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Srivastava A, Tilea A, Kim DD, Dalton VK, Fendrick AM. Out-of-pocket costs for diagnostic testing following abnormal prostate cancer screening among privately insured men. Cancer 2024. [PMID: 39005006 DOI: 10.1002/cncr.35392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Prostate cancer is the most common malignancy among men and following a positive prostate-specific antigen (PSA) screening test, patients may undergo more expensive diagnostic testing. However, testing-related out-of-pocket costs (OOPCs), which may preclude patients from completing the screening process, have not been previously quantified. OOPCs for follow-up diagnostic testing (i.e., prostate biopsy and/or magnetic resonance imaging [MRI]) in patients with private insurance undergoing prostate cancer screening were estimated. METHODS Men ages 55 to 69 years old who underwent PSA-based prostate cancer screening from 2010 to 2020 from the IBM Marketscan database were identified. The number of patients undergoing follow-up diagnostic testing within 12 months of screening was tabulated, dividing patients into three groups: (1) biopsy only, (2) MRI only, and (3) MRI + biopsy. Over the study period, patients with nonzero cost-sharing and calculated inflation-adjusted OOPCs, adding copayment, coinsurance, and deductible payments, for each group were identified. RESULTS Among screened patients (n = 3,075,841) from 2010 through 2020, 91,850 had a second PSA test and an elevated PSA level, of which 40,329 (43.9%) underwent subsequent diagnostic testing. More than 75% of these patients experienced cost-sharing, and median OOPCs rose substantially over the study period for patients undergoing biopsy only ($79 to $214), MRI only ($81 to $490), and MRI and biopsy ($353 to $620). CONCLUSIONS OOPCs from diagnostic testing after prostate cancer screening are common and rising. This work aligns with the recent position statement from the American Cancer Society, that payers should eliminate cost-sharing, which may undermine the screening process, for diagnostic testing following cancer screening.
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Affiliation(s)
- Arnav Srivastava
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anca Tilea
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - David D Kim
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Vanessa K Dalton
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - A Mark Fendrick
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Ky TD, Loan NT, Thinh NT, Binh MT. Nonadherence to oral cancer chemotherapy in hepatocellular carcinoma: prevalence and predictive factors in Vietnam. BMC Cancer 2024; 24:841. [PMID: 39009994 PMCID: PMC11247847 DOI: 10.1186/s12885-024-12601-2] [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: 08/29/2023] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE Standard oral cancer chemotherapy (OCT) or targeted therapy (OTT) has expanded the treatment methods for hepatocellular carcinoma (HCC). However, its principal nonadherence causes a reduction in efficacy. We aimed to evaluate the status of nonadherence and influencing factors among outpatient patients with HCC. PATIENTS AND METHODS In 2021, a prospective observational study was conducted on 384 patients with either old or newly diagnosed HCC treated with OTT. Nonadherence to OCT was determined using the eight-item Morisky Medication Adherence Scale, with a score < 6 points. The patients were finished with a six-month follow-up investigation by questionnaires. RESULTS 54,8% of HCC outpatients were nonadherent to OCT, with a mean Morisky score of 5.19. They dropped out of the treatment mainly because of drug side effects, such as fatigue (72.4%), hand-foot syndrome (42.7%), diarrhea (38.3%), nausea (25%), insomnia (24.7%), abdominal pain (12%), and anxiety about these adverse events (65.9%). Additionally, financial difficulties and low relative copayments were significantly correlated with the noncompliant treatment of patients (OR = 2.29, 95% CI = 1.32-3.98, P = 0.003; OR = 4.36, 95% CI = 0.95-19.93, P = 0.039, respectively). Moreover, inadequate individual information about the clinical course, the art of treatment, and medication usage instructions were suggestive barriers to adherence to treatment (OR = 1.96, 95% CI = 1.08-3.55, P = 0.024; OR = 1.86, 95% CI = 1.1-3.14, P = 0.02; OR = 2.34, 95% CI = 1.29-4.26, P = 0.004, respectively). Finally, a low level of trust in doctors was an essential factor in nonadherence (Mean of the Anderson Trust in Physician Scale scores counted 38.12 vs. 43.97, respectively for non-adherence vs. adherence, P = 0.00001). CONCLUSIONS This study suggests a high rate of primary nonadherence to standard oral targeted therapy among HCC outpatient patients because of drug side effects, patient awareness of treatment, and lack of confidence in healthcare providers. Close supervision, proper medication instructions, appropriate dosage reductions, and comprehensive patient counseling might be necessary to control nonadherence.
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Affiliation(s)
- Thai Doan Ky
- Department of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Thi Loan
- Department of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Nguyen Tien Thinh
- Department of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam
| | - Mai Thanh Binh
- Department of Gastroenterology and Hepatology, 108 Military Central Hospital, Hanoi, Vietnam.
