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Myers SP, Aviki E, Sevilimedu V, Thom B, Gemignani ML. Financial Toxicity Among Women with Breast Cancer Varies by Age and Race. Ann Surg Oncol 2024; 31:8040-8047. [PMID: 39078600 DOI: 10.1245/s10434-024-15895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION Financial toxicity negatively affects clinical outcomes in breast cancer. Underrepresented demographics may be at higher risk for financial toxicity. We characterized disparities on the basis of age and other factors. PATIENTS AND METHODS Surveys completed by women with stage 0-IV breast cancer treated at Memorial Sloan Kettering Cancer Center between 06/2022 and 05/2023 were analyzed. The comprehensive score for financial toxicity (COST) scale was used to assess financial toxicity. Descriptive statistics were calculated for differences in financial toxicity/related factors, and outcomes by age and race. Associations between variables of interest and COST scores were analyzed using linear regression. RESULTS Of 8512 respondents (75% white, 9.3% Asian, 8.4% Black), most (68%) had clinical stage 0/I disease. Stratified by age, young Black women had higher financial toxicity than young white or Asian women (p < 0.001). On multivariable analysis, women age < 45 years experienced higher financial toxicity than older women (coefficient - 2.0, 95% CI - 2.8 to - 1.1, p < 0.001). Compared with white women, financial toxicity was greater among Black (coefficient - 6.8, 95% CI - 7.8 to - 5.8) and Asian women (coefficient - 3.5, 95% CI - 4.4 to - 2.5). Cost-related medication non-adherence was more frequent among Black and Asian women (p < 0.001). Asian women more often paid for treatment with savings than white and Black women (p < 0.001). Young women reported using savings for treatment-related costs more than older (45% vs. 32%); p < 0.001). CONCLUSIONS Racial minorities and young patients are disproportionately affected by financial toxicity. Further studies are planned to determine how financial toxicity evolves over time and whether referral to financial services effectively reduces toxicity.
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Affiliation(s)
- Sara P Myers
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline Aviki
- Division of Gynecologic Oncology, NYU Langone Health, Mineola, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA.
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Myers SP, Aviki E, Sevilimedu V, Thom B, Gemignani ML. ASO Author Reflections: Young Adults and Racial Minorities May Be at High Risk for Financial Toxicity After Breast Cancer Treatment. Ann Surg Oncol 2024; 31:8112-8113. [PMID: 39172300 DOI: 10.1245/s10434-024-16050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024]
Affiliation(s)
- Sara P Myers
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emeline Aviki
- Division of Gynecologic Oncology, NYU Langone Health, Mineola, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bridgette Thom
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Surgery, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA.
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Uppal N, Broekhuis JM, Gomez-Mayorga JL, Chen HW, Chaves N, James B. Association between patient-reported financial burden and catastrophic health expenditures in cancer survivors. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2024; 12:100752. [PMID: 39317137 DOI: 10.1016/j.hjdsi.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 08/25/2024] [Accepted: 09/16/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE To measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE). METHODS We extracted data from the Medical Expenditures Panel Survey from 2011 to 2017 to conduct a retrospective population-based cohort study and multivariable logistic regression to assess the financial burden of cancer across 16 cancer types and compare patient-reported metrics to CHE rates. RESULTS Patients with ovarian cancer were most likely to report inability paying bills (34.5 %) and filing for bankruptcy (9.4 %), while patients with thyroid cancer were most likely to incur debt (22.4 %). Patients with kidney cancer had the highest mean debt ($46,915). CHEs were independently predicted by inability to pay medical bills (OR [95 % CI], 1.96 [1.14-3.35]) and bankruptcy filing (OR [95 % CI], 3.90 [1.21-12.60]. CONCLUSIONS AND IMPLICATIONS We report important variations in the financial burden across cancer types and underscore the importance of assessing how patient-reported measures are related to CHEs. POLICY IMPLICATIONS The financial burden of cancer care could explain the lack of improved outcomes with increased national health spending.
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Affiliation(s)
- Nishant Uppal
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jordan M Broekhuis
- Harvard Medical School, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Hao Wei Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin James
- Harvard Medical School, Boston, MA, USA; Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Gharzai LA, Liu YA, Sun Z, Mady LJ, Mohn M, Larson A, Kircher S, Yanez B, Carlos RC, Pottow J, Jagsi R, Sadigh G. Financial Toxicity Screening Preferences in Patients With Breast Cancer. JCO Oncol Pract 2024:OP2400415. [PMID: 39288337 DOI: 10.1200/op.24.00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/18/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
PURPOSE Financial toxicity is an important issue in cancer that affects quality of life and treatment adherence. Screening can identify patients at risk but consensus on appropriate timing or methods is lacking. METHODS We sent an anonymous survey to e-mail subscribers of a nationwide breast cancer-specific philanthropic organization in July 2023 asking about financial toxicity screening preferences. Frequencies, percentages, and medians were calculated for categorical and continuous variables. RESULTS Of 5,774 potential participants, 738 respondents with a confirmed cancer diagnosis participated (12.7% response rate). Participants were 93% female (n = 690), had a median age of 50 years (IQR, 44-57), were 57% non-Hispanic White (n = 418), 20% Black/African-American (n = 149), 9.2% Hispanic (n = 68). 93% confirmed a breast cancer diagnosis (n = 689), and 54% were currently undergoing treatment (n = 400). Most indicated not being asked about financial stressors by (58%, n = 425) and not receiving assistance from their care team (68%, n = 498). Most preferred for providers to reach out regarding financial needs (83%, n = 615). Most wished for these discussions to take place early (when first diagnosed [45%, n = 334] or when treatment selected [37%, n = 275]) and to be asked frequently (each appointment [42%, n = 312] or once per month [36%, n = 268]). Participants felt most comfortable discussing financial needs with a social worker or patient/financial navigator (92%, n = 679), in person (75%, n = 553), or via telephone (65%, n = 479). CONCLUSION Patients in this sample primarily consisting of women with breast cancer desired financial screening to occur early, often, and to be initiated by their providers. Patient preferences can inform optimal implementation of financial toxicity screening practices. Continued work refining best practices for financial toxicity screening should incorporate these patient preferences.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Yingzhe Alex Liu
- Department of Biostatistics, Northwestern University, Chicago, IL
| | - Zequn Sun
- Department of Biostatistics, Northwestern University, Chicago, IL
| | - Leila J Mady
- Department of Otolaryngology, Johns Hopkins University, Baltimore, MD
| | - Michelle Mohn
- Department of Social Work, Northwestern University, Chicago, IL
| | - Alexis Larson
- Department of Radiation Oncology, Northwestern University, Chicago, IL
| | - Sheetal Kircher
- Division of Medical Oncology, Department of Internal Medicine, Northwestern University, Chicago, IL
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John Pottow
- University of Michigan Law School, Ann Arbor, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Gelareh Sadigh
- Department of Radiology, University of California Irvine, Irvine, CA
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Samaha NL, Mady LJ, Armache M, Hearn M, Stemme R, Jagsi R, Gharzai LA. Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review. J Am Coll Radiol 2024; 21:1380-1397. [PMID: 38762031 DOI: 10.1016/j.jacr.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/14/2024] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT. METHODS A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States. RESULTS Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies. DISCUSSION FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.
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Affiliation(s)
- Nadia L Samaha
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leila J Mady
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Armache
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Madison Hearn
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rachel Stemme
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Reshma Jagsi
- Chair, Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois.
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Obeng-Gyasi S, Gokun Y, Presley CJ, Rosko A, Plascak J, Paskett ED. Practical Insights From Integrating Financial Hardship Screening at a Comprehensive Cancer Center. J Am Coll Radiol 2024; 21:1398-1401. [PMID: 39117186 DOI: 10.1016/j.jacr.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio.
| | - Yevgeniya Gokun
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, and Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Division of Hematology, Department of Internal Medicine, Columbus, The Ohio State University, Ohio
| | - Ashley Rosko
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Division of Hematology, Department of Internal Medicine, Columbus, The Ohio State University, Ohio
| | - Jesse Plascak
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio; Division of Hematology, Department of Internal Medicine, Columbus, The Ohio State University, Ohio; Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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Betts AC, Roth ME, Albritton K, Pruitt SL, Lupo PJ, Wang JS, Shay LA, Allicock MA, Murphy CC. Racialized inequities in live birth after cancer: A population-based study of 63,000 female adolescents and young adults with cancer. Cancer 2024; 130:2928-2937. [PMID: 38696087 PMCID: PMC11364139 DOI: 10.1002/cncr.35341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Fertility after cancer is a top concern for adolescents and young adults with cancer (AYAs) (15-39 years old at diagnosis). The authors characterized live births after cancer by race and ethnicity ("race/ethnicity") in a population-based sample of female AYAs. METHODS This study used Texas Cancer Registry data linked to birth certificates (1995-2016) to estimate cumulative incidence of live birth, based on first live birth after cancer, and compared differences by race/ethnicity. Proportional subdistribution hazards models were used to estimate associations between race/ethnicity and live birth, adjusted for diagnosis age, cancer type, stage, year, and prior live birth, overall and for each cancer type. RESULTS Among 65,804 AYAs, 10-year cumulative incidence of live birth was lower among non-Hispanic Black AYAs than other racial/ethnic groups: 10.2% (95% confidence interval [CI], 9.4-10.9) compared to 15.9% (95% CI, 14.1-17.9) among Asian or Pacific Islander, 14.7% (95% CI, 14.2-15.3) among Hispanic, and 15.2% (95% CI, 14.8-15.6) among non-Hispanic White AYAs (p < .01). In the adjusted overall model, Black AYAs were less likely to have a live birth after cancer than all other groups. In adjusted models for each cancer type, live birth was significantly less likely for Black AYAs with gynecologic cancers or lymphomas (compared to White AYAs) or thyroid cancers (compared to Hispanic AYAs). CONCLUSION Black AYAs are less likely than AYAs of other races/ethnicities to have a live birth after cancer, in contrast to patterns of live birth in the general population. Research and action to promote childbearing equity after cancer are imperative.
