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Wang S, Lapen K, Kohli K, Chino F, Dee EC. Family financial toxicity of cancer in the United States: implications beyond the individual. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100849. [PMID: 39185034 PMCID: PMC11342212 DOI: 10.1016/j.lana.2024.100849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Affiliation(s)
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Tran BT, Tran TT, Dac QAN, Nguyen HL, Nguyen TX, Nguyen NPT, Nguyen TG, Le DD, Nguyen MT. Financial toxicity in patients with cancer: a cross-sectional study at an oncology hospital in central Vietnam. Support Care Cancer 2024; 32:581. [PMID: 39120733 DOI: 10.1007/s00520-024-08791-x] [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: 01/19/2024] [Accepted: 08/06/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE Cancer imposes a substantial financial burden on patients because of the high out-of-pocket expenses and the significant hardships. Financial toxicity describes the impact of cancer care costs at the patient level. Although the financial impact of cancer has been recognized, understanding the extent and determinants of financial toxicity in specific contexts is crucial. This study investigated the level of financial toxicity and its associated factors among patients with cancer at an oncology hospital in central Vietnam. METHODS This cross-sectional study included 334 patients with cancer. Direct interviews and medical record reviews were used for data collection. Financial toxicity was assessed using the 11-item Comprehensive Score for financial Toxicity (COST). A logistic regression model was used to determine factors associated with financial toxicity. RESULTS A notable 87.7% of patients experienced financial toxicity due to cancer cost, with 37.7% experiencing mild financial toxicity and 49.7% suffering from moderate financial toxicity, 0.3% reporting severe financial toxicity. Individuals with low household income exhibited a higher proportion of financial toxicity compared to that of those with higher income (odds ratio (OR) = 5.78, 95% confidence interval (CI): 1.29-25.68). Compared with that of participants in the early stages, a higher burden was found in patients with advanced-stage cancer (OR = 3.88, 95% CI: 1.36-11.11). CONCLUSION Our study indicates that patients with cancer in Vietnam facefinancial toxicity. It is thus necessary for interventions to mitigate the financial burden on patients with cancer, focusing on vulnerable individuals and patients in the advanced stages.
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Affiliation(s)
- Binh Thang Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam.
| | - Thi Tao Tran
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
| | - Quynh Anh Nguyen Dac
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
- Faculty of Medicine, University of Medicine and Pharmacy, Duy Tan University, Da Nang City, Vietnam
| | - Hoang Lan Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
| | - Thanh Xuan Nguyen
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Thua Thien Hue, Vietnam
| | | | - Thanh Gia Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
| | - Dinh Duong Le
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
| | - Minh Tu Nguyen
- Undergraduate Training Office, University of Medicine and Pharmacy, Hue University, Hue City, Thua Thien Hue, Vietnam
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Lim MSH, Voon PJ, Ali A, Mohamad FS, Jong LL, Chew LP, Bujang MA, Augustin Y, Cheng YK. Gaps in cancer care in a multi-ethnic population in Sarawak, Borneo: A central referral centre study. PLoS One 2024; 19:e0296954. [PMID: 39058692 PMCID: PMC11280152 DOI: 10.1371/journal.pone.0296954] [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: 05/09/2023] [Accepted: 12/22/2023] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The state of Sarawak on the island of Borneo in East Malaysia, in working towards developing and strengthening cancer services through a holistic patient-centred approach, must focus on the comprehensive needs of cancer patients by taking into account the psycho-social, cultural and spiritual aspects of Sarawak's multi-ethnic, multi-cultural population. METHODS A 42-item survey questionnaire was developed and validated with a total of 443 patients. The perceived importance of information provided and level of patient satisfaction were assessed with a 5-point Likert scale in 10 domains (Diagnosis, Surgery, Radiotherapy, Systemic therapy, Clinical trials, Pain management, Treatment monitoring, Psychosocial support, Sexual care and fertility issues, and Financial support). A Spearman's rank correlation test was applied to determine the correlation between response in both item and domain categories for perceived importance and satisfaction. RESULTS Overall, patients were more satisfied with information related to cancer diagnosis, treatment and surgery but less satisfied with information pertaining to sexual aspects of care and family planning, psycho-social support and financial support. The majority of patients were satisfied with the level of treatment-related information received but preferred the information to be delivered in more easily comprehendible formats. Sexual aspects of care and family planning, psychosocial support and treatment monitoring post-discharge were perceived as important but seldom addressed by health care professionals due to lack of professional counsellors, social workers and clinical nurse specialists. Many patients face financial toxicity following a cancer diagnosis, particularly when diagnosed with advanced cancer requiring complex multi-modality treatment. CONCLUSION Cancer patients in Sarawak have various unmet information needs. Written information and educational videos in local indigenous languages may be more suitable for Sarawak's multi-ethnic population. Sexual aspects of care and family planning are challenging but essential topics to discuss, in particular due to the high prevalence of breast and cervical cancer amongst young women of reproductive age in Sarawak. Financial assessment and information on support services offered by government and non-government organisations should be provided to eligible patients. A holistic needs assessment of each patient at time of diagnosis and support through their cancer journey requires a multi-disciplinary team of medical, nursing and allied health professionals including clinical nurse specialists, pharmacists, counsellors, physiotherapists, occupational therapists, speech and language therapists, dieticians and social workers.
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Affiliation(s)
- Melissa Siaw Han Lim
- Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Adibah Ali
- Department of General Surgery, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Fitri Suraya Mohamad
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
- Department of Cognitive Sciences, Faculty of Cognitive Sciences and Human Development, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
| | - Lin Lin Jong
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
| | - Lee Ping Chew
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
- Hematology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Mohamad Adam Bujang
- Clinical Research Centre, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia
| | - Yolanda Augustin
- Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
- St George's University of London, London, United Kingdom
| | - Yuong Kang Cheng
- Society for Cancer Advocacy and Awareness Kuching, Kuching, Sarawak, Malaysia
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4
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Mohanty SK, Wadasadawala T, Sen S, Maiti S, E J. Catastrophic health expenditure and distress financing of breast cancer treatment in India: evidence from a longitudinal cohort study. Int J Equity Health 2024; 23:145. [PMID: 39044204 PMCID: PMC11265332 DOI: 10.1186/s12939-024-02215-2] [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: 07/30/2023] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To estimate the catastrophic health expenditure and distress financing of breast cancer treatment in India. METHODS The unit data from a longitudinal survey that followed 500 breast cancer patients treated at Tata Memorial Centre (TMC), Mumbai from June 2019 to March 2022 were used. The catastrophic health expenditure (CHE) was estimated using households' capacity to pay and distress financing as selling assets or borrowing loans to meet cost of treatment. Bivariate and logistic regression models were used for analysis. FINDINGS The CHE of breast cancer was estimated at 84.2% (95% CI: 80.8,87.9%) and distress financing at 72.4% (95% CI: 67.8,76.6%). Higher prevalence of CHE and distress financing was found among rural, poor, agriculture dependent households and among patients from outside of Maharashtra. About 75% of breast cancer patients had some form of reimbursement but it reduced the incidence of catastrophic health expenditure by only 14%. Nearly 80% of the patients utilised multiple financing sources to meet the cost of treatment. The significant predictors of distress financing were catastrophic health expenditure, type of patient, educational attainment, main income source, health insurance, and state of residence. CONCLUSION In India, the CHE and distress financing of breast cancer treatment is very high. Most of the patients who had CHE were more likely to incur distress financing. Inclusion of direct non-medical cost such as accommodation, food and travel of patients and accompanying person in the ambit of reimbursement of breast cancer treatment can reduce the CHE. We suggest that city specific cancer care centre need to be strengthened under the aegis of PM-JAY to cater quality cancer care in their own states of residence. TRIAL REGISTRATION CTRI/2019/07/020142 on 10/07/2019.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400 088, India.
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, 410 210, India
| | - Soumendu Sen
- International Institute for Population Sciences, Mumbai, 400 088, India
| | - Suraj Maiti
- International Institute for Population Sciences, Mumbai, 400 088, India
| | - Jishna E
- International Institute for Population Sciences, Mumbai, 400 088, India
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Bhoo-Pathy N, Taylor C, Unger-Saldaña K. Operationalizing patient-centered cancer care in low- and middle-income countries. Cell Rep Med 2024; 5:101517. [PMID: 38776876 PMCID: PMC11148561 DOI: 10.1016/j.xcrm.2024.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/17/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
Rising cancer survival rates in low- and middle-income countries (LMICs) necessitate a paradigm shift to holistic, patient-driven care, focusing on meaningful outcomes aligned with individual values. Data, co-creation, continuous improvement, and collaboration are key. By prioritizing patient-defined metrics and patient empowerment, LMICs can transform cancer care, fostering sustained well-being beyond disease control.