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Joyce DD, Boehmer KR, Kamath CC, LaVecchia CM, Sharma V, Schulte PJ, Tilburt JC, Penson DF, Boorjian SA. Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Mixed Methods Approach to Identify Effective Interventions. UROLOGY PRACTICE 2024; 11:640-652. [PMID: 38899638 PMCID: PMC11192241 DOI: 10.1097/upj.0000000000000589] [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: 01/08/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Financial toxicity associated with treatments for metastatic prostate cancer remains poorly defined. We sought to understand aspects of financial toxicity not captured in a commonly employed financial toxicity questionnaire and identify potential interventions to help alleviate financial toxicity through a convergent mixed methods approach. METHODS Patients seen at our institution's advanced prostate cancer clinic were approached for completion of the Comprehensive Score for Financial Toxicity (COST-FACIT) questionnaire (quantitative analysis). A maximal variation purposive sample was chosen to participate in focus group discussions (qualitative analysis). Conventional content analysis was performed using an inductive approach. COST-FACIT scores were compared between patients experiencing high and low financial toxicity using Wilcoxon rank sum test. RESULTS Three themes were identified through qualitative analysis: (1) workload, (2) coping strategies, and (3) communication. We found alignment with the existing theory of financial capacity across our findings. Two unique aspects of financial toxicity emerged that were not assessed quantitatively and deemed to be significant. Specifically, cost transparency (including health care teams knowledgeable about and willing to discuss costs) and inclusion of informal caregivers in financial toxicity screening and decision-making may guide future interventions aimed at limiting financial toxicity in this population. CONCLUSIONS Prolonged treatment courses involving multiple lines of treatment with varying costs result in distinct financial toxicity components for patients with metastatic prostate cancer that are not assessed with COST-FACIT. Improving cost transparency, health care team knowledge and engagement, and providing resources to support informal caregivers may have a significant impact on the financial toxicity experienced by these patients.
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Affiliation(s)
| | - Kasey R. Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Celia C. Kamath
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Christina M. LaVecchia
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of English, University of Cincinnati, Cincinnati, OH
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Jon C. Tilburt
- Department of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
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O'Connor RM, Huang DS, Rimel BJ, Kim KH, Li AJ, Taylor KN, Liang MI. Unmet financial needs among patients crowdfunding to support gynecologic cancer care. Gynecol Oncol 2024; 186:199-203. [PMID: 38833852 DOI: 10.1016/j.ygyno.2024.05.017] [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: 02/26/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Patients may use crowdfunding to solicit donations, typically from multiple small donors using internet-based means, to offset the financial toxicity of cancer care. OBJECTIVE To describe crowdfunding campaigns by gynecologic cancer patients and to compare campaign characteristics and needs expressed between patients with cervical, uterine, and ovarian cancer. STUDY DESIGN We queried the public crowdfunding forum GoFundMe.com for "cervical cancer," "uterine cancer," and "ovarian cancer." The first 200 consecutive posts for each cancer type fundraising within the United States were analyzed. Data on campaign goals and needs expressed were manually extracted. Descriptive statistics and bivariate analyses were performed. RESULTS Among the 600 fundraising pages, the median campaign goal was $10,000 [IQR $5000-$23,000]. Campaigns raised a median of 28.6% of their goal with only 8.7% of campaigns reaching their goal after a median of 54 days online. On average, ovarian cancer campaigns had higher monetary goals, more donors, and larger donation amounts than cervical cancer campaigns and raised more money than both cervical and uterine cancer campaigns. Campaigns were fundraising to support medical costs (80-85%) followed by lost wages (36-56%) or living expenses (27-41%). Cervical cancer campaigns reported need for non-medical costs more frequently than uterine or ovarian cancer campaigns. States without Medicaid expansions (31% of the national population) were over-represented among cervical cancer and uterine cancer, but not ovarian cancer campaigns. CONCLUSIONS Crowdfunding pages reveal patients fundraising for out-of-pocket costs in the thousands of dollars and a wide range of unmet financial needs based on cancer type.
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Affiliation(s)
- Reed M O'Connor
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dandi S Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B J Rimel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kenneth H Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Li
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kristin N Taylor
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Doherty M. Why Study Guaranteed Income in Oncology? Lessons Learned From Launching the Guaranteed Income and Financial Treatment Trial. J Am Coll Radiol 2024:S1546-1440(24)00532-5. [PMID: 38908741 DOI: 10.1016/j.jacr.2024.06.008] [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: 11/30/2023] [Revised: 05/03/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research.
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Affiliation(s)
- Meredith Doherty
- Assistant Professor, School of Social Policy and Practice; Senior Fellow, Leonard Davis Institute of Health Economics; Full Member, Abramson Cancer Center, Perelman School of Medicine; and Innovation Faculty, Penn Center for Cancer Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Li H, Sun Y, Yang T, Yin X, Zhu Z, Shi J, Tong L, Yang J, Ren H. Dyadic effects of financial toxicity and social support on the fear of cancer recurrence in breast cancer patients and caregivers: an actor-partner interdependence mediation model. BMC Nurs 2024; 23:378. [PMID: 38840268 PMCID: PMC11151716 DOI: 10.1186/s12912-024-02046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE In this study, the actor-partner interdependence mediation model (APIMeM) was applied to breast cancer patients and their caregivers to assess the factors that affect the fear of cancer recurrence. In particular, the purpose of this study was to evaluate the mediating effect of social support on financial toxicity and the fear of cancer recurrence, providing an effective basis for developing plans to reduce the level of fear of cancer recurrence. METHODS This study employed a cross-sectional design, and 405 dyads of breast cancer patients and their caregivers were enrolled. Financial toxicity, social support, and fear of cancer recurrence were assessed by computing comprehensive scores for financial toxicity based on patient-reported outcome measures, the Social Support Rating Scale, and the Fear of Cancer Recurrence Inventory Short Form, respectively. The data were analysed using SPSS 24.0 and AMOS 23.0. RESULTS The results showed that the fear of cancer recurrence of breast cancer patients and their caregivers was significantly related to dyadic financial toxicity and social support. In addition, the financial toxicity of breast cancer patients and their caregivers had significant actor effects and partner effects on the fear of cancer recurrence through dyadic social support. CONCLUSIONS The financial toxicity of breast cancer patients and their caregivers could produce actor and partner effects on the fear of cancer recurrence through the mediation of social support, which provided empirical support for improving reducing the level of fear of cancer recurrence among patients and caregivers at the dyadic level.