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Affiliation(s)
- Andrea C. Betts
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Michael E. Roth
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sandi L. Pruitt
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Philip J. Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer S. Wang
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
| | - L. Aubree Shay
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Marlyn A. Allicock
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, Houston, TX, USA
| | - Caitlin C. Murphy
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA
- Center for Health Promotion and Prevention Research, Houston, TX, USA
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Almallah WR, Bakas T, Shaughnessy E, Morrison CF. Factors and Beliefs Affecting Women Diagnosed With Breast Cancer to Initiate Cancer Treatment: A Systematic Review. West J Nurs Res 2024; 46:623-634. [PMID: 39076138 DOI: 10.1177/01939459241262653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Initiating treatment within the optimal time is critical for women with breast cancer. A delay in cancer treatment initiation can result in increased morbidity and mortality and decreased overall survival. OBJECTIVE This systematic review aims to investigate the literature for the factors and beliefs affecting women diagnosed with breast cancer with regard to initiating cancer treatment. METHODS The PubMed, CINAHL, and PsycINFO databases were searched using the terms of breast cancer, initiating or seeking treatment, and beliefs. The Johns Hopkins Evidence-Based Practice Research Evidence Appraisal Tool was used to evaluate the included articles. RESULTS Sixteen articles were included in this review. The addressed factors were classified as (1) patient-related factors, (2) disease-related factors, (3) provider-related factors, and (4) system-related factors. The identified beliefs were cultural beliefs and perceived barriers to initiating treatment. CONCLUSION Although the literature reported multiple factors and beliefs that impact the time of initiating treatment among women with breast cancer, more research is needed to fully understand the beliefs influencing treatment initiation. It is essential to address and screen the factors and beliefs identified for women diagnosed with breast cancer to enhance treatment initiation early and prevent any possible delay. Interventions can be developed to overcome the factors and beliefs that may lead to late treatment initiation. Advocacy for new policies should be in action to reduce the disparities associated with treatment initiation among women with breast cancer.
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Affiliation(s)
- Walaa R Almallah
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
- College of Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Tamilyn Bakas
- University of Cincinnati College of Nursing, Cincinnati, OH, USA
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Nwankwo JC, Nagornaya A. Therapeutic potential of twenty-first century music for cancer survivorship: from music and conceptual metaphor perspectives to a synergetic effect approach. Support Care Cancer 2024; 32:520. [PMID: 39017779 DOI: 10.1007/s00520-024-08719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
This paper examines the therapeutic potential of twenty-first century music as a means of supplementary therapeutic care for cancer survivorship. It presents a study of songs by Rihanna, Beyoncé, Adele, Coldplay, and Imagine Dragons, which combines the analysis of relevant music features and conceptual metaphors in the lyrics to examine the effect of the songs on the audience. The main aim of this study was to highlight the emotional and cognitive impact of these songs on listeners and identify their potential role in improving the psychological condition of patients with cancer who are downtrodden or reeling from the pain of surgery, chemotherapy, and side effects of treatment. This article adopts the conceptual metaphorical framework proposed by Lakoff and Johnson (1980) and the metaphor identification procedure (MIP) (Pragglejazz group, 2007) to examine the targeted use of metaphors features in the lyrics of the selected songs. The findings show that although there is a therapeutic potential associated with the songs analyzed, there are also potential risks for patients with cancer. "".
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Waters AR, Petermann VM, Planey AM, Manning M, Spencer JC, Spees LP, Rosenstein DL, Gellin M, Padilla N, Reeder-Hayes KE, Wheeler SB. Financial burden among metastatic breast cancer patients: a qualitative inquiry of costs, financial assistance, health insurance, and financial coping behaviors. Cancer Causes Control 2024; 35:955-961. [PMID: 38388859 PMCID: PMC11129926 DOI: 10.1007/s10552-024-01854-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood. METHODS Qualitative interviews were conducted to describe the experiences of financial burden for MBC patients, focusing on the drivers of financial burden, their experience using their health insurance, accessing financial assistance, and any resulting cost-coping behaviors. Interviews were transcribed and qualitatively analyzed using a descriptive phenomenological approach to thematic analysis. RESULTS A total of n = 11 MBC patients or caregiver representatives participated in the study. MBC patients were on average 50.2 years of age (range: 28-65) and 72.7% non-Hispanic White. MBC patients were diagnosed as metastatic an average of 3.1 years (range: 1-9) before participating in the study. Qualitative analysis resulted in four themes including (1) causes of financial burden, (2) financial assistance mechanisms, (3) health insurance and financial burden, and (4) cost-coping behaviors. Both medical and non-medical costs drove financial burden among participants. All participants reported challenges navigating their health insurance and applying for financial assistance. Regardless of gaining access to assistance, financial burden persisted for nearly all patients and resulted in cost-coping behaviors. CONCLUSION Our findings suggest that current systems for health insurance and financial assistance are complex and difficult to meet patient needs. Even when MBC patients accessed assistance, excess financial burden persisted necessitating use of financial coping-behaviors such as altering medication use, maintaining employment, and taking on debt.
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Affiliation(s)
- Austin R Waters
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Victoria M Petermann
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Arrianna Marie Planey
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lisa P Spees
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neda Padilla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Harris JP, Ku E, Harada G, Hsu S, Chiao E, Rao P, Healy E, Nagasaka M, Humphreys J, Hoyt MA. Severity of Financial Toxicity for Patients Receiving Palliative Radiation Therapy. Am J Hosp Palliat Care 2024; 41:592-600. [PMID: 37406195 PMCID: PMC10772523 DOI: 10.1177/10499091231187999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.
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Affiliation(s)
- Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Eric Ku
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Garrett Harada
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Sophie Hsu
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Elaine Chiao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Pranathi Rao
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Erin Healy
- Department of Radiation Oncology, University of California Irvine, Orange, CA, USA
| | - Misako Nagasaka
- Department of Medicine, Division of Hematology/Oncology, University of California Irvine, Orange, CA, USA
| | - Jessica Humphreys
- Department of Geriatrics and Extended Care, Division of Palliative Care, Tibor Rubin VA Medical Center, Long Beach, CA, USA
- Department of Medicine, Division of Palliative Medicine, University of California, San Francisco, CA, USA
| | - Michael A Hoyt
- Department of Population Health & Disease Prevention, University of California Irvine, Irvine, CA, USA
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Wang LL, Xu RH. Development of a rapid tool for screening financial toxicity based on the comprehensive score for financial toxicity. J Cancer Policy 2024; 40:100475. [PMID: 38552715 DOI: 10.1016/j.jcpo.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
OBJECTIVE This study aimed to use item response theory (IRT) to develop and validate a short version of the Chinese COmprehensive Score for financial Toxicity (COST-S-C) in patients with cancer. METHODS A total of 500 patients with cancer participated in the survey. Confirmatory factor analysis (CFA) was used to assess the factor structure of the COST-S-C. A two-parameter IRT model was used to examine the item fit of the COST-S-C. Item discrimination, item characteristic curves (ICCs), item information curves (IICs), and item fit were estimated. Differential item functioning (DIF) was assessed for participants' gender and age. Reliability, convergent and discriminant validity was examined as well as estimating the optimal cut-off points of the COST-S-C. RESULTS The CFA results supported the bi-factor structure of the COST-S-C. The IRT analysis findings revealed that several items showed problems with the ICCs, providing little information in terms of IICs as well as poor discrimination. Item 5 showed a negligible DIF problem with age. A valid 3-item COST-S-C scale and its optimal cut-off point was developed. CONCLUSIONS The COST-S-C is a valid and quick screening tool used to distinguish patients with cancer who report significant financial toxicity in various medical settings.
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Affiliation(s)
- Ling-Ling Wang
- Center for Health policy and management studies, Nanjing University, Nanjing, China; Department of Blood Transfusion Medicine, Jinling Hospital, School of Medicine, Nanjing, University Nanjing, China
| | - Richard Huan Xu
- Department of Rehabilitation Sciences, Faculty of Health and Social Science, the Hong Kong Polytechnic University, Hong Kong, China; JC School of Public Health and Primary Care, Faculty of Medicine, the Chinese University of Hong Kong, the Hong Kong Special Administrative Region of China.
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13
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Patra A, deSouza R, Nag S, Pant HB, Agiwal V, A Y N, Kumar Y, Murthy G. Burden of Financial Hardship Among Breast Cancer Survivors in Maharashtra, India. Cureus 2024; 16:e61625. [PMID: 38966461 PMCID: PMC11222713 DOI: 10.7759/cureus.61625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Improved breast cancer treatments have increased survival rates, but prolonged and costly therapies strain survivors financially. This study addresses the dearth of research on financial difficulties among breast cancer survivors (BCS) in India. METHODS A mixed-methods study was employed; we assessed financial hardship (FH) using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT), a validated 12-item questionnaire. The minimum score represents FH (FH was categorized based on scores <27). RESULTS Out of 80 surveyed BCS, 60% experienced FH and had a median age of 48 years (40.5-56.5 years). Factors such as occupation, education, income, expenditures, insurance coverage, and impact on savings exhibited significant associations with FH. With only one-third having health insurance and 43.8% self-funding treatment, this research sheds light on the urgent need for targeted support and policies to alleviate the financial burdens faced by BCS in the Indian context. CONCLUSION Financial hardship harms the mental and physical health of BCS. Collaborative efforts among policymakers, healthcare professionals, and insurers are crucial to establishing a compassionate healthcare system that addresses both immediate health and long-term financial concerns.
