new cancer cases and 16 700 (9610 to 23 600) cancer deaths averted, 111 000 (64 800 to 158 000) QALYs gained, and US$1480 (884 to 2080) million saved in cancer-related medical costs among US adults. The policy was associated with net cost savings of US$1460 (864 to 2060) million and US$1350 (486 to 2260) million from healthcare and societal perspectives, respectively. Additional industry reformulation would substantially increase policy impact. Greater health gains and cost savings were predicted among young adults, Hispanic and non-Hispanic Black individuals. CONCLUSIONS Study findings suggest that menu calorie labelling is associated with lower obesity-related cancer burdens and reduced healthcare costs. Policymakers may prioritise nutrition policies for cancer prevention in the USA.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heesun Eom
- New York Academy of Medicine, New York, New York, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts, USA
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tuft University, Boston, Massachusetts, USA
| | - Y Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Agbafe VC, Metzger N, Garlick BR, Caverly T, Saini S, Kerr E, Matloub S, Kullgren JT. Achieving greater value for veterans through full cost transparency in primary care. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2023; 11:100687. [PMID: 36870189 PMCID: PMC9979772 DOI: 10.1016/j.hjdsi.2023.100687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
The COVID-19 pandemic has led to increased use of telephone and video encounters in the Veterans Health Administration and many other healthcare systems. One important difference between these virtual modalities and traditional face-to-face encounters is the different cost-sharing, travel costs, and time costs that patients face. Making the full costs of different visit modalities transparent to patients and their clinicians can help patients obtain greater value from their primary care encounters. From April 6, 2020 to September 30, 2021 the VA waived all copayments for Veterans receiving care from the VA, but since this policy was temporary it is important that Veterans receive personalized information about their expected costs so they can obtain the most value from their primary care encounters. To test the feasibility, acceptability, and preliminary effectiveness of this approach, our team conducted a 12 week pilot project at the VA Ann Arbor Healthcare System from June-August 2021 in which we made personalized estimates of out-of-pocket, travel, and time costs available and transparent to patients and clinicians in advance of scheduled encounters and at the point of care. We found that it was feasible to generate and deliver personalized cost estimates in advance of visits, that this information was acceptable to patients, and that patients who used cost estimates during a visit with a clinician found this information helpful and would want to receive it again in the future. To achieve greater value in healthcare, systems must continue to pursue new ways to provide transparent information and needed support to patients and clinicians. This means ensuring clinical visits provide the highest levels of access, convenience, and return on patients' healthcare-associated spending while minimizing financial toxicity.
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Affiliation(s)
| | - Nora Metzger
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Brittani R Garlick
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tanner Caverly
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sameer Saini
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Eve Kerr
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sana Matloub
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, USA; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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Chido-Amajuoyi OG, Nnamani I, Agbedia O. Disparities in Physician Office Visit Wait Time Among Cancer Survivors in the USA. J Gen Intern Med 2023; 38:1106-1108. [PMID: 36581790 PMCID: PMC10039150 DOI: 10.1007/s11606-022-07986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | - Ikenna Nnamani
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
| | - Owhofasa Agbedia
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Patel KB, Turner K, Alishahi Tabriz A, Gonzalez BD, Oswald LB, Nguyen OT, Hong YR, Jim HSL, Nichols AC, Wang X, Robinson E, Naso C, Spiess PE. Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer. JAMA Netw Open 2023; 6:e2250211. [PMID: 36626174 PMCID: PMC9856804 DOI: 10.1001/jamanetworkopen.2022.50211] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth. OBJECTIVE To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021. MAIN OUTCOMES AND MEASURES The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used. RESULTS The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile. CONCLUSIONS AND RELEVANCE In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.
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Affiliation(s)
- Krupal B. Patel
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Edmondo Robinson
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida
| | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E. Spiess
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
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11
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Lim SA, Hao SB, Boyd BA, Mitsakos A, Irish W, Burke AM, Parikh AA, Snyder RA. Opportunity Costs of Surgical Resection and Perioperative Chemotherapy for Locoregional Pancreatic Adenocarcinoma. JCO Oncol Pract 2022; 18:302-309. [PMID: 34709961 DOI: 10.1200/op.21.00311] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Given the perioperative morbidity and intensity of multimodality treatment, patients with resected pancreatic ductal adenocarcinoma (PDAC) spend a substantial amount of time in clinical care. The primary aim was to determine total time spent in multimodality care for patients with locoregional PDAC. METHODS A cohort study of all patients who underwent curative-intent resection for PDAC at a single-institution, tertiary care center was performed (2015-2019). Exact times for all relevant visits were abstracted from the primary medical record, and travel time was calculated. Care time was divided into preoperative, surgical, radiation, and systemic therapy phases of care. Primary outcome measures were the percentage of total survival time (TST) and percentage of overall survival (OS) days spent in receipt of care. RESULTS One hundred seven patients were included. Patients spent a median of 5.0% (interquartile range [IQR] 2.4%-10.1%) of TST and 11.0% (IQR, 5.7%-20.4%) of OS days in receipt of clinical care. Preoperative, surgical, radiation, and systemic therapy phases of care comprised a median of 0.9% (IQR, 0.4%-2.2%), 3.0% (IQR, 1.9%-6.8%), 4.4% (IQR, 3.6%-6.3%), and 10.0% (IQR, 6.2%-14.1%) of OS days. The median per-visit travel time was 60 minutes (IQR, 32-120), and the median cumulative travel time was 22.0 hours (IQR, 12.0-51.5). 12.1% (n = 13) and 7.8% (n = 4) of patients spent > 10% of TST in receipt of surgical and systemic therapy care, respectively. CONCLUSION Patients with locoregional pancreatic cancer spend a considerable percentage of their survival time in receipt of oncologic care. Further research to determine predictors of increased time burden is warranted to better inform shared decision making.
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Affiliation(s)
- Szu-Aun Lim
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Scarlett B Hao
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Breana A Boyd
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Anastasios Mitsakos
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - William Irish
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Aidan M Burke
- Department of Radiation Oncology, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Alexander A Parikh
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
| | - Rebecca A Snyder
- Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC
- Department of Public Health, Brody School of Medicine at East Carolina University, Greenville, NC
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12
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Gupta A, Eisenhauer EA, Booth CM. The Time Toxicity of Cancer Treatment. J Clin Oncol 2022; 40:1611-1615. [PMID: 35235366 DOI: 10.1200/jco.21.02810] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Arjun Gupta
- Division of Hematology, Oncology & Transplantation, University of Minnesota, Minneapolis, MN
| | | | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Canada.,Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, Canada
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13
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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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14
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Wang L, Du M, Cudhea F, Griecci C, Michaud DS, Mozaffarian D, Zhang FF. Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015‒2018. Am J Public Health 2021; 111:2008-2018. [PMID: 34648383 PMCID: PMC8630501 DOI: 10.2105/ajph.2021.306475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. 2021;111(11):2008-2018. https://doi.org/10.2105/AJPH.2021.306475).