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Affiliation(s)
- Hongyan Li
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yabin Sun
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Tianye Yang
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Xin Yin
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Zhu Zhu
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jianjun Shi
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Lingling Tong
- China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jia Yang
- Changchun Central Hospital, Changchun, Jilin Province, China
| | - Hui Ren
- The First Hospital of Jilin University, Changchun, Jilin Province, China.
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Rashidi A, Jung J, Kao R, Nguyen EL, Le T, Ton B, Chen WP, Ziogas A, Sadigh G. Interventions to mitigate cancer-related medical financial hardship: A systematic review and meta-analysis. Cancer 2024. [PMID: 38758809 DOI: 10.1002/cncr.35367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/01/2024] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This study systematically reviewed interventions mitigating financial hardship in patients with cancer and assessed effectiveness using a meta-analytic method. METHODS PubMed, Cochrane, Scopus, CINAHL, and Web of Science were searched for articles published in English during January 2000-April 2023. Two independent reviewers selected prospective clinical trials with an intervention targeting and an outcome measuring financial hardship. Quality appraisal and data extraction were performed independently by two reviewers using a quality assessment tool. A random-effects model meta-analysis was performed. Reporting followed the preferred reporting items for systematic review and meta-analyses guidelines. RESULTS Eleven studies (2211 participants; 55% male; mean age, 59.29 years) testing interventions including financial navigation, financial education, and cost discussion were included. Financial worry improved in only 27.3% of 11 studies. Material hardship and cost-related care nonadherence remained unchanged in the two studies measuring these outcomes. Four studies (373 participants; 37% male, mean age, 55.88 years) assessed the impact of financial navigation on financial worry using the comprehensive score of financial toxicity (COST) measure (score range, 0-44; higher score = lower financial worry) and were used for meta-analysis. There was no significant change in the mean of pooled COST score between post- and pre-intervention (1.21; 95% confidence interval, -6.54 to 8.96; p = .65). Adjusting for pre-intervention COST, mean change of COST significantly decreased by 0.88 with every 1-unit increase in pre-intervention COST (p = .02). The intervention significantly changed COST score when pre-intervention COST was ≤14.5. CONCLUSION A variety of interventions have been tested to mitigate financial hardship. Financial navigation can mitigate financial worry among high-risk patients.
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Affiliation(s)
- Ali Rashidi
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Jinho Jung
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Raymond Kao
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Emily Lan Nguyen
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Theresa Le
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Brandon Ton
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Wen-Pin Chen
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA
| | - Argyrios Ziogas
- Chao Family Comprehensive Cancer Center, University of California Irvine, Irvine, California, USA
- Department of Medicine, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, California, USA
| | - Gelareh Sadigh
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
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Xu B, So WK, Choi KC, Huang Y, Liu M, Qiu L, Tan J, Tao H, Yan K, Yang F. Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study. Asia Pac J Oncol Nurs 2024; 11:100443. [PMID: 38665637 PMCID: PMC11039943 DOI: 10.1016/j.apjon.2024.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Objective We assessed financial toxicity (FT) among Chinese patients with cancer and investigated associated risk factors guided by a multilevel conceptual framework. Methods Applying multistage stratified sampling, we selected six tertiary and six secondary hospitals across three economically diverse provinces in China. From February to October 2022, 1208 patients with cancer participated. FT was measured using the COmprehensive Score for financial Toxicity (COST), with 28 potential risk factors identified at multilevel. Multiple regression analysis was used for risk factor identification. Results FT prevalence was 82.6% (95% confidence interval [CI]: 80.5%, 84.8%), with high FT (COST score ≤ 18.5) observed in 40.9% of participants (95% CI: 38.1%, 43.7%). Significant risk factors included younger age at cancer diagnosis, unmarried status, low annual household income, negative impact of cancer on participants' or family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side effects, high perceived stress, poor emotional/informational support, lack of social medical insurance or having urban and rural resident basic medical insurance, lack of commercial medical insurance, tertiary hospital treatment, and inadequate cost discussions with healthcare providers (all P < 0.05). Conclusions Cancer-related FT is prevalent in China, contributing to disparities in cancer care access and health-related outcomes. The risk factors associated with cancer-related FT encompasses multilevel, including patient/family, provider/practice, and payer/policy levels. There is an urgent need for collective efforts by patients, healthcare providers, policymakers, and insurers to safeguard the financial security and well-being of individuals affected by cancer, promoting health equities in the realm of cancer care.