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Affiliation(s)
- Abhilash Patra
- Epidemiology and Public Health, Indian Institute of Public Health, Hyderabad, IND
| | | | - Shona Nag
- Oncology, Sahyadri Group of Hospitals, Pune, IND
| | - Hira B Pant
- Data Management and Biostatistics, Indian Institute of Public Health, Hyderabad, IND
| | - Varun Agiwal
- Data Management and Biostatistics, Indian Institute of Public Health, Hyderabad, IND
| | - Nirupama A Y
- Epidemiology and Public Health, Indian Institute of Public Health, Hyderabad, IND
| | - Yashaswini Kumar
- Epidemiology and Public Health, Indian Institute of Public Health, Hyderabad, IND
| | - Gvs Murthy
- Epidemiology and Public Health, Indian Institute of Public Health, Hyderabad, IND
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14
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Carrera PM, Curigliano G, Santini D, Sharp L, Chan RJ, Pisu M, Perrone F, Karjalainen S, Numico G, Cherny N, Winkler E, Amador ML, Fitch M, Lawler M, Meunier F, Khera N, Pentheroudakis G, Trapani D, Ripamonti CI. ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer. ESMO Open 2024; 9:102992. [PMID: 38626634 PMCID: PMC11033153 DOI: 10.1016/j.esmoop.2024.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022. METHODS A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting. RESULTS AND DISCUSSION A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.
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Affiliation(s)
- P M Carrera
- German Cancer Research Center, Heidelberg, Germany; Healtempact: Health/Economic Insights-Impact, Hengelo, The Netherlands.
| | - G Curigliano
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
| | - D Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Rome, Italy
| | - L Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - R J Chan
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - M Pisu
- University of Alabama in Birmingham, Birmingham, USA
| | - F Perrone
- National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | | | - G Numico
- Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - N Cherny
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Winkler
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Medical Faculty, Department of Medical Oncology, Heidelberg, Germany
| | - M L Amador
- Spanish Association Against Cancer (AECC), Madrid, Spain
| | - M Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - M Lawler
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - F Meunier
- European Initiative on Ending Discrimination against Cancer Survivors and Belgian Royal Academy of Medicine (ARMB), Brussels, Belgium
| | | | | | - D Trapani
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
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15
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Gupta K, Parashar B. Financial Toxicity in Radiation Oncology. Cureus 2024; 16:e58643. [PMID: 38644946 PMCID: PMC11032110 DOI: 10.7759/cureus.58643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 04/23/2024] Open
Abstract
Financial toxicity details the financial burden patients face due to a variety of medical costs. Cancer patients, especially those receiving radiation therapy, are at a much higher risk of experiencing economic hardships than healthy people or people with other conditions. There are a variety of risk factors associated with financial toxicity as well as numerous tools to assess the toxicity experienced by patients. In this review article, we present a concise overview of contributors, risk factors, case studies, tools, impacts, and potential interventions of financial toxicity.
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Affiliation(s)
| | - Bhupesh Parashar
- Radiation Oncology, Zucker School of Medicine at Hofstra/Northwell, Lake Success, USA
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16
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Yabroff KR, Sylvia Shi K, Zhao J, Freedman AN, Zheng Z, Nogueira L, Han X, Klabunde CN, de Moor JS. Importance of Patient Health Insurance Coverage and Out-of-Pocket Costs for Genomic Testing in Oncologists' Treatment Decisions. JCO Oncol Pract 2024; 20:429-437. [PMID: 38194620 DOI: 10.1200/op.23.00153] [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: 03/15/2023] [Revised: 08/14/2023] [Accepted: 11/14/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE Use of genomic testing, especially multimarker panels, is increasing in the United States. Not all tests and related treatments are covered by health insurance, which can result in substantial patient out-of-pocket (OOP) costs. Little is known about oncologists' treatment decisions with respect to patient insurance coverage and OOP costs for genomic testing. METHODS We identified 1,049 oncologists who used multimarker tumor panels from the 2017 National Survey of Precision Medicine in Cancer Treatment. Separate multivariable ordinal logistic regressions examined associations of oncologist-, practice-, and area-level characteristics and oncologists' ratings of importance (very, somewhat, or a little/not important) of insurance coverage and OOP costs for genomic testing in treatment decisions, adjusting for oncologist years of experience, sex, race and ethnicity, specialty, use of next-generation sequencing (NGS) tests, region, tumor boards, patient insurance mix, and area-level socioeconomic characteristics. RESULTS Among oncologists, 47.3%, 32.7%, and 20.0% reported that patient insurance coverage for genomic testing was very, somewhat, or a little/not important, respectively, in treatment decisions. In addition, 56.9%, 28.0%, and 15.2% reported that OOP costs for testing were very, somewhat, or a little/not important, respectively. In adjusted analyses, oncologists who used NGS tests were more likely to report patient insurance and OOP costs as important (odds ratio [OR], 2.00 [95% CI, 1.16 to 3.45] and OR, 2.12 [95% CI, 1.22 to 3.68], respectively) in treatment decisions compared with oncologists who did not use these tests, as were oncologists who treated solid tumors, rather than only hematological cancers. More years of experience and higher percentages of Medicaid or self-paid/uninsured patients in the practice were associated with reporting insurance coverage (OR, 1.43 [95% CI, 1.09 to 1.89]) and OOP costs (OR, 1.51 [95% CI, 1.13 to 2.01]) as important. Oncologists in practices with molecular tumor boards for genomic tests were less likely to report coverage (OR, 0.63 [95% CI, 0.47 to 0.85]) and OOP costs (OR, 0.72 [95% CI, 0.53 to 0.97]) as important than their counterparts in practices without these tumor boards. CONCLUSION Most oncologists rate patient health insurance and OOP costs for genomic tests as important considerations in subsequent treatment recommendations. Modifiable factors associated with these ratings can inform interventions to support patient-physician decision making about care.
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Affiliation(s)
- K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Kewei Sylvia Shi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Andrew N Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Leticia Nogueira
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Rockville, MD
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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17
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Berlin NL, Albright BB, Moss HA, Offodile AC. Catastrophic health expenditures, insurance churn, and non-employment among women with breast cancer. JNCI Cancer Spectr 2024; 8:pkae006. [PMID: 38331405 PMCID: PMC11003299 DOI: 10.1093/jncics/pkae006] [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: 09/27/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Breast cancer treatment and survivorship entails a complex and expensive continuum of subspecialty care. Our objectives were to assess catastrophic health expenditures, insurance churn, and non-employment among women younger than 65 years who reported a diagnosis of breast cancer. We also evaluated changes in these outcomes related to implementation of the Affordable Care Act. METHODS The data source for this study was the Medical Expenditure Panel Survey (2005-2019), which is a national annual cross-sectional survey of families, providers, and insurers in the United States. To assess the impact of breast cancer, comparisons were made with a matched cohort of women without cancer. We estimated predicted marginal probabilities to quantify the effects of covariates in models for catastrophic health expenditures, insurance churn, and non-employment. RESULTS We identified 1490 respondents younger than 65 years who received care related to breast cancer during the study period, representing a weight-adjusted annual mean of 1 062 129 patients. Approximately 31.8% of women with breast cancer reported health expenditures in excess of 10% of their annual income. In models, the proportion of women with breast cancer who experienced catastrophic health expenditures and non-employment was inversely related to increasing income. During Affordable Care Act implementation, mean number of months of uninsurance decreased and expenditures increased among breast cancer patients. CONCLUSIONS Our study underscores the impact of breast cancer on financial security and opportunities for patients and their families. A multilevel understanding of these issues is needed to design effective and equitable strategies to improve quality of life and survivorship.
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Affiliation(s)
- Nicholas L Berlin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin B Albright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Haley A Moss
- Division of Gynecologic Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Anaeze C Offodile
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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18
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Ding X, Zhao F, Zhu M, Wang Q, Wei S, Xue J, Li Z. A systematic review and meta-analysis of interventions to reduce perceived stress in breast cancer patients. Complement Ther Clin Pract 2024; 54:101803. [PMID: 38159534 DOI: 10.1016/j.ctcp.2023.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/12/2023] [Accepted: 09/23/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Breast cancer (BC) patients commonly face stress that causes severe psychological and physiological problems. The main objective of the review was to confirm the effect of interventions on breast cancer patients' perceived stress, and the secondary objective was to explore the impact of interventions on anxiety, depression, and inflammatory markers. METHODS A systematic and comprehensive search for randomized controlled trials (RCTs) that reported interventions' effects on perceived stress in breast cancer patients was performed in nine databases. RESULTS Twenty-four RCTs, including 1887 participants, met the inclusion criteria, summarizing six categories for the intervention group: mindfulness and yoga, exercise, cognitive-behavioral stress management, self-regulation, relaxation training, and acupuncture. Compared with usual care or other types of care, mindfulness and yoga had excellent effects against perceived stress, anxiety, and depression; self-regulation could reduce perceived stress and anxiety; exercise could reduce perceived stress; acupuncture could reduce the level of depression; mindfulness could improve the TNF-α level, and yoga can reduce the level of salivary cortisol and DNA damage. CONCLUSION This systematic review indicated that nondrug interventions, such as mindfulness and yoga, effectively reduce perceived stress, anxiety, and depression. Rigorous studies with large sample sizes are needed to address the limitations of small sample sizes and shortcomings in methodology in this area.
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Affiliation(s)
- Xiaotong Ding
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China.
| | - Fang Zhao
- Department of Internal Medicine, National Cancer Center/ National Clinical Research Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Mingyue Zhu
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China.
| | - Qing Wang
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China; School of Nursing, Lanzhou University, 28 Yanxi Road, Chengguan District, Lanzhou, 730010, China.
| | - Shuaifang Wei
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China.
| | - Jiajun Xue
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China.