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Affiliation(s)
- Lu Wang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Mengxi Du
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Frederick Cudhea
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Christina Griecci
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dominique S Michaud
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dariush Mozaffarian
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Fang Fang Zhang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
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15
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Yabroff KR, Mariotto A, Tangka F, Zhao J, Islami F, Sung H, Sherman RL, Henley SJ, Jemal A, Ward EM. Annual Report to the Nation on the Status of Cancer, Part 2: Patient Economic Burden Associated With Cancer Care. J Natl Cancer Inst 2021; 113:1670-1682. [PMID: 34698839 PMCID: PMC9891103 DOI: 10.1093/jnci/djab192] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries provide annual information about cancer occurrence and trends in the United States. Part 1 of this annual report focuses on national cancer statistics. This study is part 2, which quantifies patient economic burden associated with cancer care. METHODS We used complementary data sources, linked Surveillance, Epidemiology, and End Results-Medicare, and the Medical Expenditure Panel Survey to develop comprehensive estimates of patient economic burden, including out-of-pocket and patient time costs, associated with cancer care. The 2000-2013 Surveillance, Epidemiology, and End Results-Medicare data were used to estimate net patient out-of-pocket costs among adults aged 65 years and older for the initial, continuing, and end-of-life phases of care for all cancer sites combined and separately for the 21 most common cancer sites. The 2008-2017 Medical Expenditure Panel Survey data were used to calculate out-of-pocket costs and time costs associated with cancer among adults aged 18-64 years and 65 years and older. RESULTS Across all cancer sites, annualized net out-of-pocket costs for medical services and prescriptions drugs covered through a pharmacy benefit among adults aged 65 years and older were highest in the initial ($2200 and $243, respectively) and end-of-life phases ($3823 and $448, respectively) and lowest in the continuing phase ($466 and $127, respectively), with substantial variation by cancer site. Out-of-pocket costs were generally higher for patients diagnosed with later-stage disease. Net annual time costs associated with cancer were $304.3 (95% confidence interval = $257.9 to $350.9) and $279.1 (95% confidence interval = $215.1 to $343.3) for adults aged 18-64 years and ≥65 years, respectively, with higher time costs among more recently diagnosed survivors. National patient economic burden, including out-of-pocket and time costs, associated with cancer care was projected to be $21.1 billion in 2019. CONCLUSIONS This comprehensive study found that the patient economic burden associated with cancer care is substantial in the United States at the national and patient levels.
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Affiliation(s)
- K Robin Yabroff
- Correspondence to: K. Robin Yabroff, PhD, Department of Surveillance and Health Equity Science, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Angela Mariotto
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Florence Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Hyuna Sung
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Recinda L Sherman
- North American Association of Central Cancer Registries, Springfield, IL, USA
| | - S Jane Henley
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Elizabeth M Ward
- North American Association of Central Cancer Registries, Springfield, IL, USA
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16
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Bordonaro R, Piazza D, Sergi C, Cordio S, Tomaselli S, Gebbia V. Out-of-pocket costs in gastrointestinal cancer patients: Lack of a perfectly framed problem contributing to financial toxicity. Crit Rev Oncol Hematol 2021; 167:103501. [PMID: 34673219 DOI: 10.1016/j.critrevonc.2021.103501] [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: 06/01/2020] [Revised: 08/15/2021] [Accepted: 10/10/2021] [Indexed: 12/01/2022] Open
Abstract
Fighting cancer is an economically expensive challenge for both health care payers, and the patients and their families and the median costs for cancer care are rapidly increasing in the last decade. Although both direct and indirect costs of medical assistance have been a frequent source of distress and contention, however analysis of the non-medical expenses incurred directly by cancer patients has not received adequate attention. Developing a deeper understanding of so-called "out-of-pocket" costs may be necessary. Out-of-pocket costs for medical care range from 7 % to 11 % of medical costs for all payers. However, the range of out-of-pocket costs shows considerable variability in different studies. In this review, we reviewed available data concerning direct and indirect medical costs, including psychosocial ones.
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Affiliation(s)
- Roberto Bordonaro
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - Concetta Sergi
- Medical Oncology Unit, Azienda Ospedaliera di Rilievo Nazionale e Alta Specializzazione (ARNAS), Ospedale Garibaldi, Catania, Italy
| | - Stefano Cordio
- Medical Oncology Unit - Azienda Ospedaliera Provinciale 7, Ragusa, Italy
| | | | - Vittorio Gebbia
- Medical Oncology and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy; PROMISE Department - University of Palermo, Palermo, Italy.
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17
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Kenzik KM, Williams GR, Bhakta N, Robison LL, Landier W, Goyal G, Mehta A, Bhatia S. Healthcare utilization and spending among older patients diagnosed with Non-Hodgkin lymphoma. J Geriatr Oncol 2021; 12:1225-1232. [PMID: 34176753 DOI: 10.1016/j.jgo.2021.06.006] [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: 05/05/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Developing appropriate care models for patients diagnosed with non-Hodgkin lymphoma (NHL) >65y require examination of current healthcare utilization patterns and cost, but non-malignant condition-specific utilization and Medicare spending among older patients has not been characterized. METHODS Using SEER-Medicare, 14,533 patients diagnosed with NHL at age > 65 between 2008 and 2015 and a comparable non-cancer cohort (n = 14,533) were identified. Hospitalizations and outpatient visits for 109 non-malignant conditions were grouped into ten categories, allowing condition-specific utilization and spending calculation from diagnosis to 5y, censoring at blood or marrow transplantation, 6mo prior to death or end (12/31/2016). Using the 90th percentile as a cut-off, factors associated with high-hospitalization rates and high-spending were evaluated. RESULTS Patients with NHL were 1.5-fold more likely to be hospitalized and 1.8-fold more likely to experience outpatient visits when compared with the non-cancer cohort. Patients with NHL had greater aging-related, cardiovascular, and gastrointestinal hospitalizations than controls (p < 0.001). Average Medicare spending/visit was higher for patients with NHL (hospitalization: $16,950 vs. $13,474, p < 0.001; outpatient: $1176 vs. $392, p < 0.001). Factors associated with high-utilization and high-spending included diffuse large B cell lymphoma subtype, non-white race, and residence in low-education area. CONCLUSIONS Older patients with NHL experienced higher utilization and higher spending per-utilization compared to a non-cancer cohort over five years from cancer diagnosis. Clinical and demographic sub-groups demonstrated increased risk for the highest spending and utilization. The substantial utilization and spending for non-malignant conditions among older patients with NHL provides quantifiable evidence for survivor-adapted healthcare management policies.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA.