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Affiliation(s)
- Binbin Xu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie K.W. So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Huang
- The Nursing Department of the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Mei Liu
- The Infection Control Department of Xuzhou Cancer Hospital, Xuzhou, China
| | - Lanxiang Qiu
- The Nursing Department of the Third Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jianghong Tan
- The Nursing Department of Zhuzhou Central Hospital, Zhuzhou, China
| | - Hua Tao
- The Oncology Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Keli Yan
- The Internal Medicine Nursing Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yang
- The Nursing Department of Nanjing Pukou People's Hospital, Nanjing, China
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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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Olateju OA, Shen C, Thornton JD. The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae050. [PMID: 38812986 PMCID: PMC11135644 DOI: 10.1093/haschl/qxae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024]
Abstract
The Patient Protection and Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating costs of cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health-spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early- and long-term effects of the ACA on nonelderly adult patients with cancer, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, which was particularly evident after 2 years of implementation. Early post-ACA (within two years of implementation), there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31%, respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28%, respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for health care policies promoting equitable care and addressing spending disparities across income brackets.
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Affiliation(s)
- Olajumoke A Olateju
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX 77204-5000, United States
| | - Chan Shen
- Departments of Surgery and Public Health Sciences, Penn State Cancer Institute, Hershey, PA 17033, United States
| | - James Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX 77204-5000, United States
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Fakhri B, Emechebe N, Manzoor BS, Jawaid D, Alhasani H, Edwards M, Tuncer HH. Real-World Health Care Resource Use and Costs Among Patients With Chronic Lymphocytic Leukemia Treated With Venetoclax-Based and Bruton Tyrosine Kinase Inhibitor-Based Regimens in the Second-Line Setting. JCO Oncol Pract 2024:OP2300630. [PMID: 38626366 DOI: 10.1200/op.23.00630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/14/2023] [Accepted: 03/07/2024] [Indexed: 04/18/2024] Open
Abstract
PURPOSE Real-world evidence comparing health care resource use (HRU) and costs between novel targeted therapies among patients with chronic lymphocytic leukemia (CLL) is lacking. We compared all-cause and CLL-specific HRU and costs between patients initiated on B-cell lymphoma 2 inhibitor (venetoclax)- or Bruton tyrosine kinase inhibitor (BTKi)-based regimens in the second-line (2L) setting. METHODS This is a retrospective observational study using Optum Clinformatics Data Mart of adult patients with CLL/small lymphocytic lymphoma who received 2L venetoclax- or BTKi-based regimens (January 2018-December 2021) for the first time and had ≥one CLL diagnostic claim after 2L initiation and ≥two claims for venetoclax or BTKi. Baseline characteristics were balanced using stabilized inverse probability of treatment weights. Mean monthly cost difference (MMCD) between cohorts for all-cause and CLL-specific per patient per month (PPPM) costs was estimated. Rates of PPPM-HRU were compared between cohorts using rate ratios (RRs). RESULTS Of 280 patients, median age 75.5 years, 64.6% and 35.4% received BTKi- versus venetoclax-based regimens, respectively. Most BTKi-treated patients received monotherapy (88.4%), whereas 62.3% of venetoclax-treated patients received combination therapy with anti-CD20 agents. The median duration of 2L therapy was 11.6 and 11.0 months for BTKi versus venetoclax cohorts, respectively. All-cause total costs were lower for venetoclax versus BTKi (MMCD [SE], $-2,497.64 [$1,006.77] in US dollars (USD); P = .01), driven by lower medication costs offsetting medical costs; trends were similar for CLL-specific estimates. Outpatient HRU was higher for venetoclax versus BTKi (RR all-cause: 1.22 versus CLL-specific: 1.64). CONCLUSION Venetoclax was associated with total monthly cost savings versus BTKis, illustrating the economic value of time-limited venetoclax-based regimens in the 2L setting.
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van de Wal D, den Hollander D, Desar IME, Gelderblom H, Oosten AW, Reyners AKL, Steeghs N, Husson O, van der Graaf WTA. Financial difficulties experienced by patients with gastrointestinal stromal tumours (GIST) in the Netherlands: data from a cross-sectional multicentre study. Support Care Cancer 2024; 32:279. [PMID: 38594390 PMCID: PMC11004045 DOI: 10.1007/s00520-024-08451-0] [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: 10/31/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
PURPOSE This study aims to (1) explore the prevalence of patient-reported financial difficulties among GIST patients, differentiating between those currently undergoing tyrosine kinase inhibitor (TKI) treatment and those who are not; (2) investigate associations between financial difficulties and sociodemographic and clinical characteristics, work, cancer-related concerns, anxiety and depression and (3) study the impact of financial difficulties on health-related quality of life. METHODS A cross-sectional study was conducted among Dutch GIST patients diagnosed between 2008 and 2018, who were invited to complete a one-time survey between September 2020 and June 2021. Patients completed nine items of the EORTC item bank regarding financial difficulties, seven work-related questions, the Hospital Anxiety and Depression Scale, Cancer Worry Scale and EORTC QLQ-C30. RESULTS In total, 328 GIST patients participated (response rate 63.0%), of which 110 (33.8%) were on TKI treatment. Patients currently treated with TKIs reported significantly more financial difficulties compared to patients not on TKIs (17.3% vs 8.7%, p = 0.03). The odds of experiencing financial difficulties was 18.9 (95% CI 1.7-214.7, p = 0.02) times higher in patients who were less able to work due to their GIST diagnosis. Patients who experienced financial difficulties had significantly lower global quality of life and functioning, and more frequently reported psychological symptoms as compared to patients who did not report financial difficulties. CONCLUSION Even in a country where the costs of TKIs and follow-up care are covered by health insurance, financial difficulties can be present in GIST patients, especially in patients on TKI treatment, and may negatively influence the quality of life.