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, 33 Ba Dachu Road, Shijingshan District, Beijing, 100144, China.
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19
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Baglien BD, Ganesh Kumar N, Berlin NL, Hawley ST, Jagsi R, Momoh AO. Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion. Semin Plast Surg 2024; 38:39-47. [PMID: 38495060 PMCID: PMC10942833 DOI: 10.1055/s-0043-1778040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p < 0.001) or a staff member (75.5% vs. 59.3%, p < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, "other") were significantly more likely to prefer a cost-of-care discussion ( p < 0.001, p = 0.02, p = 0.05, p = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.
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Affiliation(s)
- Brigit D. Baglien
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nishant Ganesh Kumar
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Nicholas L. Berlin
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Adeyiza O. Momoh
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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20
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Azzani M, Atroosh WM, Anbazhagan D, Kumarasamy V, Abdalla MMI. Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis. Front Public Health 2024; 11:1266533. [PMID: 38229668 PMCID: PMC10789858 DOI: 10.3389/fpubh.2023.1266533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Background There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology, International Medical School (IMS), Management & Science University (MSU), Shah Alam, Selangor, Malaysia
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Mona Mohamed Ibrahim Abdalla
- Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
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21
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Tesfaye EA, O'Neill RC, McGregor T, Clemens MW. Financial Toxicity in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Ann Plast Surg 2024; 92:34-40. [PMID: 37994417 DOI: 10.1097/sap.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Financial toxicity is a growing concern due to its considerable effects on medical adherence, quality of life, and mortality. The cost associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is substantial from diagnosis to treatment, including adjuvant therapy and surgery. This study aims to assess the prevalence of financial toxicity in BIA-ALCL patients. METHODS We performed a cross-sectional, survey-based study on women with confirmed cases of BIA-ALCL from December 2019 to March 2023. The primary study outcomes were financial toxicity measured by Comprehensive Score for Financial Toxicity (COST) score and patient-reported financial burden measured by the responses to the Evaluation of the Financial Impact of BIA-ALCL survey. Lower COST scores signify higher financial toxicity. Responses were linked to patient data extracted from the medical records. RESULTS Thirty-two women treated for confirmed BIA-ALCL were included. Patients were all White and were diagnosed at a median age of 51 years (range, 41-65 years). The mean COST score was 27.9 ± 2.23. Lower COST scores were associated with receipt of radiotherapy ( P = 0.033), exceeding credit card limits ( P = 0.036), living paycheck to paycheck ( P = 0.00027), requiring financial support from friends and family ( P = 0.00044), and instability in household finances ( P = 0.034). CONCLUSIONS Financial toxicity is prevalent in BIA-ALCL patients and has a substantial impact on patient reported burden. Insurance denial is frequent for patients with a prior history of cosmetic augmentation. Risk assessments and cost discussions should occur throughout the care continuum to minimize financial burden.
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Affiliation(s)
- Eliora A Tesfaye
- From the Department of Plastic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Rebecca C O'Neill
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Terri McGregor
- Breast Implant Safety Alliance (BISA), North Bay, Ontario, Canada
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX
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22
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You W, Pilehvari A, Shi R, Cohn W, Sheffield C, Chow PI, Krukowski BA, Anderson R. A multi-dimensional assessment of financial hardship of cancer patients using existing health system data. Cancer Med 2023; 12:22263-22277. [PMID: 37987094 PMCID: PMC10757134 DOI: 10.1002/cam4.6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Existing financial hardship screening does not capture the multifaceted and dynamic nature of the problem. The use of existing health system data is a promising way to enable scalable and sustainable financial hardship screening. METHODS We used existing data from 303 adult patients with cancer at the University of Virginia Comprehensive Cancer Center (2016-2018). All received distress screening and had a valid financial assistance screening based solely on household size-adjusted income. We constructed a composite index that integrates multiple existing health system data (Epic, distress screening, and cancer registry) to assess comprehensive financial hardship (e.g., material conditions, psychological responses, and coping behaviors). We examined differences of at-risk patients identified by our composite index and by existing single-dimension criterion. Dynamics of financial hardship over time, by age, and cancer type, were examined by fractional probit models. RESULTS At-risk patients identified by the composite index were generally younger, better educated, and had a higher annual household income, though they had lower health insurance coverage. Identified periods to intervene for most patients are before formal diagnosis, 2 years, and 6 years after diagnosis. Within 2 years of diagnosis and more than 4 years after diagnosis appear critical for subgroups of patients who may suffer from financial hardship disparities. CONCLUSION Existing health system data provides opportunities to systematically measure and track financial hardship in a systematic, scalable and sustainable way. We find that the dimensions of financial hardship can exhibit different patterns over time and across patient subgroups, which can guide targeted interventions. The scalability of the algorithm is limited by existing data availability.
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Affiliation(s)
- Wen You
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Asal Pilehvari
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Ruoding Shi
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Wendy Cohn
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Christina Sheffield
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | - Philip I‐Fon Chow
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
| | | | - Roger Anderson
- University of Virginia Comprehensive Cancer CenterCharlottesvilleVirginiaUSA
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Yuan X, Zhang X, He J, Xing W. Interventions for financial toxicity among cancer survivors: A scoping review. Crit Rev Oncol Hematol 2023; 192:104140. [PMID: 37739147 DOI: 10.1016/j.critrevonc.2023.104140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.
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Affiliation(s)
- Xiaoyi Yuan
- School of nursing, Fudan University, Shanghai, China
| | - Xuehui Zhang
- School of nursing, Fudan University, Shanghai, China
| | - Jing He
- School of nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of nursing, Fudan University and core research member of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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24
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Puthanmadhom Narayanan S, Ren D, Oesterreich S, Lee AV, Rosenzweig MQ, Brufsky AM. Effects of socioeconomic status and race on survival and treatment in metastatic breast cancer. NPJ Breast Cancer 2023; 9:90. [PMID: 37914742 PMCID: PMC10620133 DOI: 10.1038/s41523-023-00595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023] Open
Abstract
Race and socioeconomic factors affect outcomes in breast cancer. We aimed to assess the effect of race and neighborhood socioeconomic status (SES) on overall survival and treatment patterns in patients with metastatic breast cancer (MBC). This is a retrospective cohort study involving patients (N = 1246) with distant breast cancer metastases diagnosed at UPMC Magee Women's Breast Cancer Clinic from 2000-2017. Overall survival and treatment patterns were compared between races (Blacks and whites) and SES groups (defined using Area Deprivation Index). Low SES, but not tumor characteristics, was associated with Black race (P < 0.001) in the study population. Low SES (Median [Interquartile Range, IQR] survival 2.3[2.2-2.5] years vs high SES 2.7[2.5-3.1] years, P = 0.01) and Black race (Median [IQR] survival 1.8[1.3-2.3] years, vs white 2.5[2.3-2.7] years P = 0.008) separately were associated with worse overall survival in patients with MBC. In the Cox Proportional Hazard model with SES, race, age, subtype, number of metastases, visceral metastasis, and year of diagnosis as covariates, low SES (Hazard ratio 1.19[1.04-1.35], P = 0.01), but not Black race (Hazard ratio 1.19[0.96-1.49], P = 0.12), independently predicted overall survival in MBC. Moreover, patients from low SES neighborhoods and Black race received fewer lines of chemotherapy than high SES and whites. In conclusion, low neighborhood SES is associated with worse outcomes in patients with MBC. Poor outcomes in Black patients with MBC, at least in part is driven by socioeconomic factors. Future studies should delineate the interplay between neighborhood SES, race, and their effects on tumor biology in MBC.
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Affiliation(s)
| | - Dianxu Ren
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Steffi Oesterreich
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Women's Cancer Research Center (WCRC), UPMC, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Adrian V Lee
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- Women's Cancer Research Center (WCRC), UPMC, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
- Magee-Womens Research Institute, Pittsburgh, PA, USA
| | - Margaret Q Rosenzweig
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
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25
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Halpern MT, de Moor JS, Han X, Zhao J, Zheng Z, Yabroff KR. Association of Employment Disruptions and Financial Hardship Among Individuals Diagnosed with Cancer in the United States: Findings from a Nationally Representative Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:1830-1839. [PMID: 37705562 PMCID: PMC10496757 DOI: 10.1158/2767-9764.crc-23-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/21/2023] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
Financial hardship (FH), defined as adverse patient effects due to cancer costs, is experienced by approximately half of individuals diagnosed with cancer. Many individuals diagnosed with cancer also experience disruptions with their employment. This study examines associations of employment disruptions and FH among a nationally representative sample of individuals diagnosed with cancer in the United States. We utilized 2016/2017 Medical Expenditure Panel Survey Experiences with Cancer data from individuals who worked for pay following cancer diagnosis. Employment disruption included taking extended paid time off work; switching to part-time/less demanding jobs; and/or retiring early due to cancer diagnosis/treatment. FH domains included: material (e.g., borrowing money/financial sacrifices); psychologic (e.g., worrying about medical bills/income); and behavioral (delaying/forgoing healthcare services because of cost). Multivariable logistic regression analyses determined associations of employment disruption and FH. Among 732 individuals with a cancer history, 47.4% experienced employment disruptions; 55.9% experienced any FH. Any FH was significantly more common among individuals with versus without employment disruptions across multiple measures and domains (68.7% vs. 44.5%; P value of difference <0.0001). Individuals with employment disruptions were more likely to have any FH [OR, 2.38; 95% confidence interval (CI), 1.62-3.52] and more FHs (OR, 2.76; 95% CI, 1.96-3.89]. This study highlights that employment disruptions are common and significantly associated with multiple domains of FH among individuals with a cancer history. Employer workplace accommodation, physician discussions regarding potential impacts of cancer care on employment, and other policies to minimize employment disruptions among individuals diagnosed with cancer may reduce FH in this vulnerable population. Significance Individuals diagnosed with cancer may have employment disruptions; they may also develop FHs. People with cancer who have employment changes are more likely to also have FHs. Physicians and employers can help individuals with cancer through advancing planning, workplace assistance, and improved medical leave and insurance policies.