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Affiliation(s)
- Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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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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Augustovski F, Tsou F, González L, Martín C, Vigo S, Gabay C, Alcaraz A, Argento F. Impact of Lung Cancer on Health-Related Quality of Life, Financial Toxicity, and Household Economics in Patients From the Public and the Private Healthcare Sector in Argentina. Value Health Reg Issues 2024; 41:94-99. [PMID: 38290167 DOI: 10.1016/j.vhri.2023.12.001] [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: 06/27/2023] [Revised: 10/23/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. METHODS We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment - General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. RESULTS We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable. CONCLUSIONS Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; University of Buenos Aires School of Medicine, Buenos Aires, Argentina; Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | | | - Lucas González
- Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | | | - Silvina Vigo
- Hospital Interzonal de Agudos y Crónicos San Juan de Dios de La Plata, Buenos Aires, Argentina; Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | - Carolina Gabay
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Fernando Argento
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Boop S, Shimony N, Boop F. How modern treatments have modified the role of surgery in pediatric low-grade glioma. Childs Nerv Syst 2024:10.1007/s00381-024-06412-w. [PMID: 38676718 DOI: 10.1007/s00381-024-06412-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/29/2024]
Abstract
Low-grade gliomas are the most common brain tumor of childhood, and complete resection offers a high likelihood of cure. However, in many instances, tumors may not be surgically accessible without substantial morbidity, particularly in regard to gliomas arising from the optic or hypothalamic regions, as well as the brainstem. When gross total resection is not feasible, alternative treatment strategies must be considered. While conventional chemotherapy and radiation therapy have long been the backbone of adjuvant therapy for low-grade glioma, emerging techniques and technologies are rapidly changing the landscape of care for patients with this disease. This article seeks to review the current and emerging modalities of treatment for pediatric low-grade glioma.
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Affiliation(s)
- Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Nir Shimony
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Le Bonheur Neuroscience Institute, LeBonheur Children's Hospital, Memphis, TN, USA
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Semmes-Murphey Clinic, Memphis, TN, USA
| | - Frederick Boop
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
- Global Program, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Ng RJ, Choo WY, Ng CW, Hairi NN. Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia. Health Policy Plan 2024; 39:268-280. [PMID: 38300142 PMCID: PMC10939357 DOI: 10.1093/heapol/czae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.
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Affiliation(s)
- Rui Jie Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Wan Yuen Choo
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Noran Naqiah Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
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Wang S, Wang J, Kang H, Zeng L, Liu G, Qiu Y, Wei M. Assessment of the prevalence and related factors of financial toxicity in cancer patients based on the COST scale: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 68:102489. [PMID: 38118267 DOI: 10.1016/j.ejon.2023.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE The high cost of cancer treatment exposes patients to financial toxicity during treatment; however, no study has comprehensively analyzed the incidence of financial toxicity using a validated assessment tool. In this study, the objective was to ascertain the incidence of financial toxicity in cancer patients and the factors influencing it. METHODS Nine electronic databases were retrieved to collect cross-sectional studies reporting financial toxicity in cancer patients. A random effects meta-analysis was applied to yield the overall prevalence of financial toxicity. Subgroup analyses were conducted depending on the factors affecting financial toxicity. RESULTS In total, 30 studies met our inclusion criteria. The pooled prevalence of financial toxicity in cancer patients was 48% (95%CI:38%-58%, I2 = 99.4%, p < 0.001). In the subgroup analysis, a higher prevalence of financial toxicity in patients aged <67 years (47%, 95%CI: 28%-66%, I2 = 97.5%, p < 0.001), female (46%, 95%CI:39%-53%, I2 = 94.9%,p < 0.001), lung cancer(57%, 95%CI:38%-75%, I2 = 96.9%, p < 0.001), developing countries (64%, 95%CI:55%-72%, I2 = 98.1%, p < 0.001), time of investigation following COVID-19 (53%, 95%CI:37%-69%, I2 = 99.4%, p < 0.001). CONCLUSION Financial toxicity is prevalent in cancer patients and is increasingly evident after COVID-19. Furthermore, the odds of financial toxicity are higher in patients who are female, younger, whose cancer type is lung cancer, and from developing countries. These findings emphasize the significance of evaluating financial toxicity in cancer patients after COVID-19, especially in developing countries. This may play a pivotal role in helping patients cope with financial toxicity.
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Affiliation(s)
- Shuping Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Jialin Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Hua Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Li Zeng
- Sichuan Nursing Vocational College, Chengdu City, Sichuan province, China.
| | - Guiling Liu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Yinong Qiu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Meng Wei
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
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Brindley C, Wijemunige N, Dieteren C, Bom J, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: a systematic review. BMC Health Serv Res 2024; 24:127. [PMID: 38263128 PMCID: PMC10807218 DOI: 10.1186/s12913-023-10464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery. METHODS A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT). RESULTS We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed. CONCLUSION Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers. TRIAL REGISTRATION PROSPERO registration number CRD42022340059 .
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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12
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Ruan J, Liu C, Yang Z, Kuang Y, Yuan X, Qiu J, Tang L, Xing W. Suffering and adjustment: a grounded theory of the process of coping with financial toxicity among young women with breast cancer. Support Care Cancer 2024; 32:96. [PMID: 38197967 DOI: 10.1007/s00520-024-08305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE To explore the process of coping with financial toxicity among young women with breast cancer and formulate a grounded theory that serves as a foundation for creating intervention strategies aimed at supporting cancer survivors. METHODS A qualitative study using the Corbin and Strauss variant of grounded theory. A series of in-depth interviews were carried out with young women with breast cancer (n = 29) using the theoretical sampling method. We analyzed data by coding core categories in the patients' coping processes and developing theory around these categories. Data collection and analysis were performed simultaneously. RESULTS A substantial theory of the process of coping with financial toxicity among young female breast cancer survivors was constructed. Two core concepts, suffering and adjustment, were identified. Young women with breast cancer suffered from financial toxicity, which was related to risk factors, coping resources, and unmet needs. To overcome financial toxicity, young women with breast cancer adjusted by reshaping consumption concept, re-dividing of family functions, re-planning of occupation career, and rebuilding life confidence. CONCLUSION This qualitative study constructed a theory delineating the coping strategies employed by young women with breast cancer in response to financial toxicity, offering profound insights into the intricacies of cancer-related financial toxicity. Identifying risk factors, enhancing coping resources, and meeting unmet needs would be helpful to patients' adjustment to financial stress.
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Affiliation(s)
- Junyi Ruan
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China
| | - Cheng Liu
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China
| | - Zhongfang Yang
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China
| | - Yi Kuang
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China
| | - Xiaoyi Yuan
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China
| | - Jiajia Qiu
- Department of Nursing Administration, Shanghai Cancer Center, Fudan University, 270 Dongan Rd, Shanghai, 200032, China
| | - Lichen Tang
- Department of Breast Surgery, Shanghai Cancer Center, Fudan University, 270 Dongan Rd, Shanghai, 200032, China.
| | - Weijie Xing
- School of Nursing, Fudan University, 305 Fenglin Rd, Shanghai, 200032, China.
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13
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Fangusaro J, Jones DT, Packer RJ, Gutmann DH, Milde T, Witt O, Mueller S, Fisher MJ, Hansford JR, Tabori U, Hargrave D, Bandopadhayay P. Pediatric low-grade glioma: State-of-the-art and ongoing challenges. Neuro Oncol 2024; 26:25-37. [PMID: 37944912 PMCID: PMC10768984 DOI: 10.1093/neuonc/noad195] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The most common childhood central nervous system (CNS) tumor is pediatric low-grade glioma (pLGG), representing 30%-40% of all CNS tumors in children. Although there is high associated morbidity, tumor-related mortality is relatively rare. pLGG is now conceptualized as a chronic disease, underscoring the importance of functional outcomes and quality-of-life measures. A wealth of data has emerged about these tumors, including a better understanding of their natural history and their molecular drivers, paving the way for the use of targeted inhibitors. While these treatments have heralded tremendous promise, challenges remain about how to best optimize their use, and the long-term toxicities associated with these inhibitors remain unknown. The International Pediatric Low-Grade Glioma Coalition (iPLGGc) is a global group of physicians and scientists with expertise in pLGG focused on addressing key pLGG issues. Here, the iPLGGc provides an overview of the current state-of-the-art in pLGG, including epidemiology, histology, molecular landscape, treatment paradigms, survival outcomes, functional outcomes, imaging response, and ongoing challenges. This paper also serves as an introduction to 3 other pLGG manuscripts on (1) pLGG preclinical models, (2) consensus framework for conducting early-phase clinical trials in pLGG, and (3) pLGG resistance, rebound, and recurrence.