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Affiliation(s)
- Deborah van de Wal
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dide den Hollander
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ingrid M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Astrid W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Neeltje Steeghs
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Olga Husson
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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13
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Rhee CH, Brown JT, Lang A, Pentz RD, Nazha B. Billing for Electronic Patient-Physician Communications: An Ethical Analysis. JCO Oncol Pract 2024:OP2300569. [PMID: 38593382 DOI: 10.1200/op.23.00569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/22/2024] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
This review paper analyzes the ethical implications of billing patients for electronic communication with physicians through electronic health records, a practice already adopted by medical institutions such as the Cleveland Clinic. The analysis assesses how billing aligns with pillars of medical ethics which include beneficence, respect for persons, and justice. Although billing may enhance communication, improve patient care, and alleviate physician burnout, concerns arise over potential consequences on patient autonomy, trust, and health care disparities. The review delves into the intricate balance of these ethical principles by first considering the potential benefits of incentivizing concise questions and improving physician workload management through billing. By reducing messages, this approach can potentially mitigate burnout and enhance care. It also acknowledges potential drawbacks such as deterring patients because of financial constraints and eroding trust in physicians and the medical team. It emphasizes the necessity of thoroughly examining all aspects of this intricate ethical dilemma to formulate a nuanced solution that protects patient well-being while respecting physicians. We propose a middle-ground approach involving nominal and transparent billing on the basis of the question's complexity, urgency, and level of expertise required in the response. Transparent billing policies, up-front communication of costs, and potential fee waivers on the basis of socioeconomic status can address equity concerns and maintain patient trust. Striking a balance between the potential benefits and drawbacks of billing for patient questions is crucial in maintaining ethical patient-physician interactions and equitable health care provision. The analysis underscores the importance of aligning online patient-physician communication with ethical principles within the evolving digital health care landscape.
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Affiliation(s)
- Christopher H Rhee
- Medical College of Georgia Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Jacqueline T Brown
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
- Ambulatory Infusion Center, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Ayannah Lang
- Hematology and Oncology in Research Ethics, Emory University School of Medicine, Atlanta, GA
| | - Rebecca D Pentz
- Hematology and Oncology in Research Ethics, Emory University School of Medicine, Atlanta, GA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
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Liang MI, Dholakia JD, Lee GM, Wang L, Kako TD, Blair I, Williams CP, Arend RC, Huh WK, Rocque GB, Pisu M. Dedicated financial hardship screening adds value to routine distress screening among gynecologic cancer patients. Gynecol Oncol 2024; 183:53-60. [PMID: 38518528 DOI: 10.1016/j.ygyno.2024.03.014] [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: 02/18/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVES To evaluate existing distress screening to identify patients with financial hardship (FH) compared to dedicated FH screening and assess patient attitudes toward FH screening. METHODS We screened gynecologic cancer patients starting a new line of therapy. Existing screening included: (1) Moderate/severe distress defined as Distress Thermometer score ≥ 4, (2) practical concerns identified from Problem Checklist, and (3) a single question assessing trouble paying for medications. FH screening included: (1) Comprehensive Score for Financial Toxicity (COST) tool and (2) 10-item Financial Needs Checklist to guide referrals. FH was defined as COST score < 26. We calculated sensitivity (patients with moderate/severe distress + FH over total patients with FH) and specificity (patients with no/mild distress + no FH over total patients with no FH) to assess the extent distress screening could capture FH. Surveys and exit interviews assessed patient perspectives toward screening. RESULTS Of 364 patients screened for distress, average age was 62 years, 25% were Black, 45% were Medicare beneficiaries, 32% had moderate/severe distress, 15% reported ≥1 practical concern, and 0 reported trouble paying for medications. Most (n = 357, 98%) patients also completed FH screening: of them, 24% screened positive for FH, 32% reported ≥1 financial need. Distress screening had 57% sensitivity and 77% specificity for FH. Based on 79 surveys and 43 exit interviews, FH screening was acceptable with feedback to improve the timing and setting of screening. CONCLUSIONS Dedicated FH screening was feasible and acceptable, but sensitivity was low. Importantly, 40% of women with FH would not have been identified with distress screening alone.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jhalak D Dholakia
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grace M Lee
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lingling Wang
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tavonna D Kako
- Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isabella Blair
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rebecca C Arend
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gabrielle B Rocque
- Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Preventive Medicine, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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15
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Pandya BJ, Young C, Packnett ER, Xie B, Lillehaugen T, Block A, Bernacki K, Touya M, LeBlanc TW. Work absenteeism, disability, and lost wages among patients with acute myeloid leukemia and their caregivers: a cohort study using US administrative claims and productivity data. Expert Rev Pharmacoecon Outcomes Res 2024; 24:521-532. [PMID: 38294308 DOI: 10.1080/14737167.2024.2311305] [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: 08/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We describe the impact of acute myeloid leukemia (AML) diagnosis on workplace absenteeism and disability days among patients and their caregivers. METHODS This retrospective study included adults with newly diagnosed AML (2009-2019) and adult caregivers of patients with newly diagnosed AML, identified from the US Merative™ MarketScan® Commercial Database. The Merative MarketScan Health and Productivity Management Database provided linked patient-level records of workplace absence and short-term (STD) and long-term disability (LTD) data. Endpoints included workplace absence, STD and LTD for patients and caregivers during 12 months pre-AML (baseline) and ≤3 years' follow-up, and corresponding cost of work loss. RESULTS Patient workplace absence decreased in the months post-AML diagnosis, but the number of STD and LTD leave days claimed increased significantly by sixfold and fourfold, respectively. The proportion of patients making STD leave claims increased within 4-5 months of diagnosis, while the proportion making LTD leave claims increased significantly starting from month 5. Caregiver workplace absence peaked in the first 2 months post-diagnosis and remained elevated versus baseline throughout the study. CONCLUSION AML diagnosis leads to workplace absenteeism and increased economic burden for patients with AML and their caregivers.