| | - Grant R Williams
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, USA; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, USA
| | - Wendy Landier
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
| | - Gaurav Goyal
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Amitkumar Mehta
- Division of Hematology and Oncology, University of Alabama at Birmingham, USA
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, USA; Division of Pediatric Oncology, University of Alabama at Birmingham, USA
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18
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Du M, Griecci CF, Cudhea FF, Eom H, Kim DD, Wilde P, Wong JB, Wang YC, Michaud DS, Mozaffarian D, Zhang F. Cost-effectiveness Analysis of Nutrition Facts Added-Sugar Labeling and Obesity-Associated Cancer Rates in the US. JAMA Netw Open 2021; 4:e217501. [PMID: 33904914 PMCID: PMC8080223 DOI: 10.1001/jamanetworkopen.2021.7501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/05/2021] [Indexed: 11/18/2022] Open
Abstract
Importance Obesity-associated cancer burdens are increasing in the US. Nutrition policies, such as the Nutrition Facts added-sugar labeling, may reduce obesity-associated cancer rates. Objective To evaluate the cost-effectiveness of Nutrition Facts added-sugar labeling and obesity-associated cancer rates in the US. Design, Setting, and Participants A probabilistic cohort state-transition model was used to conduct an economic evaluation of added-sugar labeling and 13 obesity-associated cancers among 235 million adults aged 20 years or older by age, sex, and race/ethnicity over a median follow-up of 34.4 years. Policy associations were considered in 2 scenarios: with consumer behaviors and with additional industry reformulation. The model integrated nationally representative population demographics, diet, and cancer statistics; associations of policy intervention with diet, diet change and body mass index, and body mass index with cancer risk; and policy and health-related costs from established sources. Data were analyzed from January 8, 2019, to May 6, 2020. Main Outcomes and Measures Net costs and incremental cost-effectiveness ratio were estimated from societal and health care perspectives. Probabilistic sensitivity analyses incorporated uncertainty in input parameters and generated 95% uncertainty intervals (UIs). Results Based on consumer behaviors, the policy was associated with a reduction of 30 000 (95% UI, 21 600-39 300) new cancer cases and 17 100 (95% UI, 12 400-22 700) cancer deaths, a gain of 116 000 (95% UI, 83 800-153 000) quality-adjusted life-years, and a saving of $1600 million (95% UI, $1190 million-$2030 million) in medical costs associated with cancer care among US adults over a lifetime. The policy was associated with a savings of $704 million (95% UI, $44.5 million-$1450 million) from the societal perspective and $1590 million (95% UI, $1180 million-$2020 million) from the health care perspective. Additional industry reformulation to reduce added-sugar amounts in packaged foods and beverages would double the impact. Greater health gains and cost savings were expected among young adults, women, and non-Hispanic Black individuals than other population subgroups. Conclusions and Relevance These findings suggest that the added-sugar labeling is associated with reduced costs and lower rates of obesity-associated cancers. Policymakers may consider and prioritize nutrition policies for cancer prevention in the US.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Christina F. Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Frederick F. Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Heesun Eom
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - David D. Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Parke Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - John B. Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
| | - Y. Claire Wang
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York
- New York Academy of Medicine, New York
- Now with Division of Substance Abuse & Mental Health, Department of Health and Social Services, State of Delaware, Newcastle
| | - Dominique S. Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
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19
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Du M, Griecci CF, Kim DD, Cudhea F, Ruan M, Eom H, Wong JB, Wilde PE, Michaud DS, Lee Y, Micha R, Mozaffarian D, Zhang FF. Cost-Effectiveness of a National Sugar-Sweetened Beverage Tax to Reduce Cancer Burdens and Disparities in the United States. JNCI Cancer Spectr 2020; 4:pkaa073. [PMID: 33409452 PMCID: PMC7771430 DOI: 10.1093/jncics/pkaa073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/24/2020] [Accepted: 06/25/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. METHODS We used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income. RESULTS A national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85). CONCLUSIONS A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Christina F Griecci
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Mengyuan Ruan
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Heesun Eom
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
| | - Parke E Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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20
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Rocque GB, Williams CP, Ingram SA, Azuero A, Mennemeyer ST, Young Pierce J, Nipp RD, Reeder-Hayes KE, Kenzik KM. Health care-related time costs in patients with metastatic breast cancer. Cancer Med 2020; 9:8423-8431. [PMID: 32955793 PMCID: PMC7666754 DOI: 10.1002/cam4.3461] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Burdens related to time spent receiving cancer care may be substantial for patients with incurable, life-limiting cancers such as metastatic breast cancer (MBC). Estimates of time spent on health care are needed to inform treatment-related decision-making. METHODS Estimates of time spent receiving cancer-related health care in the initial 3 months of treatment for patients with MBC were calculated using the following data sources: (a) direct observations from a time-in-motion quality improvement evaluation (process mapping); (b) cross-sectional patient surveys; and (c) administrative claims. Average ambulatory, inpatient, and total health care time were calculated for specific treatments which differed by antineoplastic type and administration method, including fulvestrant (injection, hormonal), letrozole (oral, hormonal), capecitabine (oral, chemotherapy), and paclitaxel (infusion, chemotherapy). RESULTS Average total time spent on health care ranged from 7% to 10% of all days included within the initial 3 months of treatment, depending on treatment. The greatest time contributions were time spent traveling for care and on inpatient services. Time with providers contributed modestly to total care time. Patients receiving infusion/injection treatments, compared with those receiving oral therapy, spent more time in ambulatory care. Health care time was higher for patients receiving chemotherapeutic agents compared to those receiving hormonal agents. CONCLUSION Time spent traveling and receiving inpatient care represented a substantial burden to patients with MBC, with variation in time by treatment type and administration method.
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Affiliation(s)
- Gabrielle B Rocque
- Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Stacey A Ingram
- Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Stephen T Mennemeyer
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | - Ryan D Nipp
- Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA, USA
| | | | - Kelly M Kenzik
- Division of Hematology & Oncology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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21
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Perceptions of time spent pursuing cancer care among patients, caregivers, and oncology professionals. Support Care Cancer 2020; 29:2493-2500. [PMID: 32935204 DOI: 10.1007/s00520-020-05763-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with cancer spend significant time receiving treatment and recovering from side effects. Little is known about how patients and their caregivers perceive time spent receiving cancer treatment and how this impacts health-related quality of life (HRQoL). Our study aims to characterize perceptions of time invested in receiving cancer therapy as experienced by patients, caregivers, and oncology professionals. METHODS We conducted semi-structured interviews with patients undergoing treatment for advanced lung cancer and melanoma, their informal caregivers, and oncology professionals (physicians, nurses, social workers, and chaplains). Participants received and provided care at a tertiary cancer center. Interviews were audiorecorded and transcribed verbatim. Transcripts were analyzed qualitatively using predominantly inductive coding to identify themes relating to time perception and cancer care. RESULTS We interviewed 29 participants (11 patients, 7 informal caregivers, and 11 oncology professionals) and found they consistently differentiated between time remaining in life ("existential time") and time required to manage cancer treatment and symptoms ("chronological time"). Patients and caregivers reported distress around the mechanics of oncologic care that interrupted their daily lives (hobbies, activities). Participants described the impact of time invested in cancer care on dimensions of quality of life, ranging from minimal to substantial negative impact. CONCLUSIONS We found that the time spent undergoing cancer treatment affects well-being and often prevents patients and caregivers from participating in meaningful activities. The investment of personal time undergoing cancer therapy for patients with advanced solid tumors merits further study and can enhance communication between patients, caregivers, and their oncologists.