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Affiliation(s)
- Jason Fangusaro
- Department of Hematology and Oncology, Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | - David T Jones
- Translational Program, Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ), University Hospital Heidelberg, Heidelberg, Germany
| | - Roger J Packer
- Brain Tumor Institute, Daniel and Jennifer Gilbert Neurofibromatosis Institute, Neuroscience and Behavioral Medicine, Children’s National Medical Center, Washington, District of Columbia, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Till Milde
- Translational Program, Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ), University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Olaf Witt
- Translational Program, Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ), University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology, Oncology, Immunology and Pulmonology, Heidelberg University Hospital; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Sabine Mueller
- Department of Neurological Surgery, University of California, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
- Department of Oncology, University Children’s Hospital Zürich, Zürich, Switzerland
| | - Michael J Fisher
- Division of Oncology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jordan R Hansford
- Michael Rice Centre for Hematology and Oncology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- South Australia ImmunoGENomics Cancer Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Uri Tabori
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Darren Hargrave
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Pratiti Bandopadhayay
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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14
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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15
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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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16
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Gopal S. The case for prioritizing malignant hematology services in low- and middle-income countries. Semin Hematol 2023; 60:189-191. [PMID: 37723025 PMCID: PMC10840687 DOI: 10.1053/j.seminhematol.2023.08.005] [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: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/20/2023]
Abstract
A clear case for can be made for prioritizing malignant hematology services in low- and middle-income countries based on large public health burden, convincing demonstrations of cure and control, innovation opportunities with likely worldwide implications, and sizable returns on investment for health systems and societies. We must now ensure that need and opportunity are matched by commensurate levels of investment and attention.
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Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD.
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17
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Bergerot CD, Wang AWT, Serpentini S, Borgese C, Kim Y. Healthcare providers' perceptions about the unmet needs of their patients with cancer across healthcare systems: results of the International Psycho-Oncology Society survivorship survey. Support Care Cancer 2023; 31:538. [PMID: 37632538 DOI: 10.1007/s00520-023-07998-8] [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: 05/17/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE Systematic understanding of patients' unmet needs is essential for providing effective supportive care. This study sought to compare the unmet needs of patients with cancer identified by health care providers (HCPs) among four major healthcare systems. METHODS HCPs (n = 247) participated in the International Psycho-Oncology Society (IPOS) Survivorship Online Survey, evaluating their patients' unmet needs. The country of HCPs was grouped into four major healthcare systems: Beveridge model, Bismarck model, National Health Insurance model, and out-of-pocket model. RESULTS Most HCPs were from countries with the Bismarck model. Substantial levels (> 50%) of unmet needs in all domains are reported across the four healthcare systems. Pediatric patients/survivors living in countries under out-of-pocket healthcare model were evaluated to have less unmet needs for managing decline in physical or cognitive functioning and insomnia/sleep difficulty/fatigue, than those in countries under Beveridge, Bismarck, and National Health Insurance models. Moreover, middle-aged patients/survivors under Beveridge and National Health Insurance models were likely to have greater unmet needs for dealing with cancer-related financial concerns than those under Bismarck model. CONCLUSION This study provides valuable insights into the unmet needs of patients with cancer in different healthcare systems, highlighting the significance of targeted interventions to address the unique needs of patients across diverse healthcare systems. Further investigation is warranted to identify the system factors associated with patients' unmet needs, enabling the development of effective healthcare policies and interventions to comprehensively address the multifaceted needs of patients with cancer.
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Affiliation(s)
- Cristiane Decat Bergerot
- Department of Supportive Care, Oncoclinicas, SMH/N Quadra 02, Ed de Clínicas, 12º Andar, Brasilia, DF, Brazil.
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18
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Pail O, Knight TG. Financial toxicity in patients with leukemia undergoing hematopoietic stem cell transplantation: A systematic review. Best Pract Res Clin Haematol 2023; 36:101469. [PMID: 37353293 DOI: 10.1016/j.beha.2023.101469] [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: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
Financial toxicity (FT) is a term used to describe the objective financial burden of cancer care including the associated coping behaviors used by patients and their caregivers. FT has been shown to result in both direct financial burdens and in clinically relevant outcomes, such as non-adherence with care, diminished quality of life, and even decreased overall survival. Much of the data has been described in solid tumors, with limited investigations in the malignant hematology population. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) face a unique financial burden driven by lengthy hospitalizations and acute and chronic morbidity that have downstream implications on their income and costs. In this review, we discuss the prevalence of FT in patients with leukemia who are eligible for HSCT. We review the impact of FT on financial and clinical outcomes and the role of various interventions that have been studied within this population.
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Affiliation(s)
- Orrin Pail
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Qiu Z, Yao L, Jiang J. Financial toxicity assessment and associated factors analysis of patients with cancer in China. Support Care Cancer 2023; 31:264. [PMID: 37058171 PMCID: PMC10101818 DOI: 10.1007/s00520-023-07714-6] [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: 11/15/2022] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE Cancer-related expenditures present a lasting economic burden on patients and their families and may exert long-term adverse effects on the patients' life and quality of life. In this study, the comprehensive score for financial toxicity (COST) was used to investigate the financial toxicity (FT) levels and related risk factors in Chinese patients with cancer. METHODS Quantitative data were collected through a questionnaire covering three aspects: sociodemographic information, economic and behavioral cost-coping strategies, and the COST scale. Univariate and multivariate analyses were performed to identify factors associated with FT. RESULTS According to 594 completed questionnaires, the COST score ranged 0-41, with a median of 18 (mean±SD, 17.98±7.978). Over 80% of patients with cancer reported at least moderate FT (COST score <26). A multivariate model showed that urban residents, coverage by other health insurance policies, and higher household income and consumption expenditures were significantly associated with higher COST scores, indicative of lower FT. The middle-aged (45-59 years old), higher out-of-pocket (OOP) medication expenditures and hospitalizations, borrowed money, and forgone treatment were all significantly associated with lower COST scores, indicating higher FT. CONCLUSION Severe FT was associated with sociodemographic factors among Chinese patients with cancer, family financial factors, and economic and behavioral cost-coping strategies. Government should identify and manage the patients with high-risk characteristics of FT and work out better health policies for them.
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Affiliation(s)
- Zenghui Qiu
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yao
- The School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junnan Jiang
- The School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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20
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Yong ASJ, Cheong MWL, Hamzah E, Teoh SL. A qualitative study of lived experiences and needs of advanced cancer patients in Malaysia: Gaps and steps forward. Qual Life Res 2023:10.1007/s11136-023-03401-5. [PMID: 36964453 PMCID: PMC10038386 DOI: 10.1007/s11136-023-03401-5] [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: 03/10/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care. METHODS Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach. RESULTS The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care. CONCLUSION Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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Liu M, Huang D, Liu Y. Financial toxicity of patients with lung cancer in China: Results from a National Survey Study. Cancer Med 2023; 12:4751-4760. [PMID: 36128854 PMCID: PMC9972021 DOI: 10.1002/cam4.5244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To develop a comprehensive understanding of financial toxicity (FT) among patients with lung cancer in China and the major factors affecting FT. METHODS Drawing from a national cross-sectional survey, which used the validated comprehensive score for financial toxicity (COST) questionnaire, we estimated the prevalence and degree of FT. Patient coping actions were investigated. Pearson's chi tests and multinomial logistic regression were used to evaluate the predictors of FT in patients with lung cancer. RESULTS The median score of FT was 20 (scored on a range of 0-44, with lower scores indicating more severe toxicity). Altogether, 77% of the sample patients had FT (COST <26), 54.5% had mild FT (COST 14-25), and 22.5% had moderate and severe FT (COST 0-13). Living in the less-developed western region of China, being male, having a lower educational level, lower annual family income, and advanced stage or worse self-reported health status were significantly related to higher FT than their counterparts (p < 0.05). Patients with higher FT tended to have a lower level of medical compliance, a higher risk of incurring debts, and reduced living expenditures relative to those with lower FT. CONCLUSION Despite China's remarkable progress in the past two decades with regard to Universal Healthcare Coverage, FT still presents a serious challenge for patients with lung cancer. Keen attention must be paid to reducing the disproportionate high financial risks of patients with low socioeconomic status.