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Affiliation(s)
- Bhavik J Pandya
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | | | - Bin Xie
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Alana Block
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Maelys Touya
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
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16
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Schlander M, van Harten W, Retèl VP, Pham PD, Vancoppenolle JM, Ubels J, López OS, Quirland C, Maza F, Aas E, Crusius B, Escobedo A, Franzen N, Fuentes-Cid J, Hernandez D, Hernandez-Villafuerte K, Kirac I, Paty A, Philip T, Smeland S, Sullivan R, Vanni E, Varga S, Vermeulin T, Eckford RD. The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions. Lancet Oncol 2024; 25:e152-e163. [PMID: 38547899 DOI: 10.1016/s1470-2045(23)00636-8] [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: 08/16/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024]
Abstract
Loss of income and out-of-pocket expenditures are important causes of financial hardship in many patients with cancer, even in high-income countries. The far-reaching consequences extend beyond the patients themselves to their relatives, including caregivers and dependents. European research to date has been limited and is hampered by the absence of a coherent theoretical framework and by heterogeneous methods and terminology. To address these shortages, a task force initiated by the Organisation of European Cancer Institutes (OECI) produced 25 recommendations, including a comprehensive definition of socioeconomic impact from the perspective of patients and their relatives, a conceptual framework, and a consistent taxonomy linked to the framework. The OECI task force consensus statement highlights directions for future research with a view towards policy relevance. Beyond descriptive studies into the dimension of the problem, individual severity and predictors of vulnerability should be explored. It is anticipated that the consensus recommendations will facilitate and enhance future research efforts into the socioeconomic impact of cancer and cancer care, providing a crucial reference point for the development and validation of patient-reported outcome instruments aimed at measuring its broader effects.
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Affiliation(s)
- Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany; Alfred Weber Institute (AWI), University of Heidelberg, Mannheim, Germany; Institute for Innovation & Valuation (InnoVal(HC)), Wiesbaden, Germany.
| | - Wim van Harten
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands; Rijnstate Hospital, Arnhem, Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Phu Duy Pham
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julie M Vancoppenolle
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Jasper Ubels
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Olaya Seoane López
- The Support Team, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Camila Quirland
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Maza
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Agustín Escobedo
- Oncology Care Management, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nora Franzen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Diego Hernandez
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Iva Kirac
- Genetic Counseling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Artus Paty
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Thierry Philip
- Organisation of European Cancer Institutes (OECI), Brussels, Belgium; Institut Curie, Paris, France
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital Comprehensive Cancer Centre, Oslo, Norway
| | | | - Elena Vanni
- Business Controlling, Humanitas Clinical and Research Center, Milan, Italy; Biomedical Sciences, Humanitas Clinical and Research Center, Milan, Italy
| | - Sinisa Varga
- Institute for Gastroenterological Tumours, Zagreb, Croatia
| | - Thomas Vermeulin
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Rachel D Eckford
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Azimuddin A, Tzeng CWD, Prakash LR, Bruno ML, Arvide EM, Dewhurst WL, Newhook TE, Kim MP, Ikoma N, Snyder RA, Lee JE, Perrier ND, Katz MH, Maxwell JE. Postoperative Global Period Cost Reduction Using 3 Successive Risk-Stratified Pancreatectomy Clinical Pathways. J Am Coll Surg 2024; 238:451-459. [PMID: 38180055 DOI: 10.1097/xcs.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND We hypothesized that iterative revisions of our original 2016 risk-stratified pancreatectomy clinical pathways would be associated with decreased 90-day perioperative costs. STUDY DESIGN From a single-institution retrospective cohort study of consecutive patients with 3 iterations: "version 1" (V1) (October 2016 to January 2019), V2 (February 2019 to October 2020), and V3 (November 2020 to February 2022), institutional data were aggregated using revenue codes and adjusted to constant 2022-dollar value. Grand total perioperative costs (primary endpoint) were the sum of pancreatectomy, inpatient care, readmission, and 90-day global outpatient care. Proprietary hospital-based costs were converted to ratios using the mean cost of all hospital operations as the denominator. RESULTS Of 814 patients, pathway V1 included 363, V2 229, and V3 222 patients. Accordion Grade 3+ complications decreased with each iteration (V1: 28.4%, V2: 22.7%, and V3: 15.3%). Median length of stay decreased (V1: 6 days, interquartile range [IQR] 5 to 8; V2: 5 [IQR 4 to 6]; and V3: 5 [IQR 4 to 6]) without an increase in readmissions. Ninety-day global perioperative costs decreased by 32% (V1 cost ratio 12.6, V2 10.9, and V3 8.6). Reduction of the index hospitalization cost was associated with the greatest savings (-31%: 9.4, 8.3, and 6.5). Outpatient care costs decreased consistently (1.58, 1.41, and 1.04). When combining readmission and all outpatient costs, total "postdischarge" costs decreased (3.17, 2.59, and 2.13). Component costs of the index hospitalization that were associated with the greatest savings were room or board costs (-55%: 1.74, 1.14, and 0.79) and pharmacy costs (-61%: 2.20, 1.61, and 0.87; all p < 0.001). CONCLUSIONS Three iterative risk-stratified pancreatectomy clinical pathway refinements were associated with a 32% global period cost savings, driven by reduced index hospitalization costs. This successful learning health system model could be externally validated at other institutions performing abdominal cancer surgery.