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22
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Essue BM, Iragorri N, Fitzgerald N, de Oliveira C. The psychosocial cost burden of cancer: A systematic literature review. Psychooncology 2020; 29:1746-1760. [PMID: 32783287 PMCID: PMC7754376 DOI: 10.1002/pon.5516] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 12/21/2022]
Abstract
Background and Objective Psychosocial costs, or quality of life costs, account for psychological distress, pain, suffering and other negative experiences associated with cancer. They contribute to the overall economic burden of cancer that patients experience. But this category of costs remains poorly understood. This hinders opportunities to make the best cancer control policy decisions. This study explored the psychosocial cost burden associated with cancer, how studies measure psychosocial costs and the impact of this burden. Methods A systematic literature review of academic and grey literature published from 2008 to 2018 was conducted by searching electronic databases, guided by the Institute of Medicine’s conceptualization of psychosocial burden. Results were analyzed using a narrative synthesis and a weighted proportion of populations affected was calculated. Study quality was assessed using the Ottawa‐Newcastle instrument. Results A total of 25 studies were included. There was variation in how psychosocial costs were conceptualized and an inconsistent approach to measurement. Most studies measured social dimensions and focused on the financial consequences of paying for care. Fewer studies assessed costs associated with the other domains of this burden, including psychological, physical, and spiritual dimensions. Fourty‐four percent of cancer populations studied were impacted by psychosocial costs and this varied by disease site (38%‐71%). Two studies monetized the psychosocial cost burden, estimating a lifetime cost per case ranging from CAD$427753 to CAD$528769. Studies were of varying quality; 60% of cross‐sectional studies had a high risk of bias. Conclusions Consistency in approach to measurement would help to elevate this issue for researchers and decision makers. At two‐thirds of the total economic burden of cancer, economic evaluations should account for psychosocial costs to better inform decision‐making. More support is needed to address the psychosocial cost burden faced by patients and their families.
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Affiliation(s)
- Beverley M Essue
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Iragorri
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Natalie Fitzgerald
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Health Economics and Organization Performance, The Canadian Partnership Against Cancer, Toronto, Ontario, Canada.,University of York, York, England
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23
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Rai A, Zheng Z, Zhao J, de Moor JS, Ekwueme DU, Yabroff KR. Patient-Provider Discussions About Out-of-Pocket Costs of Cancer Care in the U.S. Am J Prev Med 2020; 59:228-236. [PMID: 32417019 PMCID: PMC9278513 DOI: 10.1016/j.amepre.2020.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Despite the importance of cost-related discussions in cancer care, little is known about the prevalence or drivers of these discussions in clinical practice. This study estimates the prevalence and examines the correlates of cancer survivors' discussions about out-of-pocket costs of cancer care with providers. METHODS The 2016 and 2017 Medical Expenditure Panel Survey Experiences with Cancer Surveys were used to identify 1,550 survivors who responded to the question on discussion about out-of-pocket costs of cancer care. Multivariable multinomial logistic regression examined the correlates of discussions about out-of-pocket costs. Analyses were performed in 2019. RESULTS Approximately one quarter of cancer survivors reported having discussed the out-of-pocket costs of cancer care. In multivariable analyses, respondents in the following categories were less likely to report no cost discussion than any cost discussion: black non-Hispanic/other race (RRR=0.67, 95% CI=0.45, 0.98; white non-Hispanic race as reference), no health insurance at diagnosis (RRR=0.51, 95% CI=0.27, 0.95; private health insurance as reference), and any experience of financial hardship (RRR=0.48, 95% CI=0.35, 0.66; no financial hardship as reference). CONCLUSIONS Patient-reported discussions about out-of-pocket costs for cancer care are infrequent in the U.S. The findings highlight the needs to improve the understanding of the barriers and facilitators for effective discussions about out-of-pocket costs of cancer care.
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Affiliation(s)
- Ashish Rai
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, Georgia.
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24
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Kim DD, Wilde PE, Michaud DS, Liu J, Lizewski L, Onopa J, Mozaffarian D, Zhang FF, Wong JB. Cost Effectiveness of Nutrition Policies on Processed Meat: Implications for Cancer Burden in the U.S. Am J Prev Med 2019; 57:e143-e152. [PMID: 31564600 PMCID: PMC6803059 DOI: 10.1016/j.amepre.2019.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/14/2019] [Accepted: 02/15/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Processed meats are associated with increased risk of colorectal and stomach cancers, but health and economic impacts of policies to discourage processed meats are not well established. This paper aims to evaluate the cost effectiveness of implementing tax and warning labels on processed meats. METHODS A probabilistic cohort-state transition model was developed in 2018, including lifetime and short-term horizons, healthcare, and societal perspectives, and 3% discount rates for costs and health outcomes. The model simulated 32 subgroups by age, gender, and race/ethnicity from the U.S. adult population and integrated nationally representative 2011-2014 data on processed meat consumption, with etiologic effects of processed meat consumption on cancer incidence, medical and indirect societal costs, and policy costs. RESULTS Over a lifetime, the 10% excise tax would prevent 77,000 cases of colorectal cancer (95% uncertainty interval=56,800, 107,000) and 12,500 cases of stomach cancer (95% uncertainty interval=6,880, 23,900), add 593,000 quality-adjusted life years (95% uncertainty interval=419,000, 827,000), and generate net savings of $2.7 billion from a societal perspective, including $1.1 billion healthcare costs saved. The warning label policy would avert 85,400 cases of colorectal cancer (95% uncertainty interval=56,600, 141,000) and 15,000 cases of stomach cancer (95% uncertainty interval=6,860, 34,500), and add 660,000 quality-adjusted life years (95% uncertainty interval=418,000, 1,070,000), with net savings of $4.5 billion from a societal perspective, including $1.3 billion healthcare costs saved. In subgroup analyses, greater health and economic benefits accrued to (1) younger subpopulations, (2) subpopulations with greater cancer risk, and (3) those with higher baseline processed meat consumption. CONCLUSIONS The model shows that implementing tax or warning labels on processed meats would be a cost-saving strategy with substantial health and economic benefits. The findings should encourage policy makers to consider nutrition-related policies to reduce cancer burden.