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Affiliation(s)
- Meicen Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dengmin Huang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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22
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Pangestu S, Rencz F. Comprehensive Score for Financial Toxicity and Health-Related Quality of Life in Patients With Cancer and Survivors: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:300-316. [PMID: 36064514 DOI: 10.1016/j.jval.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Financial toxicity is recognized as an important adverse effect of cancer treatment that may decrease patients' health-related quality of life (HRQOL). We aim to perform a systematic review and meta-analysis on studies investigating the association of HRQOL and financial toxicity measured with the Comprehensive Score for Financial Toxicity in patients with cancer and survivors. METHODS A systematic literature search was completed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (last update April 2022). Methodological quality of included studies was assessed using the Appraisal Tool for Cross-Sectional Studies and the Critical Appraisal Skills Program Cohort Study Checklist. Where possible, study outcomes were pooled by random-effects meta-analysis. RESULTS Thirty-one studies were included with a combined sample of 13 481 patients and survivors with more than 25 cancer types from 9 countries. Nineteen different validated HRQOL instruments were used in these studies, with the Functional Assessment of Cancer Therapy - General (n = 9), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (n = 5), and EQ-5D (n = 5) being the most common. All but one included studies reported that higher financial toxicity was significantly associated with worse HRQOL. Ten HRQOL domains were correlated with financial toxicity, including physical health (r = 0.34-0.66), social health (r = 0.16-0.55), mental health (r = 0.21-0.54), and daily functioning (r = 0.23-0.52). The meta-analysis indicated a moderate correlation between financial toxicity and overall HRQOL as measured by the Functional Assessment of Cancer Therapy instruments (r = 0.49, 95% confidence interval 0.44-0.54). CONCLUSIONS This is the first systematic review and meta-analysis to summarize the literature on the association of financial toxicity and HRQOL in patients with cancer and survivors. Our findings substantiate financial toxicity as a relevant outcome of cancer care that is associated with a decline of HRQOL.
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Affiliation(s)
- Stevanus Pangestu
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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23
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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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24
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Amiri P, Mohammadi A, Bahaadinbeigy K, Kalantari Khandani B, Maazed V. Identifying unmet information needs of advanced cancer patients in Iran: An in-depth qualitative study. Health Sci Rep 2022; 5:e914. [PMID: 36320651 PMCID: PMC9617646 DOI: 10.1002/hsr2.914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/18/2022] [Accepted: 10/17/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims One of the main vital needs for self-care in patients with advanced cancer is information need. Meeting this need has significant positive effects on improving their treatment and care. This study was conducted to identify the unmet information needs of patients with advanced cancer in Iran. Methods This exploratory study was performed from July to February 2021 in the Kerman University of Medical Sciences cancer treatment centers. Oncologists selected eligible patients by purposeful sampling method. Semistructured and in-depth interviews were conducted with selected patients to collect data. Interviews continued until data saturation. Each interview was audio-recorded and transcribed verbatim. Results In the interviews, 15 patients with advanced cancer ranging in age from 43 to 65 years participated. The most common type of cancer in women was breast (71.4%) and prostate (50%) in men. The two main categories of "types of unmet information needs" and "reasons for not meeting information needs" were extracted from the analysis of patient interviews, with six and four subcategories, respectively. Conclusion Cancer patients had a large number of unmet information needs. At the time of identifying the unmet information needs of cancer patients, the basic reasons for not meeting these needs should also be considered because cultural differences and social gaps in societies are inevitable.
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Affiliation(s)
- Parasto Amiri
- Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Ali Mohammadi
- Department of Health Information Technology, Paramedical SchoolKermanshah University of Medical SciencesKermanshahIran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in HealthKerman University of Medical SciencesKermanIran
| | - Behjat Kalantari Khandani
- Department of Oncology, Shahid Bahonar Hospital, School of MedicineKerman University of Medical SciencesKermanIran
| | - Vahid Maazed
- Hematology and Oncology, Faculty of MedicineKerman University of Medical SciencesKermanIran
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25
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Howard AF, Lynch K, Thorne S, Porcino A, Lambert L, De Vera MA, Wolff AC, Hedges P, Beck SM, Torrejón MJ, Kelly MT, McKenzie M. Occupational and Financial Setbacks in Caregivers of People with Colorectal Cancer: Considerations for Caregiver-Reported Outcomes. Curr Oncol 2022; 29:8180-8196. [PMID: 36354706 PMCID: PMC9689650 DOI: 10.3390/curroncol29110646] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 01/14/2023] Open
Abstract
Family caregivers of patients with cancer provide substantial physical, emotional, and functional care throughout the cancer trajectory. While caregiving can create employment and financial challenges, there is insufficient evidence to inform the development of caregiver-reported outcomes (CROs) that assess these experiences. The study purpose was to describe the occupational and financial consequences that were important to family caregivers of a patient with colorectal cancer (CRC) in the context of public health care, which represent potential considerations for CROs. In this qualitative Interpretive Description study, we analyzed interview data from 78 participants (25 caregivers, 37 patients, and 16 healthcare providers). Our findings point to temporary and long-term occupational and financial setbacks in the context of CRC. Caregiving for a person with CRC involved managing occupational implications, including (1) revamping employment arrangements, and (2) juggling work, family, and household demands. Caregiver financial struggles included (1) responding to financial demands at various stages of life, and (2) facing the spectre of lifelong expenses. Study findings offer novel insight into the cancer-related occupational and financial challenges facing caregivers, despite government-funded universal health care. Further research is warranted to develop CRO measures that assess the multifaceted nature of these challenges.
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Affiliation(s)
- A. Fuchsia Howard
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
- Correspondence:
| | - Kelsey Lynch
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Sally Thorne
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | | | - Leah Lambert
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
- BC Cancer, Vancouver, BC V5Z 4C2 Canada
| | - Mary A. De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Angela C. Wolff
- School of Nursing, Trinity Western University, Langley, BC V2Y 1Y1, Canada
| | | | - Scott M. Beck
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
- BC Cancer, Vancouver, BC V5Z 4C2 Canada
| | | | - Mary T. Kelly
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Michael McKenzie
- BC Cancer, Vancouver, BC V5Z 4C2 Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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26
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FNU N, Kuan WC, Kong YC, Bustamam RS, Wong LP, Subramaniam S, Ho GF, Zaharah H, Yip CH, Bhoo-Pathy N. Cancer-related costs, the resulting financial impact and coping strategies among cancer survivors living in a setting with a pluralistic health system: a qualitative study. Ecancermedicalscience 2022; 16:1449. [PMID: 36405936 PMCID: PMC9666287 DOI: 10.3332/ecancer.2022.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Evidence on the financial experiences of cancer survivors living in settings with pluralistic health systems remains limited. We explored the out-of-pocket costs, the resulting financial impact and the coping strategies adopted by cancer survivors in Malaysia, a middle-income country with a government-led tax-funded public health sector, and a predominantly for-profit private health sector. METHODS Data were derived from 20 focus group discussions that were conducted in five public and private Malaysian hospitals, which included 102 adults with breast, cervical, colorectal or prostate cancers. The discussions were segregated by type of healthcare setting and gender. Thematic analysis was performed. RESULTS Five major themes related to cancer costs emerged: 1) cancer therapies and imaging services, 2) supportive care, 3) complementary therapies, 4) non-medical costs and 5) loss of household income. Narratives on out-of-pocket medical costs varied not only by type of healthcare setting, clinical factors and socioeconomic backgrounds, but also by private health insurance ownership. Non-health costs (e.g. transportation, food) and loss of income were nonetheless recurring themes. Coping mechanisms that were raised included changing of cancer treatment decisions, continuing work despite ill health and seeking financial assistance from third parties. Unmet needs in coping with financial distress were especially glaring among the women. CONCLUSION The long-term costs of cancer (medications, cancer surveillance, supportive care, complementary medicine) should not be overlooked even in settings where there is access to highly subsidised cancer care. In such settings, patients may also have unmet needs related to non-health costs of cancer and loss of income.
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Affiliation(s)
- Noorulain FNU
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Wai-Chee Kuan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustamam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, 50586 Kuala Lumpur, Malaysia
| | - Li-Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - ShriDevi Subramaniam
- Institute of Clinical Research, National Institutes of Health, 40170 Shah Alam, Malaysia
| | - Gwo-Fuang Ho
- Department of Clinical Oncology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hafizah Zaharah
- Department of Radiotherapy and Oncology, National Cancer Institute, 62250 Putrajaya, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, 47500 Subang Jaya, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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27
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Donkor A, Atuwo-Ampoh VD, Yakanu F, Torgbenu E, Ameyaw EK, Kitson-Mills D, Vanderpuye V, Kyei KA, Anim-Sampong S, Khader O, Khader J. Financial toxicity of cancer care in low- and middle-income countries: a systematic review and meta-analysis. Support Care Cancer 2022; 30:7159-7190. [PMID: 35467118 PMCID: PMC9385791 DOI: 10.1007/s00520-022-07044-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/05/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The costs associated with cancer diagnosis, treatment and care present enormous financial toxicity. However, evidence of financial toxicity associated with cancer in low- and middle-income countries (LMICs) is scarce. AIM To determine the prevalence, determinants and how financial toxicity has been measured among cancer patients in LMICs. METHODS Four electronic databases were searched to identify studies of any design that reported financial toxicity among cancer patients in LMICs. Random-effects meta-analysis was used to derive the pooled prevalence of financial toxicity. Sub-group analyses were performed according to costs and determinants of financial toxicity. RESULTS A total of 31 studies were included in this systematic review and meta-analysis. The pooled prevalence of objective financial toxicity was 56.96% (95% CI, 30.51, 106.32). In sub-group meta-analyses, the objective financial toxicity was higher among cancer patients with household size of more than four (1.17% [95% CI, 1.03, 1.32]; p = 0.02; I2 = 0%), multiple cycles of chemotherapy (1.94% [95% CI, 1.00, 3.75]; p = 0.05; I2 = 43%) and private health facilities (2.87% [95% CI, 1.89, 4.35]; p < 0.00001; I2 = 26%). Included studies hardly focused primarily on subjective measures of financial toxicity, such as material, behavioural and psychosocial. One study reported that 35.4% (n = 152 of 429) of cancer patients experienced high subjective financial toxicity. CONCLUSIONS This study indicates that cancer diagnosis, treatment and care impose high financial toxicity on cancer patients in LMICs. Further rigorous research on cancer-related financial toxicity is needed.