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Affiliation(s)
- Ahad Azimuddin
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
- Texas A&M School of Medicine, Houston, TX (Azimuddin)
| | - Ching-Wei D Tzeng
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Laura R Prakash
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Morgan L Bruno
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Elsa M Arvide
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Whitney L Dewhurst
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Timothy E Newhook
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Michael P Kim
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Naruhiko Ikoma
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Rebecca A Snyder
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jeffrey E Lee
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Nancy D Perrier
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Matthew Hg Katz
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jessica E Maxwell
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
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Wu VS, Shen X, de Moor J, Chino F, Klein J. Financial Toxicity in Radiation Oncology: Impact for Our Patients and for Practicing Radiation Oncologists. Adv Radiat Oncol 2024; 9:101419. [PMID: 38379894 PMCID: PMC10876607 DOI: 10.1016/j.adro.2023.101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 11/16/2023] [Indexed: 02/22/2024] Open
Abstract
With rising costs of diagnosis, treatment, and survivorship, financial burdens on patients with cancer and negative effects from high costs, called financial toxicity (FT), are growing. Research suggests that FT may be experienced by more than half of working-age cancer survivors and a similar proportion may incur debt or avoid recommended prescription medications due to treatment costs. As FT can lead to worse physical, psychological, financial, and survival outcomes, there is a discrete need to identify research gaps around this issue that constrain the development and implementation of effective screening and innovative care delivery interventions. Prior research, including within a radiation oncology-specific context, has sought to identify the scope of FT among patients with cancer, develop assessment tools to evaluate patient risk, quantify financial sacrifices, and qualify care compromises that occur when cancer care is unaffordable. FT is a multifactorial problem and potential solutions should be pursued at all levels of the health care system (patient-provider, institutional, and systemic) with specific regard for patients' individual/local contexts. Solutions may include selecting alternative treatment schedules, discussing financial concerns with patients, providing financial navigation services, low-cost transportation options, and system-wide health policy shifts. This review summarizes existing FT research, describes tools developed to measure FT, and suggests areas for intervention and study to help improve FT and outcomes for radiation oncology patients.
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Affiliation(s)
- Victoria S. Wu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Medical Center, Kansas City, Kansas
| | - Janet de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Klein
- Department of Radiation Oncology, Maimonides Medical Center and State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, New York
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An Z, Nie J, Huang Y, Fang P, Meng X, Cai C, Yu L. Contribution of non-socioeconomic factors to healthy quality of life in socioeconomically deprived patients with advanced gastrointestinal cancer: Measuring attributable fraction. J Adv Nurs 2024; 80:1154-1165. [PMID: 37710401 DOI: 10.1111/jan.15862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The quality of life of patients with advanced gastrointestinal cancer is seriously impaired, and socioeconomic deprivation often has a serious impact on their quality of life. However, little is known about the relative contribution of non-socioeconomic factors to the quality of life of patients with advanced gastrointestinal cancer with socioeconomic deprivation. AIM This study aims to investigate the situation and predictors of quality of life of patients with socioeconomic deprivation and evaluate the independent effects of some non-socioeconomic factors. DESIGN A retrospective study based on cross-sectional design. METHODS Data were obtained from 1075 patients with advanced gastrointestinal cancer who received family palliative treatment in the hospice ward of Zhongnan Hospital of Wuhan University from March 2010 to October 2020, including demographic and clinical questionnaires, Karnofsky Performance Status scale and Cancer Pain and Quality of Life Questionnaire of Chinese Cancer Patients. RESULTS The quality of life of patients with advanced gastrointestinal cancer with socioeconomic deprivation is impaired and is affected by gait, self-care ability, abdominal distension, nutritional status, weight loss, constipation and posture. Improvement in six of these factors-gait, self-care ability, abdominal distension, nutritional status, weight loss and posture-has an independent positive impact on the development of a healthy quality of life for patients. CONCLUSIONS Gait, self-care ability, abdominal distension, nutritional status, weight loss and posture are important determinants of healthy quality of life in patients with advanced gastrointestinal cancer with socioeconomic deprivation, and early identification and strength management of these non-socioeconomic factors may neutralize the negative impact of socioeconomic factors on the quality of life. IMPLICATIONS FOR PRACTICE This study provides new ideas and intervention entry points for global nurses in practice innovations to improve the quality of life of socioeconomically deprived patients with advanced gastrointestinal cancer. It enables them to focus on the effectiveness of non-socioeconomic factors in the development and implementation of targeted care plans for patients with advanced gastrointestinal cancer experiencing socioeconomic deprivation globally. REPORTING METHOD This study was reported in strict compliance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Zifen An
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
| | - Jiaqi Nie
- School of Public Health, Wuhan University, Wuhan, China
| | - Yanfang Huang
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
| | - Pei Fang
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
- Medical Center for Gastrointestinal Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Xianmei Meng
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
| | - Chunfeng Cai
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
| | - Liping Yu
- Wuhan University School of Nursing, Center for Nurturing Care Research, Wuhan University, Wuhan, China
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Pandey M, Bramhankar M, Anand A. Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey. J Cancer Policy 2024; 39:100469. [PMID: 38278353 DOI: 10.1016/j.jcpo.2024.100469] [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: 10/11/2023] [Revised: 12/04/2023] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens of cancer treatment, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment. METHODS This study employed unit-level cross-sectional data from the 75th round (2017-18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location. RESULTS The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %). CONCLUSION The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.