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Affiliation(s)
- David D Kim
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts.
| | - Parke E Wilde
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Dominique S Michaud
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Junxiu Liu
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Lauren Lizewski
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Jennifer Onopa
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - John B Wong
- Division of Clinical Decision Making, Tufts Medical Center, Boston, Massachusetts
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25
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Islami F, Miller KD, Siegel RL, Zheng Z, Zhao J, Han X, Ma J, Jemal A, Yabroff KR. National and State Estimates of Lost Earnings From Cancer Deaths in the United States. JAMA Oncol 2019; 5:e191460. [PMID: 31268465 DOI: 10.1001/jamaoncol.2019.1460] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Information on the economic burden of cancer mortality can serve as a tool in setting policies and prioritizing resources for cancer prevention and control. However, contemporary data are lacking for the United States nationally and by state. Objective To estimate lost earnings due to death from cancer overall and for the major cancers in the United States nationally and by state. Design, Setting, and Participants Person-years of life lost (PYLL) were calculated using numbers of cancer deaths and life expectancy data in individuals aged 16 to 84 years who died from cancer in the United States in 2015. The annual median earnings in the United States were used to assign a monetary value for each PYLL by age and sex. Cancer mortality and life expectancy data were obtained from the National Center for Health Statistics and annual median earnings from the US Census Bureau's 2016 Current Population Survey's March Annual Social and Economic Supplement. Data analysis was performed from October 22, 2018, to February 25, 2019. Main Outcomes and Measures Lost earnings due to cancer death, represented as estimated future wages in the absence of premature death. Results A total of 8 739 939 person-years of life were lost to cancer death in persons aged 16 to 84 years in the United States in 2015, translating to lost earnings of $94.4 billion (95% CI, $91.7 billion-$97.3 billion). For individual cancer sites, lost earnings were highest for lung cancer ($21.3 billion), followed by colorectal ($9.4 billion), female breast ($6.2 billion), and pancreatic ($6.1 billion) cancer. Age-standardized lost earning rates per 100 000 were lowest in the West and highest in the South, ranging from $19.6 million (95% CI, $19.1 million-$20.2 million) in Utah to $35.3 million ($34.4 million-$36.3 million) in Kentucky. Approximately 2.4 million PYLL and $27.7 billion (95% CI, $26.9 billion-$28.5 billion) in lost earnings (29.3% of total that occurred in 2015) would have been avoided in 2015 if all states had the same age-specific PYLL or lost earning rates as Utah. Conclusions and Relevance Our findings indicate large state variation in the economic burden of cancer and suggest the potential for substantial financial benefit through delivery of effective cancer prevention, screening, and treatment to minimize premature cancer mortality in all states.
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Affiliation(s)
- Farhad Islami
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Kimberly D Miller
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Jiemin Ma
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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26
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Primary care physicians’ perspectives of the survivorship care for older breast cancer survivors: a pilot study. Support Care Cancer 2019; 28:645-652. [DOI: 10.1007/s00520-019-04855-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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27
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Simard J, Kamath S, Kircher S. Survivorship Guidance for Patients with Colorectal Cancer. Curr Treat Options Oncol 2019; 20:38. [DOI: 10.1007/s11864-019-0635-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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28
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Nipp RD, Sonet EM, Guy GP. Communicating the Financial Burden of Treatment With Patients. Am Soc Clin Oncol Educ Book 2018; 38:524-531. [PMID: 30231377 DOI: 10.1200/edbk_201051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, high health care costs and the financial burden of cancer care have received increased attention. In response to the financial burden of cancer care, patients may jeopardize their health outcomes by not properly adhering to prescribed therapies or even forgoing and delaying care in an effort to defray costs. In addition, the financial burden experienced by patients with cancer may negatively impact clinical outcomes, such as quality of life, physical and psychological symptoms, and potentially, even survival. Notably, in the current era of targeted treatment and immunotherapies for patients with cancer, the rising costs of cancer continue to remain at the forefront of patient concerns. Therefore, a critical need exists to determine how best to assist patients with the cost burden of cancer diagnosis and treatment.
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Affiliation(s)
- Ryan D Nipp
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ellen Miller Sonet
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Gery P Guy
- From the Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, MA; CancerCare, New York, NY; Divisions of Unintentional Injury Prevention and Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
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29
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Pisu M, Henrikson NB, Banegas MP, Yabroff KR. Costs of cancer along the care continuum: What we can expect based on recent literature. Cancer 2018; 124:4181-4191. [PMID: 30475400 DOI: 10.1002/cncr.31643] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cancer costs should be discussed by patients and providers, but information is not readily available. Results from recently published studies (in the last 5 years) on direct and indirect cancer costs may help guide these discussions. METHODS The authors reviewed studies published between 2013 and 2017 that reported direct health care costs and indirect (productivity losses) costs. The annual mean total and net costs of cancer were summarized for all payers and for survivors only by age (ages 18-64 and ≥65 years), by phase of care (initial [ie, 12 months from diagnosis], continuing, and end-of-life [ie, 12 months before death]), or for recently diagnosed (within 1-2 years of diagnosis) and longer term survivors. RESULTS For all payers combined, costs for cancers like breast, prostate, colorectal, and lung cancers were $20,000 to $100,000 in the initial phase, $1000 to $30,000 annually in the continuing phase, and ≥$60,000 in the end-of-life phase. Annual out-of-pocket costs to recently diagnosed survivors were >$1000 for medical care and time costs, approximately $2000 for productivity losses, and from $2500 to >$4000 for employment disability, depending on age. For longer term survivors, the cost of medical care was approximately $1500 for older survivors and $747 for younger survivors, time costs were $831 to $955 for older survivors and $459 to $630 for younger survivors, and productivity losses were approximately $800. Disability among long-term survivors was similar to that among short-term survivors. Limitations of the reviewed studies included older data and under-representation of higher cost cancers. CONCLUSIONS Frequently updated cost information for all cancer types is needed to guide discussions of anticipated short-term and long-term cancer-related costs with survivors. Cancer 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - K Robin Yabroff
- Department of Intramural Research, American Cancer Society, Atlanta, Georgia
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30
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Shen C, Dasari A, Gu D, Chu Y, Zhou S, Xu Y, Halperin D, Fu S, Yao JC, Shih YCT. Costs of Cancer Care for Elderly Patients with Neuroendocrine Tumors. PHARMACOECONOMICS 2018; 36:1005-1013. [PMID: 29682693 DOI: 10.1007/s40273-018-0656-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The incidence and prevalence of neuroendocrine tumors (NETs) have been steadily rising. NETs can arise in various parts of the body and have distinct pathogenesis, clinical manifestations, treatment, and survival compared to other neoplasms. The magnitude of the economic burden of NETs is largely unknown. This study aimed to estimate the cost of illness for NETs among elderly patients based on a large amount of observational data. METHODS We estimated the direct medical costs by phase of care using the Surveillance, Epidemiology, and End Results-Medicare data, including claims from January 1, 2002 through to December 31, 2012. Patients' care was categorized into three phases: initial phase (first year after diagnosis), terminal phase (last year of life), and continuing phase (the period between). We estimated the cost of illness by calculating the difference in medical costs between NET patients and a matched sample from a non-cancer control group. RESULTS Our study sample included 8409 elderly NET patients in the initial phase, 9218 patients in the continuing phase, and 7897 in the terminal phase. The mean cost of care for the initial phase was $46,462 in 2016 US dollars; mean cost of care for the terminal phase with a cancer-related death was $122,702; while the mean cost of care for the continuing phase was $10,457. The mean 5-year cost was $87,079. CONCLUSIONS This population-based study showed that NET patients had substantial continuing phase costs and 5-year costs. Among elderly NET patients, those with pancreas as the primary cancer site had the highest costs.