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Affiliation(s)
- Andrew Donkor
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, New South Wales, Sydney, Australia.
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Vivian Della Atuwo-Ampoh
- Department of Medical Imaging, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Frederick Yakanu
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Eric Torgbenu
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, New South Wales, Sydney, Australia
- Department of Physiotherapy and Rehabilitation Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kofi Adesi Kyei
- Department of Radiography, University of Ghana, Accra, Ghana
| | | | - Omar Khader
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Jamal Khader
- Radiation Oncology Department, King Hussein Cancer Centre, Amman, Jordan
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28
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Knight TG, Aguiar M, Robinson M, Morse A, Chen T, Bose R, Ai J, Ragon BK, Chojecki AL, Shah NA, Sanikommu SR, Symanowski J, Copelan EA, Grunwald MR. Financial Toxicity Intervention Improves Outcomes in Patients With Hematologic Malignancy. JCO Oncol Pract 2022; 18:e1494-e1504. [DOI: 10.1200/op.22.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Patients with hematologic malignancies are extremely vulnerable to financial toxicity (FT) because of the high costs of treatment and health care utilization. This pilot study identified patients at high risk because of FT and attempted to improve clinical outcomes with comprehensive intervention. METHODS: All patients who presented to the Levine Cancer Institute's Leukemia Clinic between May 26, 2019, and March 10, 2020, were screened for inclusion by standardized two question previsit survey. Patients screening positive were enrolled in the comprehensive intervention that used nurse navigators, clinical pharmacists, and community pro bono financial planners. Primary outcomes were defined as improvement in mental and physical quality of life in all patients and improvement in overall survival in the high-risk disease group. RESULTS: One hundred seven patients completed comprehensive intervention. Patients experiencing FT had increased rates of noncompliance including to prescription (16.8%) and over-the-counter medications (15.9%). The intervention resulted in statistically significantly higher quality of life when measured by using Patient-Reported Outcomes Measurement Information System physical (12.5 ± 2.2 v 13.7 ± 1.8) and mental health scores (11.4 ± 2.2 v 12.4 ± 2.2; all P < .001). In patients with high-risk disease (as determined by using disease-specific scoring systems), risk of death in those receiving the intervention was 0.44 times the risk of death in those without the intervention after adjusting for race, and treatment with stem-cell transplant, oral chemotherapy, or immunotherapy (95% CI, 0.21 to 0.94; P = .034). CONCLUSION: Screening and intervention on FT for patients with hematologic malignancies is associated with increased quality of life and survival.
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Affiliation(s)
- Thomas G. Knight
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - Myra Robinson
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Allison Morse
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Tommy Chen
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Rupali Bose
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jing Ai
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Brittany K. Ragon
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Aleksander L. Chojecki
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Nilay A. Shah
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Srinivasa R. Sanikommu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - James Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Edward A. Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Michael R. Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
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29
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Zhu Z, Xing W, Wen H, Sun Y, So WKW, Lizarondo L, Peng J, Hu Y. Psychometric properties of self-reported financial toxicity measures in cancer survivors: a systematic review. BMJ Open 2022; 12:e057215. [PMID: 35750459 PMCID: PMC9234804 DOI: 10.1136/bmjopen-2021-057215] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The aim of this systematic review was to summarise the psychometric properties of patient-reported outcome measures (PROMs) measuring financial toxicity (FT) in cancer survivors. DESIGN This systematic review was conducted according to the guidance of the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. DATA SOURCES Comprehensive searches were performed in PubMed, MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, ProQuest and Cochrane Library from database inception to February 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies that reported any PROMs for measuring FT in cancer survivors who were ≥18 years old. FT was defined as perceived subjective financial distress resulting from objective financial burden. Studies that were not validation studies and that used a PROM only as an outcome measurement were excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data from the included papers. We used the COSMIN criteria to summarise and evaluate the psychometric properties of each study regarding structural validity, internal consistency, reliability, measurement error, hypothesis testing for construct validity, cross-cultural validity/measurement invariance, criterion validity and responsiveness. RESULTS A total of 23 articles (21 PROMs) were eligible for inclusion in this study. The findings highlighted that the Comprehensive Score for Financial Toxicity (COST) had an adequate development process and showed better psychometric properties than other PROMs, especially in internal consistency (Cronbach's α=0.92), reliability (intraclass correlation coefficient=0.80) and hypothesis testing (r=0.42-0.20). CONCLUSIONS From a psychometric property perspective, the COST could be recommended as the most suitable worldwide available measure for use in research and clinical practice across different contexts. We suggest that PROMs should be selected only after careful consideration of the local socioeconomic context. Future studies are warranted to develop various FT PROMs based on different social and cultural backgrounds and to clarify the theoretical grounds for assessing FT.
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Affiliation(s)
- Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
| | - Weijie Xing
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
| | - Huan Wen
- School of Public Health, Fudan University, Shanghai, China
| | - Yanling Sun
- School of Public Health, Fudan University, Shanghai, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Lucylynn Lizarondo
- The Joanna Briggs Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jian Peng
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Hu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Fudan University, Shanghai, China
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30
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Eala MAB, Dee EC, Ginsburg O, Chua MLK, Bhoo-Pathy N. Financial toxicities of cancer in low- and middle-income countries: Perspectives from Southeast Asia. Cancer 2022; 128:3013-3015. [PMID: 35713589 DOI: 10.1002/cncr.34353] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/04/2022] [Accepted: 05/25/2022] [Indexed: 12/19/2022]
Affiliation(s)
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Rockville, Maryland, USA
| | - Melvin Lee Kiang Chua
- Department of Head and Neck and Thoracic Cancers, Divisions of Radiation Oncology and Medical Sciences, Duke-NUS Medical School, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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31
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Chong SC, Rajah R, Chow PL, Tan HC, Chong CM, Khor KY, Lee WP, Tan WY. Perspectives toward biosimilars among oncologists: A Malaysian survey. J Oncol Pharm Pract 2022:10781552221104773. [PMID: 35698761 DOI: 10.1177/10781552221104773] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Biosimilars confer significant cost-saving advantages and expand patients' access to biologic therapies in cancer care. In line with the increasing availability of antineoplastic biosimilars, it is pertinent to understand the oncologists' view on the adoption of biosimilars in their clinical practice. The study aimed to assess (i) the prevalence of biosimilar use, (ii) perception towards biosimilars, (iii) factors influencing the use of biosimilars and (iv) knowledge about biosimilars among Malaysian oncologists. METHODS A cross-sectional survey was conducted among clinical oncologists and medical oncologists in Malaysia between January 2020 and February 2021 using a structured 31-item questionnaire. RESULTS Among the 121 oncologists registered in the country, 36 responded (response rate = 30%). A total of 64% of the respondents prescribed biosimilars either often or always. Most oncologists (72%) agreed or strongly agreed that switching will not have a significant effect on the treatment benefit, with lower percentages saying that they agreed or strongly agreed that it will not lead to the emergence of additional adverse effects (56%) or harmful immunogenicity (64%). Patients' preferences (40%) and the non-availability of biosimilars in hospitals (34%) are the major barriers cited to the prescribing of biosimilars. Cost differences and robust pharmacovigilance activities are the two most important factors that would influence the prescribing of biosimilars. The mean score of knowledge in biosimilar among respondents was 3.81 (± 0.86) out of a maximum possible score of 6. CONCLUSIONS The identified gap in prescribing and the use of biosimilars among Malaysian oncologists warrant educational intervention and robust pharmacovigilance activities to facilitate the prescribing of biosimilars and ultimately increase the accessibility to biologics in cancer treatment.