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Affiliation(s)
| | | | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Jingxuan Zhao
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K. Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Fijany AJ, Friedlich N, Olsson SE, Bishay AE, Pekarev M. Current Trends in Autologous Breast Reconstruction and the Implications of Impending Changes to Insurance Reimbursement. Cureus 2023; 15:e43855. [PMID: 37736469 PMCID: PMC10510947 DOI: 10.7759/cureus.43855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction In 2019, the Centers for Medicare & Medicaid Services (CMS) combined all autologous breast flap procedures under one billing code, effective from December 31, 2024. This change will result in equal insurance reimbursement rates for popular flap options, such as transverse rectus abdominis muscle (TRAM) and deep inferior epigastric perforator (DIEP) flaps, which were previously billed separately using S-codes based on complexity. Methods This study aimed to analyze insurance code changes for autologous breast reconstruction flap procedures. Data were collected from the American Society of Plastic Surgeons' annual plastic surgery statistics reports, including specific insurance codes and case volumes from 2007 to 2020. A comprehensive analysis was conducted to assess recent trends in flap utilization rates, documenting any modifications or additions to the existing codes and their implementation years. Results The study analyzed billing codes and case volumes for autologous breast reconstruction procedures, with a focus on the DIEP flap and other alternatives. Non-autologous breast reconstruction procedures showed consistently higher case volumes compared to autologous procedures from 2007 to 2020. Notably, the popularity of the DIEP flap surpassed that of other flap options after 2011. Conclusion The removal of S-codes for autologous breast reconstruction by CMS and the subsequent potential decrease in insurance coverage for the DIEP flap may lead to a decrease in its utilization and a shift toward more invasive options, like the TRAM flap. This change could result in financial burdens for patients and widen socioeconomic disparities in breast reconstruction, limiting access to preferred reconstructive methods and impacting patient autonomy and overall well-being.
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Affiliation(s)
- Arman J Fijany
- Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Nicole Friedlich
- Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Sofia E Olsson
- Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Anthony E Bishay
- Neurosurgery, Vanderbilt University School of Medicine, Nashville, USA
| | - Maxim Pekarev
- Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
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27
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Shi JJ, McGinnis GJ, Peterson SK, Taku N, Chen YS, Yu RK, Wu CF, Mendoza TR, Shete SS, Ma H, Volk RJ, Giordano SH, Shih YCT, Nguyen DK, Kaiser KW, Smith GL. Pilot study of a Spanish language measure of financial toxicity in underserved Hispanic cancer patients with low English proficiency. Front Psychol 2023; 14:1188783. [PMID: 37492449 PMCID: PMC10364629 DOI: 10.3389/fpsyg.2023.1188783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Background Financial toxicity (FT) reflects multi-dimensional personal economic hardships borne by cancer patients. It is unknown whether measures of FT-to date derived largely from English-speakers-adequately capture economic experiences and financial hardships of medically underserved low English proficiency US Hispanic cancer patients. We piloted a Spanish language FT instrument in this population. Methods We piloted a Spanish version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure using qualitative cognitive interviews and surveys in un-/under-insured or medically underserved, low English proficiency, Spanish-speaking Hispanics (UN-Spanish, n = 23) receiving ambulatory oncology care at a public healthcare safety net hospital in the Houston metropolitan area. Exploratory analyses compared ENRICh FT scores amongst the UN-Spanish group to: (1) un-/under-insured English-speaking Hispanics (UN-English, n = 23) from the same public facility and (2) insured English-speaking Hispanics (INS-English, n = 31) from an academic comprehensive cancer center. Multivariable logistic models compared the outcome of severe FT (score > 6). Results UN-Spanish Hispanic participants reported high acceptability of the instrument (only 0% responded that the instrument was "very difficult to answer" and 4% that it was "very difficult to understand the questions"; 8% responded that it was "very difficult to remember resources used" and 8% that it was "very difficult to remember the burdens experienced"; and 4% responded that it was "very uncomfortable to respond"). Internal consistency of the FT measure was high (Cronbach's α = 0.906). In qualitative responses, UN-Spanish Hispanics frequently identified a total lack of credit, savings, or income and food insecurity as aspects contributing to FT. UN-Spanish and UN-English Hispanic patients were younger, had lower education and income, resided in socioeconomically deprived neighborhoods and had more advanced cancer vs. INS-English Hispanics. There was a higher likelihood of severe FT in UN-Spanish (OR = 2.73, 95% CI 0.77-9.70; p = 0.12) and UN-English (OR = 4.13, 95% CI 1.13-15.12; p = 0.03) vs. INS-English Hispanics. A higher likelihood of severely depleted FT coping resources occurred in UN-Spanish (OR = 4.00, 95% CI 1.07-14.92; p = 0.04) and UN-English (OR = 5.73, 95% CI 1.49-22.1; p = 0.01) vs. INS-English. The likelihood of FT did not differ between UN-Spanish and UN-English in both models (p = 0.59 and p = 0.62 respectively). Conclusion In medically underserved, uninsured Hispanic patients with cancer, comprehensive Spanish-language FT assessment in low English proficiency participants was feasible, acceptable, and internally consistent. Future studies employing tailored FT assessment and intervention should encompass the key privations and hardships in this population.
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Affiliation(s)
- Julia J. Shi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Gwendolyn J. McGinnis
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert K. Yu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tito R. Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sanjay S. Shete
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hilary Ma
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diem-Khanh Nguyen
- University of California Riverside School of Medicine, Riverside, CA, United States
| | - Kelsey W. Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L. Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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29
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Gharzai LA, Jagsi R. Incorporating financial toxicity considerations into clinical trial design to facilitate patient-centered decision-making in oncology. Cancer 2023; 129:1143-1148. [PMID: 36775839 DOI: 10.1002/cncr.34677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PLAIN LANGUAGE SUMMARY Financial toxicity is increasingly being recognized as an important and devastating consequence of cancer treatment that receives little attention when clinical trials are being designed. There is a significant need to obtain this important information in an era of increasingly expensive anticancer treatments. Patients who are informed of all implications of therapy-efficacy, side effects, cost, and broader financial impact-are able to select the best cancer treatment for themselves.
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Affiliation(s)
| | - Reshma Jagsi
- University of Michigan, Ann Arbor, Michigan, USA
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30
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Cheng H, Lin L, Liu T, Wang S, Zhang Y, Tian L. Financial toxicity of breast cancer over the last 30 years: A bibliometrics study and visualization analysis via CiteSpace. Medicine (Baltimore) 2023; 102:e33239. [PMID: 36961181 PMCID: PMC10036026 DOI: 10.1097/md.0000000000033239] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/17/2023] [Indexed: 03/25/2023] Open
Abstract
This literature on financial toxicity (FT) of breast cancer aimed to identify the leading countries, institutions, key researchers, influential references, top journals, research hotspots, and frontiers in the field. Published articles on FT in breast cancer patients were systematically retrieved and screened from the Web of Science databases from inception to March 28, 2022. The CiteSpace software was used to generate knowledge maps to analyze bibliometric characteristics in FT research on breast cancer patients. A total of 615 publications were included, with a year-on-year increase in the number of publications. A total of 591 authors conducted research on the FT in breast cancer patients, with Yabroff KR being the most prolific author. The US was the absolute leader in this field, with almost all major research institutions and authors located in the US. Supportive Care in Cancer was the most productive journal, and the Journal of Clinical Oncology was the most co-cited journal. The keywords representing the research hotspots were "quality of life," "care," "cost," etc. Keywords burst detection indicated that "financial toxicity," "survivors," "impact," "burden," "income," and "experience" have become the new research frontiers in the last 5 years. There is an overall upward trend in the research on FT of breast cancer over the last 30 years, which has important and ongoing research value. There is still a paucity of relevant research and more collaboration between authors, institutions, and countries is needed in the future to identify future research directions.
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Affiliation(s)
- Hui Cheng
- The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Tingting Liu
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Shaotong Wang
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Yueyue Zhang
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, China
- School of Nursing, Medical College of Soochow University, Suzhou, China
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Chandra M, Yu R, Shete S. Association between employer-based health promotion programs and adherence to breast cancer screening in Texas. Prev Med Rep 2023; 32:102128. [PMID: 36846467 PMCID: PMC9945785 DOI: 10.1016/j.pmedr.2023.102128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Breast cancer is the most common cancer diagnosed among women in Texas. Although adherence to recommended screening mammogram guidelines enables early detection and reduces breast cancer risks, screening mammogram adherence is low in Texas. With the rising percentage of women in the workforce, employer-based health promotion programs could be an effective measure in increasing mammogram adherence, thereby reducing breast cancer risk in Texas. Although employer-based health programs are common in the state, little is known about their effectiveness in increasing screening mammogram adherence among age-eligible employed females. The study survey was administered using Qualtrics and the study participants were representative of the Texas population. The study population included 318 females from Texas who were 50-74 years old. Among those who had access to employer-based health promotion programs, 65.4 % were adherent and 34.6 % were non-adherent to the guidelines. Population-weighted survey logistic regression analysis showed no significant association between access to employer-based health promotion programs and mammogram adherence for employed women (AOR: 0.85 [0.15-4.79], p-value = 0.86). However, access to healthcare coverage (AOR: 7.58 [2.89-19.88], p-value < 0.001), those who disagree with the fatalistic belief that everything causes cancer (AOR: 2.99 [1.45-6.19], p-value < 0.001), and those who perceive cancer screening important (AOR: 12.36 [2.26-67.47], p < 0.05) were found as significant determinants of mammogram adherence among females in Texas. The study concluded that access to employer-based health promotion programs alone was insufficient to improve breast cancer screening. The employers and the insurance companies, with support from the government, should develop a comprehensive program that addresses all structural and psychosocial barriers to employee breast cancer screening adherence.