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Affiliation(s)
- Chan Shen
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA.
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Arvind Dasari
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dian Gu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA
| | - Yiyi Chu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA
| | - Daniel Halperin
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shuangshuang Fu
- Department of Epidemiology, Human Genetics, and Environmental Science, The University of Texas Health Science Center in Houston, Houston, TX, USA
| | - James C Yao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, 77030, USA
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Doroudi M, Coughlan D, Banegas MP, Han X, Robin Yabroff K. Is Cancer History Associated With Assets, Debt, and Net Worth in the United States? JNCI Cancer Spectr 2018; 2:pky004. [PMID: 31360843 DOI: 10.1093/jncics/pky004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/19/2018] [Accepted: 02/14/2018] [Indexed: 11/14/2022] Open
Abstract
Background Financial hardships experienced by cancer survivors have become a prominent public health issue in the United States. Few studies of financial hardship have assessed financial holdings, including assets, debts, and their values, associated with a cancer history. Methods Using the 2008-2011 Medical Expenditure Panel Survey, we identified 1603 cancer survivors and 34 915 individuals age 18-64 years without a cancer history to assess associations between self-reported cancer history and assets, debts, and net worth. Distributions of self-reported asset and debt ownership, their values, and net worth were compared for adults with and without a cancer history with chi-square statistics. Multivariable ordered probit regression analysis was conducted to assess the association between cancer history and net worth using a two-sided Wald test. All analyses were stratified by age group (18-34, 35-44, 45-54, and 55-64 years). Statistical tests were two-sided. Results Among those age 45-54 years, cancer survivors had a lower proportion of home ownership than individuals without a cancer history (59.0% vs 67.1%, P = .0014) and were statistically significantly more likely to have negative net worth (≤-$3000) and less likely to have positive net worth (≥$3000). Cancer survivors were more likely to have debt than individuals without a cancer history, especially among those age 18-34 years (41.3% vs 27.1%, P < .001). Conclusions Cancer history is associated with lower asset ownership, more debt, and lower net worth, especially in survivors age 45-54 years. Longitudinal studies of financial holdings will be important to inform development of interventions to reduce financial hardship.
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Affiliation(s)
- Maryam Doroudi
- Early Detection Branch, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Diarmuid Coughlan
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | | | - Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA
| | - K Robin Yabroff
- Office of Health Policy, US Department of Health and Human Services, Washington, DC
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Hornbrook MC, Grant M, Wendel C, Bulkley JE, Mcmullen CK, Altschuler A, Temple LK, Herrinton LJ, Krouse RS. Rectal Cancer Survivors' Participation in Productive Activities. Perm J 2017; 22:17-022. [PMID: 29236653 DOI: 10.7812/tpp/17-022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Rectal cancer and its treatment impair survivors' productivity. OBJECTIVE To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. DESIGN We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. MAIN OUTCOME MEASURES Productive activities, functional health status, and bowel management at the time of the survey. RESULTS Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. CONCLUSION Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.
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Affiliation(s)
- Mark C Hornbrook
- Senior Investigator Emeritus at the Center for Health Research in Portland, OR.
| | - Marcia Grant
- Distinguished Professor in the Department of Nursing Research and Education at the City of Hope National Medical Center in Duarte, CA.
| | - Christopher Wendel
- Instructor at the University of Arizona College of Medicine and Arizona Center on Aging in Tucson.
| | - Joanna E Bulkley
- Research Associate at the Center for Health Research in Portland, OR.
| | - Carmit K Mcmullen
- Medical Anthropologist and Investigator in the Science Programs Department at the Center for Health Research in Portland, OR.
| | - Andrea Altschuler
- Research Project Manager for the Division of Research in Oakland, CA.
| | - Larissa Kf Temple
- Chief of the Division of Colorectal Surgery at the University of Rochester Medical Center in NY.
| | | | - Robert S Krouse
- Instructor of Surgery at the University of Pennslvania School of Medicine and Chief of Surgery for the CMC Veterans Affairs Medical Center in Philadelphia.
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Iadeluca L, Mardekian J, Chander P, Hopps M, Makinson GT. The burden of selected cancers in the US: health behaviors and health care resource utilization. Cancer Manag Res 2017; 9:721-730. [PMID: 29238222 PMCID: PMC5713681 DOI: 10.2147/cmar.s143148] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To characterize the disease burden among survivors of those cancers having the highest incidence in the US. Methods Adult (≥18 years) survivors of the 11 most frequently diagnosed cancers were identified from publically available data sources, including the Surveillance Epidemiology and End Results 9 1973-2012, National Health Interview Survey 2013, and the Medical Expenditure Panel Survey 2011. Chi-square tests and one-way analyses of variance were utilized to assess differences between cancer survivors and non-cancer controls in behavioral characteristics, symptoms and functions, preventative screenings, and health care costs. Results Hematologic malignancies, melanoma, and breast, prostate, lung, colon/rectal, bladder, kidney/renal, uterine, thyroid, and pancreatic cancers had the highest incidence rates. Breast cancer had the highest incidence among women (156.4 per 100,000) and prostate cancer among men (167.2 per 100,000). The presence of pain (P=0.0003), fatigue (P=0.0005), and sadness (P=0.0012) was consistently higher in cancer survivors 40-64 years old vs. non-cancer controls. Cancer survivors ≥65 years old had higher rates of any functional limitations (P=0.0039) and reported a lack of exercise (P<0.0001) compared with the non-cancer controls. However, obesity rates were similar between cancer survivors and non-cancer controls. Among cancer survivors, an estimated 13.5 million spent $169.4 billion a year on treatment, with the highest direct expenditures for breast cancer ($39 billion), prostate cancer ($37 billion), and hematologic malignancies ($25 billion). Prescription medications and office-based visits contributed equally as the cost drivers of direct medical spending for breast cancer, while inpatient hospitalization was the driver for prostate (52.8%) and lung (38.6%) cancers. Conclusion Understanding the resource utilization implications, health, and well-being of cancer survivors can inform approaches to interventions for improving long-term care.