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Affiliation(s)
- Soon Cien Chong
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Retha Rajah
- Pharmacy Department, Seberang Jaya Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Poh Lee Chow
- Radiotherapy and Oncology Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Hsio Ching Tan
- Radiotherapy and Oncology Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Chin Man Chong
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Kar Yee Khor
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Wan Ping Lee
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
| | - Wan Ying Tan
- Pharmacy Department, Penang General Hospital, Ministry of Health Malaysia, Penang, Malaysia
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32
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Udayakumar S, Solomon E, Isaranuwatchai W, Rodin DL, Ko YJ, Chan KKW, Parmar A. Cancer treatment-related financial toxicity experienced by patients in low- and middle-income countries: a scoping review. Support Care Cancer 2022; 30:6463-6471. [PMID: 35322274 DOI: 10.1007/s00520-022-06952-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE In the past decade, literature has called attention to financial toxicities experienced by cancer patients. Though studies have addressed research questions in high-income countries, there remains a paucity of in-depth reviews regarding low- and middle-income countries (LMICs). Our scoping review provides an overview of treatment-related financial toxicities experienced by cancer patients in LMICs. METHODS A systematic search was conducted in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. English peer-reviewed articles that (a) explored patients' experience with financial toxicity due to cancer treatment (b) were specific to LMICs as defined by the World Bank and (c) focused on qualitative data were included. Details regarding participants and main findings were extracted and synthesized. RESULTS The search yielded 6290 citations, and 42 studies across 3 low-income, 9 lower-middle-income and 8 upper-middle-income countries. Main themes identified included cancer patients encountered various material hardships, managed costs with different coping behaviours and experienced negative psychological responses to their financial burden. Higher levels of financial toxicities were associated with patient characteristics such as lower socio-economic status and lack of insurance, as well as patient outcomes such as lower quality of life. CONCLUSION Cancer patients in LMIC experience deleterious financial toxicities as a result of treatment. This comprehensive characterization of financial toxicities will better allow health systems to adopt evidence-based mitigation strategies to reduce the financial burden on patients.
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Affiliation(s)
| | - Eden Solomon
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Danielle L Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Yoo-Joung Ko
- St. Michael's Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kelvin K W Chan
- Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, ON, Toronto, Canada.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON, Canada
| | - Ambica Parmar
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Odette Cancer Centre, Sunnybrook Health Sciences Centre, ON, Toronto, Canada.
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Cauley CE, Kalady MF. Special Considerations of Anastomotic Leak in Patients with Rectal Cancer. Clin Colon Rectal Surg 2021; 34:426-430. [PMID: 34853565 DOI: 10.1055/s-0041-1735275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anastomotic leak in patients with rectal cancer has the potential to cause worse oncologic outcomes in addition to major morbidity and mortality risk of this dreaded complication. Anatomic location of the rectal cancer determines the ability to perform a restorative operation and the height of the anastomosis in relation to the anal canal. Clinical staging dictates the need for neoadjuvant treatment (such as chemotherapy and radiation) which may also contribute to anastomotic leak risk. In addition to oncologic outcomes, anastomotic leak can impact bowel function, the need for permanent stoma, and long-term quality of life. This study will discuss special considerations for anastomotic leak prevention and clinical implications of this complication in patients with rectal cancer.
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Affiliation(s)
- Christy E Cauley
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew F Kalady
- Division of Colon and Rectal Surgery, The Ohio State University, Columbus, OH
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34
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Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol 2021; 22:e541-e549. [PMID: 34856151 DOI: 10.1016/s1470-2045(21)00468-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/21/2022]
Abstract
Although financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and outcome among the Indian population. In this study, we systematically reviewed the prevalence, determinants, and consequences of financial toxicity among patients with cancer in India. 22 studies were included in the systematic review. The determinants of financial toxicity include household income, type of health-care facility used, stage of disease, area of residence, age at the time of diagnosis, recurrent cancer, educational status, insurance coverage, and treatment modality. Financial toxicity was associated with poor quality of life, accumulation of debts, premature entry into the labour market, and non-compliance with therapy. Our findings emphasise the need for urgent strategies to mitigate financial toxicity among patients with cancer in India, especially in the most deprived sections of society. The qualitative evidence synthesised in this systematic review could provide a basis for the development of such interventions to reduce financial toxicity among patients with cancer.
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Affiliation(s)
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Aju Mathew
- Malankara Orthodox Syrian Church Medical College, Kolenchery, India.
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35
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Abrams HR, Durbin S, Huang CX, Johnson SF, Nayak RK, Zahner GJ, Peppercorn J. Financial toxicity in cancer care: origins, impact, and solutions. Transl Behav Med 2021; 11:2043-2054. [PMID: 34850932 DOI: 10.1093/tbm/ibab091] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term "financial toxicity" has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.
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Affiliation(s)
- Hannah R Abrams
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sienna Durbin
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cher X Huang
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Rahul K Nayak
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Greg J Zahner
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey Peppercorn
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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36
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Mostafavi RM, Nichols KE. Identifying Childhood Cancer Survivors at Increased Genetic Risk for Second Malignant Neoplasms: Use of a Novel Screening Tool. J Clin Oncol 2021; 39:3195-3198. [PMID: 34473566 DOI: 10.1200/jco.21.01817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Roya M Mostafavi
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Kim E Nichols
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
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37
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Cost-Effectiveness of Colorectal Cancer Genetic Testing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168330. [PMID: 34444091 PMCID: PMC8394708 DOI: 10.3390/ijerph18168330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths worldwide. Approximately 3–5% of CRCs are associated with hereditary cancer syndromes. Individuals who harbor germline mutations are at an increased risk of developing early onset CRC, as well as extracolonic tumors. Genetic testing can identify genes that cause these syndromes. Early detection could facilitate the initiation of targeted prevention strategies and surveillance for CRC patients and their families. The aim of this study was to determine the cost-effectiveness of CRC genetic testing. We utilized a cross-sectional design to determine the cost-effectiveness of CRC genetic testing as compared to the usual screening method (iFOBT) from the provider’s perspective. Data on costs and health-related quality of life (HRQoL) of 200 CRC patients from three specialist general hospitals were collected. A mixed-methods approach of activity-based costing, top-down costing, and extracted information from a clinical pathway was used to estimate provider costs. Patients and family members’ HRQoL were measured using the EQ-5D-5L questionnaire. Data from the Malaysian Study on Cancer Survival (MySCan) were used to calculate patient survival. Cost-effectiveness was measured as cost per life-year (LY) and cost per quality-adjusted life-year (QALY). The provider cost for CRC genetic testing was high as compared to that for the current screening method. The current practice for screening is cost-saving as compared to genetic testing. Using a 10-year survival analysis, the estimated number of LYs gained for CRC patients through genetic testing was 0.92 years, and the number of QALYs gained was 1.53 years. The cost per LY gained and cost per QALY gained were calculated. The incremental cost-effectiveness ratio (ICER) showed that genetic testing dominates iFOBT testing. CRC genetic testing is cost-effective and could be considered as routine CRC screening for clinical practice.
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Rajah HDA, Ting CQ, Ahmad M, Leong WC, Bhoo-Pathy N, Chan CMH. Reliability and Validity of the Brief Illness Perception Questionnaire in Bahasa Malaysia for Patients with Cancer. Asian Pac J Cancer Prev 2021; 22:2487-2492. [PMID: 34452562 PMCID: PMC8629479 DOI: 10.31557/apjcp.2021.22.8.2487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The main purpose of this study was to identify the psychometric properties and validate the Bahasa Malaysia version of the Brief Illness Perception Questionnaire among patients with cancer. METHODS A total of 129 newly diagnosed patients with cancer were consecutively sampled. Reliability and validity of the questionnaire were tested using translation validity, test-retest reliability, Principal Component Analysis, Cronbach's alpha coefficient for domains and item-total correlation. RESULTS The questionnaire indicates excellent test-retest reliability. The Principal Component Analysis (PCA) revealed that Kaiser-Meyer-Olkin (KMO) is 0.60 for the two-factor structure of the Brief Illness Perception Questionnaire of the Bahasa Malaysia version which consists of cognitive illness representation and emotional illness representation. CONCLUSION The Brief Illness Perception Questionnaire in the Bahasa Malaysia version is a useful tool to use among patients with cancer in Malaysia context despite moderate psychometric properties. This is based on the premise that the questionnaire can be used as a quick tool to assess illness perceptions among Malaysian with cancer in routine oncology practice.
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Affiliation(s)
- Harenthri Devy Alagir Rajah
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Campus Kuala Lumpur, Kuala Lumpur, Malaysia.
- Faculty of Arts and Social Science, University Tunku Abdul Rahman, Kampar, Perak, Malaysia.
| | - Chie Qiu Ting
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Mahadir Ahmad
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Campus Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Wun Chin Leong
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Campus Kuala Lumpur, Kuala Lumpur, Malaysia.
- Department of Radiotherapy and Oncology, National Cancer Institute, Putrajaya, Malaysia.
| | | | - Caryn Mei Hsien Chan
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Campus Kuala Lumpur, Kuala Lumpur, Malaysia.