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Affiliation(s)
- Monalisa Chandra
- Department of Epidemiology, UT MD Anderson Cancer Center, Houston TX, USA
| | - Robert Yu
- Department of Biostatistics, UT MD Anderson Cancer Center, Houston TX, USA
| | - Sanjay Shete
- Department of Epidemiology, UT MD Anderson Cancer Center, Houston TX, USA,Department of Biostatistics, UT MD Anderson Cancer Center, Houston TX, USA,Division of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, Houston TX, USA,Corresponding author at: Department of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, 1155 Pressler St, CPB8.3080, Houston TX 77030, USA.
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32
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Neuman HB, Schumacher JR. Follow-up and Cancer Survivorship. Surg Clin North Am 2023; 103:169-185. [DOI: 10.1016/j.suc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ehsan AN, Wu CA, Minasian A, Singh T, Bass M, Pace L, Ibbotson GC, Bempong-Ahun N, Pusic A, Scott JW, Mekary RA, Ranganathan K. Financial Toxicity Among Patients With Breast Cancer Worldwide: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2255388. [PMID: 36753274 PMCID: PMC9909501 DOI: 10.1001/jamanetworkopen.2022.55388] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023] Open
Abstract
Importance Financial toxicity (FT) is the negative impact of cost of care on financial well-being. Patients with breast cancer are at risk for incurring high out-of-pocket costs given the long-term need for multidisciplinary care and expensive treatments. Objective To quantify the FT rate of patients with breast cancer and identify particularly vulnerable patient populations nationally and internationally. Data Sources A systematic review and meta-analysis were conducted. Four databases-Embase, PubMed, Global Index Medicus, and Global Health (EBSCO)-were queried from inception to February 2021. Data analysis was performed from March to December 2022. Study Selection A comprehensive database search was performed for full-text, English-language articles reporting FT among patients with breast cancer. Two independent reviewers conducted study screening and selection; 462 articles underwent full-text review. Data Extraction and Synthesis A standardized data extraction tool was developed and validated by 2 independent authors; study quality was also assessed. Variables assessed included race, income, insurance status, education status, employment, urban or rural status, and cancer stage and treatment. Pooled estimates of FT rates and their 95% CIs were obtained using the random-effects model. Main Outcomes and Measures FT was the primary outcome and was evaluated using quantitative FT measures, including rate of patients experiencing FT, and qualitative FT measures, including patient-reported outcome measures or patient-reported severity and interviews. The rates of patients in high-income, middle-income, and low-income countries who incurred FT according to out-of-pocket cost, income, or patient-reported impact of expenditures during breast cancer diagnosis and treatment were reported as a meta-analysis. Results Of the 11 086 articles retrieved, 34 were included in the study. Most studies were from high-income countries (24 studies), and the rest were from low- and middle-income countries (10 studies). The sample size of included studies ranged from 5 to 2445 people. There was significant heterogeneity in the definition of FT. FT rate was pooled from 18 articles. The pooled FT rate was 35.3% (95% CI, 27.3%-44.4%) in high-income countries and 78.8% (95% CI, 60.4%-90.0%) in low- and middle-income countries. Conclusions and Relevance Substantial FT is associated with breast cancer treatment worldwide. Although the FT rate was higher in low- and middle-income countries, more than 30% of patients in high-income countries also incurred FT. Policies designed to offset the burden of direct medical and nonmedical costs are required to improve the financial health of vulnerable patients with breast cancer.
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Affiliation(s)
- Anam N. Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Catherine A. Wu
- Harvard Medical School, Boston, Massachusetts
- Department of Plastic Surgery, University of California, Orange
| | - Alexandra Minasian
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tavneet Singh
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lydia Pace
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Geoffrey C. Ibbotson
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Nefti Bempong-Ahun
- United Nations Institute for Training and Research, Palais des Nations, Geneva, Switzerland
- The Global Surgery Foundation, Geneva, Switzerland
| | - Andrea Pusic
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - John W. Scott
- Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor
| | - Rania A. Mekary
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Kavitha Ranganathan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Rose L, Schnell PM, Radcliff L, Lustberg M, Dulmage B. Retrospective cohort study of scalp cooling in breast cancer patients. Support Care Cancer 2023; 31:118. [PMID: 36645520 DOI: 10.1007/s00520-022-07562-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023]
Abstract
For patients with cancer, alopecia is a common side effect that negatively impacts personal identity, body image, self-esteem, quality of life, and medical decision-making. Scalp cooling is a technique used to prevent alopecia in patients undergoing chemotherapy in which patients wear a cooled cap during chemotherapy infusions, causing localized vasoconstriction of blood vessels on the scalp. Because of the recent emergence of scalp cooling, there is a need to explore further the reasons why patients pursue this treatment. A retrospective chart review of women with breast cancer treated at The Ohio State University was conducted to investigate how factors such as patient age, race, ethnicity, insurance status, stage of cancer, and chemotherapy regimen influenced patients' decisions to incorporate scalp cooling into their treatment plan as compared to those who did not. Findings revealed that patient age, race, insurance status, and chemotherapy regimen were predictors of a patient's likelihood to undergo scalp cooling. Patients diagnosed at younger age and those with private insurance were more likely to utilize scalp cooling. In comparison to White patients, non-White patients were less likely to choose scalp cooling. Furthermore, patients placed on the chemotherapy regimen of AC or AC-T were less likely to pursue scalp cooling than patients on PTCH or TC regimens. These findings provide background for the development of educational resources for both patients interested in this therapy and healthcare providers discussing this treatment option in dermatology and oncology settings.
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Affiliation(s)
- Lucy Rose
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Lindsey Radcliff
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Maryam Lustberg
- Breast Cancer Center, Smilow Cancer Hospital, Yale University, New Haven, CT, USA
| | - Brittany Dulmage
- The Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Department of Dermatology, The Ohio State University Wexner Medical Center, 540 Officenter Place, Suite 240, OH, 43230, Gahanna, USA.
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Financial hardship in breast cancer survivors: a prospective analysis of change in financial concerns over time. Support Care Cancer 2023; 31:62. [DOI: 10.1007/s00520-022-07493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
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36
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Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care. J Am Coll Radiol 2023; 20:37-39. [PMID: 36503172 PMCID: PMC9797364 DOI: 10.1016/j.jacr.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
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Afaya A, Ramazanu S, Bolarinwa OA, Yakong VN, Afaya RA, Aboagye RG, Daniels-Donkor SS, Yahaya AR, Shin J, Dzomeku VM, Ayanore MA, Alhassan RK. Health system barriers influencing timely breast cancer diagnosis and treatment among women in low and middle-income Asian countries: evidence from a mixed-methods systematic review. BMC Health Serv Res 2022; 22:1601. [PMID: 36587198 PMCID: PMC9805268 DOI: 10.1186/s12913-022-08927-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Globally, breast cancer is the most common cancer type and the leading cause of cancer mortality among women in developing countries. A high prevalence of late breast cancer diagnosis and treatment has been reported predominantly in Low- and Middle-Income Countries (LMICs), including those in Asia. Thus, this study utilized a mixed-methods systematic review to synthesize the health system barriers influencing timely breast cancer diagnosis and treatment among women in Asian countries. METHODS We systematically searched five electronic databases for studies published in English from 2012 to 2022 on health system barriers that influence timely breast cancer diagnosis and treatment among women in Asian countries. The review was conducted per the methodology for systematic reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while health system barriers were extracted and classified based on the World Health Organization (WHO)'s Health Systems Framework. The mixed-methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Twenty-six studies were included in this review. Fifteen studies were quantitative, nine studies were qualitative, and two studies used a mixed-methods approach. These studies were conducted across ten countries in Asia. This review identified health systems barriers that influence timely breast cancer diagnosis and treatment. The factors were categorized under the following: (1) delivery of health services (2) health workforce (3) financing for health (4) health information system and (5) essential medicines and technology. Delivery of health care (low quality of health care) was the most occurring barrier followed by the health workforce (unavailability of physicians), whilst health information systems were identified as the least barrier. CONCLUSION This study concluded that health system factors such as geographical accessibility to treatment, misdiagnosis, and long waiting times at health facilities were major barriers to early breast cancer diagnosis and treatment among Asian women in LMICs. Eliminating these barriers will require deliberate health system strengthening, such as improving training for the health workforce and establishing more healthcare facilities.
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Affiliation(s)
- Agani Afaya
- Mo-Im Nursing Research Institute, College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Sheena Ramazanu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Vida Nyagre Yakong
- Department of Preventive Health Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Adongo Afaya
- Department of Midwifery and Women’s Health, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | | | - Ahmed-Rufai Yahaya
- Hariri School of Nursing, American University of Beruit, Beirut, Lebanon
- Department of Internal Medicine, Tamale Teaching Hospital, Tamale, Ghana
| | - Jinhee Shin
- Woosuk University, College of Nursing, Wanju, Republic of Korea
| | - Veronica Millicent Dzomeku
- Department of Nursing, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Amogre Ayanore
- Department of Health Policy Planning and Management, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research. Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
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Nezu K, Yamashita S, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Nishimura K, Nonomura N, Negoro H, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Suzukamo Y, Ito A, Arai Y. Association of financial toxicity with quality of life in testicular cancer survivors. Int J Urol 2022; 29:1526-1534. [PMID: 36102302 DOI: 10.1111/iju.15039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study. METHODS We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. RESULTS With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). CONCLUSIONS TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.