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Guy GP, Yabroff KR, Ekwueme DU, Rim SH, Li R, Richardson LC. Economic Burden of Chronic Conditions Among Survivors of Cancer in the United States. J Clin Oncol 2017; 35:2053-2061. [PMID: 28471724 PMCID: PMC6059377 DOI: 10.1200/jco.2016.71.9716] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose The prevalence of cancer survivorship and chronic health conditions is increasing. Limited information exists on the economic burden of chronic conditions among survivors of cancer. This study examines the prevalence and economic effect of chronic conditions among survivors of cancer. Methods Using the 2008 to 2013 Medical Expenditure Panel Survey, we present nationally representative estimates of the prevalence of chronic conditions (heart disease, high blood pressure, stroke, emphysema, high cholesterol, diabetes, arthritis, and asthma) and multiple chronic conditions (MCCs) and the incremental annual health care use, medical expenditures, and lost productivity for survivors of cancer attributed to individual chronic conditions and MCCs. Incremental use, expenditures, and lost productivity were evaluated with multivariable regression. Results Survivors of cancer were more likely to have chronic conditions and MCCs compared with adults without a history of cancer. The presence of chronic conditions among survivors of cancer was associated with substantially higher annual medical expenditures, especially for heart disease ($4,595; 95% CI, $3,262 to $5,927) and stroke ($3,843; 95% CI, $1,983 to $5,704). The presence of four or more chronic conditions was associated with increased annual expenditures of $10,280 (95% CI, $7,435 to $13,125) per survivor of cancer. Annual lost productivity was higher among survivors of cancer with other chronic conditions, especially stroke ($4,325; 95% CI, $2,687 to $5,964), and arthritis ($3,534; 95% CI, $2,475 to $4,593). Having four or more chronic conditions was associated with increased annual lost productivity of $9,099 (95% CI, $7,224 to $10,973) per survivor of cancer. The economic impact of chronic conditions was similar among survivors of cancer and individuals without a history of cancer. Conclusion These results highlight the importance of ensuring access to lifelong personalized screening, surveillance, and chronic disease management to help manage chronic conditions, reduce disruptions in employment, and reduce medical expenditures among survivors of cancer.
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Affiliation(s)
- Gery P Guy
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
| | - K Robin Yabroff
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
| | - Donatus U Ekwueme
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
| | - Sun Hee Rim
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
| | - Rui Li
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
| | - Lisa C Richardson
- Gery P. Guy Jr, Donatus U. Ekwueme, Sun Hee Rim, Rui Li, and Lisa C. Richardson, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; and K. Robin Yabroff, US Department of Health and Human Services, Washington, DC
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Franco K, Shuk E, Philip E, Blanch-Hartigan D, Parker PA, Matasar M, Horwitz S, Kissane D, Banerjee SC, Bylund CL. Communication between oncologists and lymphoma survivors during follow-up consultations: A qualitative analysis. J Psychosoc Oncol 2017; 35:513-530. [PMID: 28358241 DOI: 10.1080/07347332.2017.1313352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cancer survivors often experience both short- and long-term challenges as a result of their cancer treatment. Many patients report feeling "lost in transition" following cancer treatment. The oncologist plays a key role in helping the patient to transition to survivorship. The purpose of this paper is to provide a descriptive understanding of the clinical care delivered during follow-up visits for lymphoma patients transitioning from active therapy into survivorship. We used thematic text analysis to identify themes in transcripts of audio recordings of 21 physicians and their patients in follow-up visits within 3 years of completing lymphoma treatment. Conversations between oncologists and patients during follow-up visits addressed a variety of themes, including specific health concerns, follow-up care, health promotion, prior treatment and test results, overall health status, emotional communication and affective tone, post-treatment rehabilitation, discussions occurring in the patient's physical examination, and social issues. However, the frequency with which these themes were discussed varied. In addition, there did not appear to be a consistent framework for these visits. The varied nature of the follow-up visits analyzed in this study suggests the need for increased structure in survivorship-care consultations.
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Affiliation(s)
- Kara Franco
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Elyse Shuk
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Errol Philip
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | | | - Patricia A Parker
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Matthew Matasar
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Steven Horwitz
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - David Kissane
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,c Department of Psychiatry , Monash University , Melbourne , Australia
| | - Smita C Banerjee
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA
| | - Carma L Bylund
- a Department of Psychiatry and Behavioral Sciences , Memorial Sloan Kettering Cancer Center , New York , NY , USA.,d Department of Medical Education , Hamad Medical Corporation , Doha , Qatar.,e Department of Psychiatry , Weill Cornell Medicine in Qatar , Doha , Qatar
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Parsons SK, Guy GP, Peacock S, Cohen JT, Rodday AM, Kiernan EA, Feeny D. Economic Evaluation in Adolescent and Young Adult Cancer: Methodological Considerations and the State of the Science. CANCER IN ADOLESCENTS AND YOUNG ADULTS 2017. [DOI: 10.1007/978-3-319-33679-4_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Chawla N, Blanch-Hartigan D, Virgo KS, Ekwueme DU, Han X, Forsythe L, Rodriguez J, McNeel TS, Yabroff KR. Quality of Patient-Provider Communication Among Cancer Survivors: Findings From a Nationally Representative Sample. J Oncol Pract 2016; 12:e964-e973. [PMID: 27221992 PMCID: PMC5455584 DOI: 10.1200/jop.2015.006999] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer. METHODS Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from "did not discuss" to "discussed in detail," a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses. RESULTS At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married. CONCLUSION Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions.
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Affiliation(s)
- Neetu Chawla
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Danielle Blanch-Hartigan
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Katherine S Virgo
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Donatus U Ekwueme
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Xuesong Han
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Laura Forsythe
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Juan Rodriguez
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - Timothy S McNeel
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
| | - K Robin Yabroff
- Kaiser Permanente Northern California, Oakland, CA; National Cancer Institute, Bethesda; and Information Management Services, Rockville, MD; Bentley University, Waltham, MA; Rollins School of Public Health, Emory University; Centers for Disease Control and Prevention; and American Cancer Society, Atlanta, GA; and Patient-Centered Outcomes Research Institute, Washington, DC
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Rim SH, Guy GP, Yabroff KR, McGraw KA, Ekwueme DU. The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:579-589. [PMID: 27649815 DOI: 10.1080/14737167.2016.1239533] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This systematic review examines the excess cost of chronic conditions on the economic burden of cancer survivorship among adults in the US. Areas covered: Twelve published studies were identified. Although studies varied substantially in populations, comorbidities examined, methods, and types of cost reported, costs for cancer survivors with comorbidities generally increased with greater numbers of comorbidities or an increase in comorbidity index score. Survivors with comorbidities incurred significantly more in total medical costs, out-of-pocket costs, and costs by service type compared to cancer survivors without additional comorbidities. Expert commentary: Cancer survivors with comorbidities bear significant excess out-of-pocket costs and their care is also more expensive to the healthcare system. On-going evaluation of different payment models, care coordination, and disease management programs for cancer survivors with comorbidities will be important in monitoring impact on healthcare costs.