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Kadravello A, Tan SB, Ho GF, Kaur R, Yip CH. Exploring Unmet Needs from an Online Metastatic Breast Cancer Support Group: A Qualitative Study. ACTA ACUST UNITED AC 2021; 57:medicina57070693. [PMID: 34356974 PMCID: PMC8305467 DOI: 10.3390/medicina57070693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
Background and Objective: Despite the increasing treatment options for patients with metastatic breast cancer (MBC), unmet needs remain common, especially in low and middle-income countries where resources are limited and MBC patients face many challenges. They often join support groups to cope with their unmet needs. Currently, many MBC patients connect with each other via online support group in view of the constant availability of support and rapid information exchange. The objective of this study is to determine the unmet needs of women with MBC from an online support group. Material and Methods: Messages in an online support group of twenty-two MBC patients over a period of three years from August 2016 till August 2019 were thematically analyzed. Results: Three themes were generated, (1) unmet information needs (2) unmet financial needs (3) unmet support needs. Women needed information on side effects of treatment, new treatment options and availability of clinical trials. Although Malaysia has universal health care coverage, access to treatment remains a major challenge. When treatment was not available in the public hospitals, or waiting lists were too long, women were forced to seek treatment in private hospitals, incurring financial catastrophe. Insufficient private insurance and inadequate social security payments force many women to consider stopping treatment. Women felt that they were not getting support from their clinicians in the public sector, who were quick to stop active treatment and advise palliation. On the other hand, clinicians in the private sector advise expensive treatment beyond the financial capability of the patients. Women with families also face the challenge of managing their family and household in addition to coping with their illness. Conclusions: There is a need for healthcare professionals, policy makers, and civil society to better address the needs of MBC patients through patient-centered, multidisciplinary and multi-organizational collaboration.
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Affiliation(s)
- Aravinthan Kadravello
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Seng-Beng Tan
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Gwo-Fuang Ho
- Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (S.-B.T.); (G.-F.H.)
| | - Ranjit Kaur
- Breast Cancer Welfare Association Malaysia, Petaling Jaya 46200, Malaysia; (A.K.); (R.K.)
| | - Cheng-Har Yip
- Breast Centre, Subang Jaya Medical Centre, Subang Jaya 47500, Malaysia
- Correspondence:
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40
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Bhoo-Pathy N, Subramaniam S, Khalil S, Kimman M, Kong YC, Ng CW, Bustamam RS, Yip CH. Out-of-Pocket Costs of Complementary Medicine Following Cancer and the Financial Impact in a Setting With Universal Health Coverage: Findings From a Prospective Cohort Study. JCO Oncol Pract 2021; 17:e1592-e1602. [PMID: 34077232 DOI: 10.1200/op.20.01052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine household spending patterns on complementary medicine following cancer and the financial impact in a setting with universal health coverage. METHODS Country-specific data from a multinational prospective cohort study, Association of Southeast Asian Nations Costs in Oncology Study, comprising 1,249 cancer survivors were included. Household costs of complementary medicine (healthcare practices or products that are not considered as part of conventional medicine) throughout the first year after cancer diagnosis were measured using cost diaries. Study outcomes comprised (1) shares of household expenditures on complementary medicine from total out-of-pocket costs and health costs that were respectively incurred in relation to cancer, (2) incidence of financial catastrophe (out-of-pocket costs related to cancer ≥ 30% of annual household income), and (3) economic hardship (inability to pay for essential household items or services). RESULTS One third of patients reported out-of-pocket household expenditures on complementary medicine in the immediate year after cancer diagnosis, accounting to 20% of the total out-of-pocket costs and 35% of the health costs. Risk of financial catastrophe was higher in households reporting out-of-pocket expenditures on complementary medicine (adjusted odds ratio: 1.39 [95% CI, 1.05 to 1.86]). Corresponding odds ratio within patients from low-income households showed that they were substantially more vulnerable: 2.28 (95% CI, 1.41 to 3.68). Expenditures on complementary medicine were, however, not associated with economic hardship in the immediate year after cancer diagnosis. CONCLUSION In settings with universal health coverage, integration of subsidized evidence-based complementary medicine into mainstream cancer care may alleviate catastrophic expenditures. However, this must go hand in hand with interventions to reduce the use of nonevidence-based complementary therapies following cancer.
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Affiliation(s)
- Nirmala Bhoo-Pathy
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shridevi Subramaniam
- Centre of Clinical Epidemiology, Institute of Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Sadia Khalil
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Yek-Ching Kong
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ros Suzanna Bustamam
- Department of Radiotherapy and Oncology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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41
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Durber K, Halkett GK, McMullen M, Nowak AK. Measuring financial toxicity in Australian cancer patients - Validation of the COmprehensive Score for financial Toxicity (FACT COST) measuring financial toxicity in Australian cancer patients. Asia Pac J Clin Oncol 2021; 17:377-387. [PMID: 33567158 DOI: 10.1111/ajco.13508] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/07/2020] [Indexed: 10/22/2022]
Abstract
AIM/BACKGROUND The FACT COST is a patient-rated measure of financial toxicity, developed and validated in a North American population. We aimed to confirm the validity and reliability of the FACT COST in Australian cancer patients, because the Australian healthcare funding structure is different to that in North America. METHODS A single center, cross-sectional study design investigated financial toxicity in oncology outpatients. Eligible adults had current malignancy, with or without active cancer treatment. The primary endpoint was the degree of financial toxicity experienced via the COST questionnaire; secondary endpoints included health-related quality of life (Functional Assessment of Cancer Therapy-General), anxiety, and depression (Hospital Anxiety and Depression Scale). Clinical and demographic data were recorded. Statistical analysis determined the internal consistency, test-retest reliability and validity of COST, and correlations between COST score and secondary endpoints. RESULTS A total of 257 patients participated (79% response rate). Fifty-three percent were female; median age 63 years (range 19-88). COST scores were skewed toward less financial toxicity, median 26 (SD 10.3, range 1-43), lower scores indicating higher toxicity. High internal consistency (Cronbach's α = 0.884), test-retest reliability (ICC = 0.801), and convergent validity were demonstrated. Financial toxicity was greatest in younger participants, those with more inpatient admissions, those with a change in employment status following diagnosis, and those in the lowest income quintile. Financial toxicity was associated with worse health-related quality of life, and greater depression and anxiety. CONCLUSION The COST measure of financial toxicity demonstrated acceptable validity parameters in an Australian outpatient population. Greater financial toxicity was associated with worse psychological well-being and with certain patient demographics.
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Affiliation(s)
- Kimberley Durber
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Georgia Kb Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Michelle McMullen
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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42
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Affiliation(s)
- Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Kanan Shah
- New York University Grossman School of Medicine, New York, New York
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Yunus SZSA, Puteh SEW, Ali AM, Daud F. The Covid Impact to Public Healthcare Utilization Among Urban Low-Income Subsidized Community in Klang Valley Malaysia. Health Serv Res Manag Epidemiol 2021; 8:23333928211002407. [PMID: 33796627 PMCID: PMC7975447 DOI: 10.1177/23333928211002407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Appropriate level of healthcare utilization is one of the aims in translating health system inputs into improving the outcome of population health. Healthcare utilization services in Malaysia remains relatively low as compared to the rate in most high-income countries and some gaps exist across socioeconomic status. After the financial handouts deemed Household Living Aid (HLA) to low-income earners, Malaysia has recently implemented a financial health protection scheme toward for low-income group known as PeKa B40 to improve their access for healthcare services. This study aims to determine the healthcare utilization among the low-income population living in urban Klang Valley, and to explore the relationship between healthcare utilization with the demographic characteristics of this population. MATERIAL AND METHODS A cross-sectional study using face to face structured questionnaire. All 447 respondents included were low-income earners enrolled in the HLA. Chi-square analysis and multiple logistic regression were used to examine association between the risk factors and healthcare utilization. RESULTS The response rate was 93.5%. The healthcare utilization among the respondents during the partial lockdown period was 19.5% and 33.1% during the recovery lockdown period. Enrollment in the PeKa B40 scheme among the 7.6% respondents was not associated with healthcare utilization. After controlling for the variables, those aged 60 years and above [AOR: 1.87; 95% (CI): (1.07; 3.27)], self-rated poor health status [AOR: 2.16; 95% (CI): (1.07; 4.34)], having NCDs [AOR: 4.21; 95% (CI): (2.23; 7.94)], and being hospitalized in the past 12 months [AOR: 3.54; 95% (CI): (1.46; 8.62)], were more likely to utilize healthcare services as compared to their counterparts. CONCLUSION The results from this study is valuable for policy recommendations to improve on the coverage of the PeKa B40 scheme and healthcare access for the low-income population especially during the pandemic.