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Affiliation(s)
- Kunihisa Nezu
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Terukazu Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Urology, Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Takahiro Osawa
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Nobuo Shinohara
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Urology, Miyagi Cancer Center, Natori, Japan
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Islam JY, Turner K, Saeb H, Powell M, Dean LT, Camacho-Rivera M. Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey. Front Public Health 2022; 10:946721. [PMID: 36483249 PMCID: PMC9723235 DOI: 10.3389/fpubh.2022.946721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years). Results Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44). Conclusion Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,*Correspondence: Jessica Y. Islam
| | - Kea Turner
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Huda Saeb
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Margaux Powell
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States,Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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Coughlin SS, Datta B, Williams LB, Bevel M, Cortes JE. Characteristics of Cancer Survivors Living in Poverty in the United States: Results From the 2020 Behavioral Risk Factor Surveillance System Survey. JCO Oncol Pract 2022; 18:e1831-e1838. [PMID: 36067453 DOI: 10.1200/op.22.00152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE There has been increasing concern over the high cost of oncology care and its long-lasting impact on the well-being of cancer survivors. METHODS We examined characteristics of impoverished cancer survivors in the United States, including their physical and mental health, using data from the 2020 Behavioral Risk Factor Surveillance System. We used binomial logistic regressions for binary outcome variables, and negative binomial regressions for count variables, to estimate the odds ratios (ORs) and incident rate ratios (IRRs) of the physical, mental, and socioeconomic-related health factors for low-income cancer survivors versus higher-income survivors. We compared the ORs and IRRs for low-income cancer survivors with those of higher income cancer survivors. RESULTS There was a two-fold increased odds (adjusted OR, 2.33; 95% CI, 1.86 to 2.91) of having fair/poor health for low-income cancer survivors compared with higher-income cancer survivors. There was an almost two-fold increased odds (adjusted OR, 1.97; 95% CI, 1.50 to 2.59) of not being able to see a doctor among low-income cancer survivors, and a 42% lower odds (adjusted OR, 0.58; 95% CI, 0.39 to 0.86) of having health insurance coverage for low-income cancer survivors compared with higher-income survivors. Incidence rate ratios for physical (IRR, 1.52; 95% CI, 1.31 to 1.75) and mental (IRR, 1.53; 95% CI, 1.26 to 1.86) unhealthy days were significantly higher among low-income cancer survivors compared with nonpoor cancer survivors. CONCLUSION Strategies are available to ameliorate financial hardship at multiple levels. Implementation of these strategies is urgently needed.
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Affiliation(s)
- Steven S Coughlin
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Biplab Datta
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA.,Institute of Public and Preventive Health, Augusta University, Augusta, GA
| | - Lovoria B Williams
- Univesity of Kentucky College of Nursing, Lexington, KY.,Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Malcolm Bevel
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Cancer Center, Augusta, GA
| | - Jorge E Cortes
- Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA.,Georgia Cancer Center, Augusta, GA
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Voleti SS, Warsame R, Mead-Harvey C, Ailawadhi S, Jain A, Fonseca R, Griffin JM, Khera N. Assessing Patient-Reported Financial Hardship in Patients With Cancer in Routine Clinical Care. JCO Oncol Pract 2022; 18:e1839-e1853. [PMID: 36166729 DOI: 10.1200/op.22.00276] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE Financial hardship (FH) in cancer care is a growing challenge for patients, their caregivers, and health care providers with impact on morbidity and mortality. In this study, we report on a standardized approach to describe the prevalence and predictors for FH as part of routine clinical workflow. We also report on the association of FH with survival in our cancer patient population. METHODS This study includes patients who completed a FH screen at least once between 2018 and 2020. Demographics, disease state, and mortality data were extracted from the medical records. Multivariable logistic regression models were used to examine association of sociodemographic and disease variables with FH. By using propensity score weighting to account for differences in demographic and clinical factors between patients with and without FH, we then fit Cox proportional hazards models to examine the relationship between FH and survival. RESULTS The study cohort included 31,154 patients. FH was reported by 14% (n = 4,250) of the patients. A significantly higher likelihood of having FH (P < .001 for all) was reported by racial/ethnic minority patients; those who were unemployed/disabled, single, or divorced; patients from disadvantaged neighborhoods; and those who were self-pay or had government insurance. Older age, being retired, and living farther from the cancer center were associated with significantly less likelihood of endorsing FH. Patients who endorsed FH had a lower survival (hazard ratio for mortality 1.46). CONCLUSION Our study identified key groups more likely to report FH in a relatively affluent population at a large cancer center and showed an adverse association between FH and survival. Further research is needed to develop clinical care pathways for patients at high risk for worse financial and clinical outcomes.
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Affiliation(s)
| | - Rahma Warsame
- Mayo Clinic Division of Hematology and Oncology, Rochester, MN
| | | | | | - Atul Jain
- Mayo Clinic Division of General Internal Medicine, Scottsdale, AZ
| | - Rafael Fonseca
- Mayo Clinic Department of Hematology and Oncology, Phoenix, AZ
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,Mayo Clinic Division of Healthcare Delivery Research, Rochester, MN
| | - Nandita Khera
- Mayo Clinic Department of Hematology and Oncology, Phoenix, AZ
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Phillips S, Raskin SE, Harrington CB, Bishop D, Gany FM. "Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City. J Psychosoc Oncol 2022; 41:411-433. [PMID: 36271879 PMCID: PMC10322638 DOI: 10.1080/07347332.2022.2136025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify consequences of unmet housing needs in the period following cancer diagnosis. DESIGN Qualitative descriptive design. PARTICIPANTS New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). METHODS One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. FINDINGS Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. CONCLUSION The simultaneous experience of cancer and unmet housing needs is broadly burdensome. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.
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Affiliation(s)
- Serena Phillips
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sarah E. Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Darla Bishop
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca M. Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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Bentley C, Teckle P, McQuarrie L, Peacock S, El Adam S. Impact of cancer on income, wealth and economic outcomes of adult cancer survivors: a scoping review. BMJ Open 2022; 12:e064714. [PMID: 36691144 PMCID: PMC9445784 DOI: 10.1136/bmjopen-2022-064714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/16/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To summarise peer-reviewed evidence on the effect of a cancer diagnosis on the different sources of income of individuals diagnosed with cancer during adulthood (age ≥18 years). DESIGN A scoping review following the Joanna Briggs Institute's methodological framework for conducting scoping reviews and reporting results following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews checklist. DATA SOURCES Ovid MEDLINE, PsycINFO, CINAHL, EMBASE, Econ-Lit and Evidence-based Medicine Reviews, and reference lists of evidence syntheses. Published literature of any study type in English was searched from January 2000 to December 2020. ELIGIBILITY AND CRITERIA Study participants were individuals diagnosed with cancer during adulthood (age ≥18 years). Studies from any country and/or healthcare system were included. Primary outcomes were employment income (eg, individual or household); investment income (eg, stocks/bonds, properties, savings); government transfer payments (eg, disability income/pension); debt and bankruptcy. DATA EXTRACTION AND SYNTHESIS Findings are summarised descriptively and in tabular form. RESULTS From 6297 citations retrieved, 63 studies (67 articles) met our inclusion criteria. Most (51%) were published in 2016-2020; 65% were published in the USA or Scandinavia. Survivors incurred debt (24 studies), depleted savings (13 studies) and liquidated stocks/bonds (7 studies) in response to a cancer diagnosis. 41 studies reported changes to employment income; of these, 12 case-control studies reported varying results: 5 reported survivors earned less than controls, 4 reported no significant differences, 2 reported mixed results and 1 reported income increased. Initial declines in income tended to lessen over time. CONCLUSIONS Cancer's impact on survivors' income is complex and time-varying. Longitudinal studies are needed to document the trend of initial declines in income, with declines lessening over time, and its variations. Study designs using standardised income measures and capturing treatment type and follow-up time will improve our understanding of cancer's impact on survivors' income.
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Affiliation(s)
- Colene Bentley
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Paulos Teckle
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa McQuarrie
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Shiraz El Adam
- Cancer Control Research, BC Cancer Agency, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
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Allostatic Load and Breast Cancer: a Systematic Review of the Literature. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emotional Distress and Financial Toxicity in Younger Adult Patients Undergoing Oncologic Surgery. Ann Surg 2022; 276:694-700. [PMID: 35838403 DOI: 10.1097/sla.0000000000005593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There has been an alarming increase in the number of young adults diagnosed with cancer. The emotional, psychosocial, and financial distress experienced by newly diagnosed young adults undergoing cancer surgery remains largely unknown. METHODS A validated biopsychosocial distress screening tool (SupportScreen®) was administered to patients diagnosed with cancer prior to surgery between 2009 and 2017 in a National Cancer Institute Comprehensive Cancer Center. Patients were stratified into younger adults ≤45 years (YA) and older adults >45 years (OA). Descriptive statistics and logistic regression were used to analyze distress outcomes. RESULTS In total, 4,297 patients were identified, with YA comprising 13.3% (n=573) of the cohort. YA reported higher emotional distress, including increased anxiety (33.8% vs. 27.4%, P=0.002), greater fear of procedures (26.7% vs. 22%, P=0.018), and difficulty managing emotions (26% vs. 20.7%, P=0.006). YA struggled more frequently to manage work/school (29.5% vs. 19.3%, P<0.001), finding resources (17.8% vs. 11.8%, P<0.001), changes in physical appearance (22.2% vs. 13.4%, P<0.001), fatigue (36% vs. 27.3%, P<0.001), and ability to have children (18.4% vs. 3%, P<0.001). Financial toxicity was significantly higher in the YA group (40.5% vs. 28%, P<0.001). While income level was strongly protective against emotional distress and financial toxicity in OAs, it was less protective against the risk of financial toxicity in YA. Younger age was an independent predictor of financial toxicity in a model adjusted to income (OR-1.52, P=0.020). CONCLUSION Younger adults in the prime of their personal and professional years of productivity require special attention when undergoing surgical evaluation for cancer. Resource allocation and counseling interventions should be integrated as part of their routine care to expedite their return to optimal physical and holistic health and mitigate psychosocial distress and financial toxicity.