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Affiliation(s)
- Sun Hee Rim
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
| | - Gery P Guy
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
| | - K Robin Yabroff
- b U.S. Department of Health and Human Services , Office of Health Policy, Assistant Secretary for Planning and Evaluation , Washington , DC , USA
| | - Kathleen A McGraw
- c Health Sciences Library , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Donatus U Ekwueme
- a Division of Cancer Prevention and Control , National Center for Chronic Disease Prevention and Health Promotion, CDC , Atlanta , GA , USA
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Koran ME, Lipnik AJ, Baker JC, Banovac F, Omary RA, Brown DB. Procedural Impact of a Dedicated Interventional Oncology Service Line in a National Cancer Institute Comprehensive Cancer Center. J Am Coll Radiol 2016; 13:1145-50. [PMID: 27297700 PMCID: PMC5012920 DOI: 10.1016/j.jacr.2016.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We tested the hypothesis that establishing a dedicated interventional oncology (IO) clinical service line would increase clinic visits and procedural volumes at a single quaternary care academic medical center. METHODS Two time periods were defined: July 2012 to June 2013 (pre-IO clinic) and July 2013 to June 2014 (first year of dedicated IO service). Staff was recruited, and clinic space was provided in the institution's comprehensive cancer center. Clinic visits and procedure numbers were documented using the institution's electronic medical record and billing forms. IO procedures included were transarterial chemoembolization, Y-90 radioembolization, perfusion mapping for Y-90, portal vein embolization, and bland embolization. We compared changes in clinic visit and procedure numbers using paired t tests. Changes after IO initiation were compared to 1-year changes in the Medicare 5% Limited Data Set by cross-referencing Current Procedure Terminology and International Classification of Diseases codes in 2012 and 2013. RESULTS Clinic visits increased from 9 to 204 (P = .003, t = 8.89, df = 3). Procedures increased from 60 to 239 (P = .018, t = 3.85, df = 4). Procedural volumes increased at least 150% for each subtype. The volumes in the 5% Limited Data Set did not change significantly over the 2-year period (443 to 385, P > .05). CONCLUSIONS The establishment of a dedicated IO service significantly increased clinic visits and procedural volumes. National trends were unchanged, suggesting that the impact of our program was not part of a sudden increase of IO procedures.
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Affiliation(s)
| | - Andrew J Lipnik
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Filip Banovac
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reed A Omary
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Arcangeli S, Greco C. Hypofractionated radiotherapy for organ-confined prostate cancer: is less more? Nat Rev Urol 2016; 13:400-8. [DOI: 10.1038/nrurol.2016.106] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, Virgo KS, McNeel TS, Chawla N, Blanch-Hartigan D, Kent EE, Li C, Rodriguez JL, de Moor JS, Zheng Z, Jemal A, Ekwueme DU. Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol 2015; 34:259-67. [PMID: 26644532 DOI: 10.1200/jco.2015.62.0468] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. METHODS We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one's share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). RESULTS Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. CONCLUSION Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.
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Affiliation(s)
- K Robin Yabroff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA.
| | - Emily C Dowling
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Gery P Guy
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Matthew P Banegas
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Amy Davidoff
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Xuesong Han
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Katherine S Virgo
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Timothy S McNeel
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Neetu Chawla
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Danielle Blanch-Hartigan
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Erin E Kent
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Chunyu Li
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Juan L Rodriguez
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Janet S de Moor
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Zhiyuan Zheng
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Ahmedin Jemal
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
| | - Donatus U Ekwueme
- K. Robin Yabroff, Matthew P. Banegas, Neetu Chawla, Danielle Blanch-Hartigan, Erin E. Kent, and Janet S. de Moor, National Cancer Institute, Bethesda; Timothy S. McNeel, Information Management Services, Calverton, MD; Emily C. Dowling, Massachusetts General Hospital, Boston; Danielle Blanch-Hartigan, Bentley University, Waltham, MA; Gery P. Guy Jr, Chunyu Li, Juan L. Rodriguez, and Donatus U. Ekwueme, Centers for Disease Control and Prevention; Xuesong Han, Zhiyuan Zheng, and Ahmedin Jemal, American Cancer Society; Katherine S. Virgo, Emory University, Atlanta, GA; Amy Davidoff, Yale School of Public Health, New Haven, CT; and Neetu Chawla, Kaiser Permanente Northern California, Oakland, CA
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Lee Smith J, Hall IJ. Advancing Health Equity in Cancer Survivorship: Opportunities for Public Health. Am J Prev Med 2015; 49:S477-82. [PMID: 26590642 PMCID: PMC4658651 DOI: 10.1016/j.amepre.2015.08.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Ingrid J Hall
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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How do patients receiving radiotherapy in a Dutch hospital value their time? A contingent valuation study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAimCancer patients spend a lot of time receiving medical care. Our study investigates patients’ preferences regarding reducing the time involved in non-palliative radiotherapy care.MethodsA total of 142 Dutch patients were included in our study. Using a contingent valuation survey, we measured the proportion of patients who preferred to reduce their patients’ time, splitting it into five different categories, and, for those who did, whether and how much they were willing to pay for this to happen.ResultsAbout 50% of the patients preferred to reduce their time waiting for admission by 1 week and their travel time by half; 20 and 62% wanted to reduce their waiting time by half and their treatment time from 20 to 5 minutes, respectively; 36% preferred to be treated 7 instead of 5 days a week; and 20% of those wishing to reduce their patients’ time were willing to pay, and their mean willingness to pay (WTP) ranged from £0·32 to £18·1 per hour’s reduction of their time.ConclusionHalf of the patients seem to assess their patients’ time as reasonable. The other half preferred to reduce it, but only about 20% of them were willing to pay for it to happen and their mean WTP was low.
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Alcusky M, Philpotts L, Bonafede M, Clarke J, Skoufalos A. The Patient Burden of Screening Mammography Recall. J Womens Health (Larchmt) 2014; 23 Suppl 1:S11-9. [DOI: 10.1089/jwh.2014.1511] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Matthew Alcusky
- Jefferson School of Population Health, Philadelphia, Pennsylvania
| | | | | | - Janice Clarke
- Jefferson School of Population Health, Philadelphia, Pennsylvania
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