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Affiliation(s)
| | - Sharifa Ezat Wan Puteh
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
| | - Adliah Mhd Ali
- Center of Quality Management of Medicines, Faculty of Pharmacy, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
| | - Faiz Daud
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia
(UKM), Kuala Lumpur, Malaysia
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44
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Kong YC, Sakti VV, Sullivan R, Bhoo-Pathy N. Cancer and COVID-19: economic impact on households in Southeast Asia. Ecancermedicalscience 2020; 14:1134. [PMID: 33281926 PMCID: PMC7685766 DOI: 10.3332/ecancer.2020.1134] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
The ongoing COVID-19 pandemic may worsen the existing financial vulnerabilities of cancer survivors who may be experiencing a double financial hit, both from cancer-induced financial toxicity as well as economic strains arising from loss of income and prolonged unemployment following the pandemic. The impact of the pandemic is likely to be more pronounced on cancer survivors living in resource-limited settings, such as in Southeast Asia. As health care systems in the region try to streamline resources and accommodate the influx of patients from COVID-19, many in the cancer community have experienced severe disruptions in their care. The delays and disruption of timely access to cancer care could lead to patients presenting with worsened conditions and at more advanced cancer stages in which treatment options tended to be costlier. Similar to countries around the world, the various forms of movement restrictions that were enforced have aggravated the rates of unemployment, loss of wages and the limited access to support from family or friends around Southeast Asia. The economic impact of COVID-19 hits even harder on the large proportion of the population in the region that works in the informal sector, who are often one paycheque or one episode of illness away from financial catastrophe. More worryingly, the lack of a robust social security system in many Southeast Asian countries, especially in terms of income protection, could ultimately force many cancer survivors to choose between paying for their treatments, or to forego treatments, and feed their families. Early identification of cancer patients experiencing financial toxicity following the pandemic will enable timely and appropriate interventions to be undertaken by various stakeholders, potentially averting a cascade of other economic fallouts that may last for years after cancer treatment.
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Affiliation(s)
- Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Veni-Venusha Sakti
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Richard Sullivan
- King's College London, Institute for Cancer Policy, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Faculty of Medicine, University of Malaya, 50603, Lembah Pantai, Kuala Lumpur, Malaysia
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Yap SL, Wong SSL, Chew KS, Kueh JSH, Siew KL. Assessing the Relationship between Socio-demographic, Clinical Profile and Financial Toxicity: Evidence from Cancer Survivors in Sarawak. Asian Pac J Cancer Prev 2020; 21:3077-3083. [PMID: 33112570 PMCID: PMC7798164 DOI: 10.31557/apjcp.2020.21.10.3077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient's financial ability is always the most critical imputes to treatment choice and adherence; as it translates into health outcomes such as survival rate and quality of life. Cancer care is likely to affect the patient's financial well-being, putting huge financial pressure to the families. Therefore, it is imperative to understand the confounding factors of financial toxicity among cancer survivors along the course of survivorship. METHODS This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors. RESULTS The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT. CONCLUSION Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.
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Affiliation(s)
- Shee-Ling Yap
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Shirly Siew-Ling Wong
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Keng-Sheng Chew
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Jerome Swee-Hui Kueh
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
| | - Ke-Lin Siew
- Faculty of Economics and Business, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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Tremblay D, Poder TG, Vasiliadis HM, Touati N, Fortin B, Lévesque L, Longo C. Translation and Cultural Adaptation of the Patient Self-Administered Financial Effects (P-SAFE) Questionnaire to Assess the Financial Burden of Cancer in French-Speaking Patients. Healthcare (Basel) 2020; 8:E366. [PMID: 32992780 PMCID: PMC7712971 DOI: 10.3390/healthcare8040366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 12/23/2022] Open
Abstract
People living with and beyond cancer (PLC) experience financial hardship associated with the disease and its treatment. Research demonstrates that the "economic toxicity" of cancer can cause distress and impair well-being, health-related quality of life and, ultimately, survival. The Patient Self-Administered Financial Effects (P-SAFE) questionnaire was created in Canada and tested in English. The objective of this study is to describe the processes of translation and cultural adaptation of the P-SAFE for use with French speaking PLC in Canada. The Canadian P-SAFE questionnaire was translated from English to French in collaboration with the developer of the initial version, according to the 12-step process recommended by the Patient-Reported Outcome (PRO) Consortium. These steps include forward and backward translation, a multidisciplinary expert committee, and cross-cultural validation using think-aloud, probing techniques, and clarity scoring during cognitive interviewing. Translation and validation of the P-SAFE questionnaire were performed without major difficulties. Minor changes were made to better fit with the vocabulary used in the public healthcare system in Quebec. The mean score for clarity of questions was 6.4 out of a possible 7 (totally clear) Cognitive interviewing revealed that lengthy questionnaire instructions could be confusing. Our team produced a Canadian-French version of the P-SAFE. After minor rewording in the instructions, the P-SAFE questionnaire appears culturally appropriate for use with French-speaking PLC in Canada. Further testing of the French version will require evaluation of psychometric properties of validity and reliability.
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Affiliation(s)
- Dominique Tremblay
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Thomas G. Poder
- Département de Gestion, Évaluation et Politique de Santé, École de Santé Publique de l’Université de Montréal (ESPUM), Université de Montréal, Montréal, QC H3N 1X9, Canada;
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est de l’Île de Montréal, Montréal, QC H1N 3M5, Canada
| | - Helen-Maria Vasiliadis
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Nassera Touati
- École Nationale D’administration Publique, Montréal, QC H2T 2C8, Canada;
| | - Béatrice Fortin
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Lise Lévesque
- Centre de Recherche Charles-Le Moyne–Saguenay–Lac-Saint-Jean sur les Innovations en Santé, 150 Place Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada; (H.-M.V.); (B.F.); (L.L.)
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Campus de Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Christopher Longo
- DeGroote School of Business, McMaster University, Hamilton, ON L8S 4L8, Canada;
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Financial burden and financial toxicity in patients with colorectal, gastro-oesophageal, and pancreatobiliary cancers: A UK study. J Cancer Policy 2020. [DOI: 10.1016/j.jcpo.2020.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kong YC, Wong LP, Ng CW, Taib NA, Bhoo-Pathy NT, Yusof MM, Aziz AF, Yehgambaram P, Ishak WZW, Yip CH, Bhoo-Pathy N. Understanding the Financial Needs Following Diagnosis of Breast Cancer in a Setting with Universal Health Coverage. Oncologist 2020; 25:497-504. [PMID: 31922332 DOI: 10.1634/theoncologist.2019-0426] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A diagnosis of cancer negatively impacts the financial wellbeing of affected individuals as well as their households. We aimed to gain an in-depth understanding of the financial needs following diagnosis of breast cancer in a middle-income setting with universal health coverage. MATERIALS AND METHODS Twelve focus group discussions (n = 64) were conducted with women with breast cancer from two public and three private hospitals. This study specifically focused on (a) health costs, (b) nonhealth costs, (c) employment and earnings, and (d) financial assistance. Thematic analysis was used. RESULTS Financial needs related to cancer treatment and health care varied according to the participant's socioeconomic background and type of medical insurance. Although having medical insurance alleviated cancer treatment-related financial difficulties, limited policy coverage for cancer care and suboptimal reimbursement policies were common complaints. Nonhealth expenditures were also cited as an important source of financial distress; patients from low-income households reported transport and parking costs as troublesome, with some struggling to afford basic necessities, whereas participants from higher-income households mentioned hired help, special food and/or supplements and appliances as expensive needs following cancer. Needy patients had a hard time navigating through the complex system to obtain financial support. Irrespective of socioeconomic status, reductions in household income due to loss of employment and/or earnings were a major source of economic hardship. CONCLUSION There are many unmet financial needs following a diagnosis of (breast) cancer even in settings with universal health coverage. Health care professionals may only be able to fulfill these unmet needs through multisectoral collaborations, catalyzed by strong political will. IMPLICATIONS FOR PRACTICE As unmet financial needs exist among patients with cancer across all socioeconomic groups, including for patients with medical insurance, financial navigation should be prioritized as an important component of cancer survivorship services, including in the low- and middle-income settings. Apart from assisting survivors to understand the costs of cancer care, navigate the complex system to obtain financial assistance, or file health insurance claims, any planned patient navigation program should also provide support to deal with employment-related challenges and navigate return to work. It is also echoed that costs for essential personal items (e.g., breast prostheses) should be covered by health insurance or subsidized by the government.
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Affiliation(s)
- Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Li-Ping Wong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chiu-Wan Ng
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nanthini Thevi Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - Wan Zamaniah Wan Ishak
- Department of Clinical Oncology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Khandelwal N, May P, Curtis JR. Financial stress after critical illness: an unintended consequence of high-intensity care. Intensive Care Med 2020; 46:107-109. [PMID: 31549224 PMCID: PMC7035881 DOI: 10.1007/s00134-019-05781-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/06/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Nita Khandelwal
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
- Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, Harborview Medical Center, University of Washington, Seattle, WA, USA.
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, 359762, Seattle, WA, 98104, USA.
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