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Halpern MT. Introduction to the Supplement: Is Now the Time for the Future of Cancer Economics Research? J Natl Cancer Inst Monogr 2022; 2022:1-3. [PMID: 35788371 DOI: 10.1093/jncimonographs/lgab017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/10/2021] [Indexed: 11/12/2022] Open
Abstract
The National Cancer Institute's Division of Cancer Control and Population Sciences hosted a virtual conference, The Future of Cancer Health Economics Research, in December 2020. This conference brought together a multidisciplinary group of researchers and other stakeholders interested in supporting and developing the field of cancer health economics research to help improve both patient outcomes and health-care systems. The introduction to the supplement describes the origins and planning for the conference and the conference sessions and presentations. The papers included in this supplement, arising from the conference sessions, help strengthened our understanding of what is cancer health economics research and how this field can provide even greater contributions in the future.
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Affiliation(s)
- Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Khera N, Zhang N, Hilal T, Durani U, Lee M, Padman R, Voleti S, Warsame RM, Borah BJ, Yabroff KR, Griffin JM. Association of Health Insurance Literacy With Financial Hardship in Patients With Cancer. JAMA Netw Open 2022; 5:e2223141. [PMID: 35877122 PMCID: PMC9315419 DOI: 10.1001/jamanetworkopen.2022.23141] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Patient-reported financial hardship is an increasing challenge in cancer care delivery. Health insurance literacy and its association with financial hardship in patients with cancer, especially after controlling for financial literacy, have not been well examined. OBJECTIVE To examine the prevalence of and factors in the association between health insurance literacy and financial literacy as well as the overall and individual domains of financial hardship and their association with health insurance literacy, both independently and when adjusted for financial literacy, in patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study recruited and enrolled patients from 2 separate ambulatory infusion centers at Mayo Clinic Arizona in Phoenix, Arizona, and the University of Mississippi Medical Center in Jackson, Mississippi. Adult patients aged 18 years or older were enrolled from December 2019 to February 2020 and from August to October 2020 at Mayo Clinic Arizona (n = 299) and from September 2020 through January 2021 at the University of Mississippi Medical Center (n = 105). Survey respondents received a $5 gift card. EXPOSURES Surveys included questions about sociodemographic characteristics, health insurance literacy and financial literacy, financial knowledge, and financial hardship and its domains (material hardship, psychological hardship, and behavioral hardship). MAIN OUTCOMES AND MEASURES Financial hardship was assessed using the COST-FACIT (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) measure and National Health Interview Survey questions to capture information about the domains of financial hardship. The Health Insurance Literacy Measure is a validated 21-item measure of a consumer's ability to select and use health insurance. Five questions from the National Financial Capability Study assessed financial literacy. RESULTS A total of 404 participants were enrolled in the study. Median (IQR) age of the respondents was 63 (54-71) years, and 219 were women (54%), 307 were non-Hispanic White individuals (76%), 153 (38%) had private insurance, and 289 (72%) had solid tumors. Overall financial hardship (denoted by median COST-FACIT score <27 points) was reported by 49% (95% CI, 44%-53%) of the cohort. Prevalence of financial hardship was higher using the National Health Interview Survey questions, with 68% (95% CI, 63%-72%) of respondents reporting at least 1 hardship domain (n = 276). Sixty-six percent (95% CI, 60%-69%) of respondents (n = 265) had a high level of financial literacy. The mean (SD) Health Insurance Literacy Measure score was 64.9 (13.3) points. In multivariable analyses, each 10-point increase in the Health Insurance Literacy Measure score was associated with lower odds of financial hardship (odds ratio, 0.82; 95% CI, 0.68-0.99; P = .04). However, this association was no longer significant after adjusting for financial literacy. CONCLUSIONS AND RELEVANCE Results of this study showed that, despite a high level of health insurance literacy and financial literacy, the prevalence of financial hardship was high. Although there were lower odds of financial hardship with increased health insurance literacy, the association was no longer significant when financial literacy was added to the model, suggesting that a high level of financial literacy may help mitigate the adverse outcome of lower health insurance literacy levels in patients with cancer.
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Affiliation(s)
- Nandita Khera
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona
| | - Nan Zhang
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona
| | - Talal Hilal
- Division of Hematology/Oncology, University of Mississippi, Jackson
| | | | | | - Rema Padman
- Carnegie Mellon University, Pittsburgh, Pennsylvania
| | - Sandeep Voleti
- Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona
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Berlin NL, Chopra Z, Bryant A, Agius J, Singh SR, Chhabra KR, Schulz P, West BT, Ryan AM, Kullgren JT. Individualized Out-of-Pocket Price Estimators for "Shoppable" Surgical Procedures: A Nationwide Cross-Sectional Study of US Hospitals. ANNALS OF SURGERY OPEN 2022; 3:e162. [PMID: 36936723 PMCID: PMC10013173 DOI: 10.1097/as9.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
To estimate the nationwide prevalence of individualized out-of-pocket (OOP) price estimators at US hospitals, characterize patterns of inclusion of 14 specified "shoppable" surgical procedures, and determine hospital-level characteristics associated with estimators that include surgical procedures. Background Price transparency for shoppable surgical services is a key requirement of several recent federal policies, yet the extent to which hospitals provide online OOP price estimators remains unknown. Methods We reviewed a stratified random sample of 485 U.S. hospitals for the presence of a tool to allow patients to estimate individualized OOP expenses for healthcare services. We compared characteristics of hospitals that did and did not offer online price estimators and performed multivariable modeling to identify facility-level predictors of hospitals offering price estimator with and without surgical procedures. Results Nearly two-thirds (66.0%) of hospitals in the final sample (95% confidence interval 61.6%-70.1%) offered an online tool for estimating OOP healthcare expenses. Approximately 58.5% of hospitals included at least one shoppable surgical procedure while around 6.6% of hospitals included all 14 surgical procedures. The most common price reported was laparoscopic cholecystectomy (55.1%), and the least common was recurrent cataract removal (20.0%). Inclusion of surgical procedures varied by total annual surgical volume and health system membership. Only 26.9% of estimators explicitly included professional fees. Conclusions Our findings highlight an ongoing progress in price transparency, as well as key areas for improvement in future policies to help patients make more financially informed decisions about their surgical care.
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Affiliation(s)
- Nicholas L. Berlin
- From the National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Zoey Chopra
- University of Michigan Medical School, Ann Arbor, MI
- University of Michigan, Ann Arbor, MI
| | - Arrice Bryant
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Simone R. Singh
- School of Public Health, University of Michigan, Ann Arbor, MI
| | | | - Paul Schulz
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Brady T. West
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Andrew M. Ryan
- School of Public Health, University of Michigan, Ann Arbor, MI
| | - Jeffrey T. Kullgren
- School of Public Health, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
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Uppal N, Cunningham Nee Lubitz C, James B. The Cost and Financial Burden of Thyroid Cancer on Patients in the US: A Review and Directions for Future Research. JAMA Otolaryngol Head Neck Surg 2022; 148:568-575. [PMID: 35511135 DOI: 10.1001/jamaoto.2022.0660] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In the US, thyroid cancer has been identified as a cancer type with a high degree of associated financial burden on patients, and survivors of thyroid cancer report higher rates of bankruptcy than those of other cancer types. However, the available literature on the financial burden of thyroid cancer has not yet been described. Observations Estimates of the out-of-pocket costs of initial thyroid cancer diagnosis and treatment range widely ($1425-$17 000) and are influenced by age, surgical treatment type, and health insurance coverage. The rates of patient-reported financial burden are heterogeneous (16%-50%) and are rarely compared with those of other cancer types. Independent risk factors of financial burden have included younger age, lack of health insurance, and annual household income of less than $49 000. Two studies measured medical debt associated with thyroid cancer diagnosis and treatment at notably different rates (2.1% vs 18.7%). The bankruptcy incidence at 1 year after cancer diagnosis is highest for thyroid cancer (9.3 per 1000 person-years) than other studied cancer types (ie, lung, uterine, leukemia/lymphoma, colorectal, melanoma, breast, prostate) and 4.39-fold higher than control individuals among those aged 35 to 49 years. Conclusions and Relevance Current estimates of the financial burden of thyroid cancer are methodologically limited and are based on cross-sectional analyses of patient-reported data. We propose novel frameworks for new research by improvements in (1) data sourcing and utilization, (2) study design, and (3) pilot interventions. To understand how out-of-pocket thyroid cancer-related expenditures transition to various forms of debt, how households finance ongoing costs of care, and rates at which debts are sent to collection agencies, future research should focus on integrating underutilized sources of primary data, including credit reports, public records, and mortgage-backed securities loan-level data. Improvements in study design, such as the development of prospective cohorts, can allow for more objectively measured estimates of out-of-pocket costs, and robust covariate analysis can further reveal the influence of demographic factors, including age, sex, race, income, and health insurance coverage. Finally, new pilot interventions on cost controls can both enable further study and alleviate financial burden.
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Affiliation(s)
- Nishant Uppal
- Harvard Medical School, Boston, Massachusetts.,Harvard Business School, Boston, Massachusetts
| | - Carrie Cunningham Nee Lubitz
- Harvard Medical School, Boston, Massachusetts.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Benjamin James
- Harvard Medical School, Boston, Massachusetts.,Division of Surgical Oncology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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