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Affiliation(s)
- Mohit Pandey
- International Institute for Population Sciences, India
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21
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Nadeem O, Ailawadhi S, Khouri J, Williams L, Catamero D, Maples K, Berdeja J. Management of Adverse Events Associated with Pomalidomide-Based Combinations in Patients with Relapsed/Refractory Multiple Myeloma. Cancers (Basel) 2024; 16:1023. [PMID: 38473381 DOI: 10.3390/cancers16051023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Multi-agent regimens incorporating immunomodulatory (IMiD®) agents such as thalidomide, lenalidomide, and pomalidomide have become the preferred standard of care for the treatment of patients with multiple myeloma (MM), resulting in improved survival outcomes. Currently, there are three IMiD agents approved for the treatment of MM: thalidomide, lenalidomide, and pomalidomide. Lenalidomide is commonly used to treat patients with newly diagnosed MM and as maintenance therapy following stem cell transplant or after disease relapse. Pomalidomide, the focus of this review, is approved in patients with relapsed/refractory MM (RRMM). Despite survival benefits, IMiD agents each have different safety profiles requiring consideration both prior to starting therapy and during treatment. Adverse event (AE) management is essential, not only to ensure treatment adherence and thus ensure optimal efficacy but also to maintain patient quality of life. Here, we discuss AEs associated with pomalidomide and present five clinically relevant hypothetical case studies in patients with RRMM to provide scenario-driven guidance regarding treatment selection and AE prevention and management in the clinical setting. Lastly, as new treatment approaches continue to be explored in MM, we also discuss novel cereblon E3 ligase modulator (CELMoD™) agents including iberdomide (CC-220) and mezigdomide (CC-92480).
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Affiliation(s)
- Omar Nadeem
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Sikander Ailawadhi
- Department of Hematology & Oncology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Jack Khouri
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Louis Williams
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | - Kathryn Maples
- Department of Pharmacy, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Jesús Berdeja
- Greco-Hainsworth Centers for Cancer Research, Tennessee Oncology, Nashville, TN 37203, USA
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22
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Somayaji D, Mohedat H, Li CS. Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care. Cancer Nurs 2024:00002820-990000000-00215. [PMID: 38416076 DOI: 10.1097/ncc.0000000000001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. OBJECTIVE This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. METHODS A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. RESULTS Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. CONCLUSIONS The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. IMPLICATIONS FOR PRACTICE Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.
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Affiliation(s)
- Darryl Somayaji
- Author Affiliation: School of Nursing, University at Buffalo (Dr Somayaji and Mrs Mohedat), New York; and Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center (Dr Li), Rochester, New York
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Cayrol J, Wakefield CE, Ilbawi A, Donoghoe M, Hoffman R, Echodu M, Schilstra C, Ortiz R, Wiener L. The lived experience of people affected by cancer: A global cross-sectional survey protocol. PLoS One 2024; 19:e0294492. [PMID: 38394101 PMCID: PMC10889872 DOI: 10.1371/journal.pone.0294492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/31/2023] [Indexed: 02/25/2024] Open
Abstract
A diagnosis of cancer impacts the person's physical and mental health and the psychosocial and financial health of their caregivers. While data on the experience of living with cancer is available, there is a dearth of data from persons in low- and middle-income countries (LMICs). The perspectives of other impacted individuals also remain understudied (e.g., bereaved family members), as well as the impact on survivors and their families over time. The objective of this study is to describe the psychosocial and financial impact of cancer on people diagnosed with cancer as a child, adolescent or adult, their families/caregivers, and the family members of those who have died from cancer, in high-income countries (HICs) and LMICs. This study is an observational, descriptive, quantitative study. Data will be collected anonymously via a digital online cross-sectional survey distributed globally by the World Health Organization (WHO) via the LimeSurvey software. Participants will include (a) adults aged 18+ who have been diagnosed with cancer at any age, who are currently undergoing cancer treatment or who have completed cancer treatment; (b) adult family members of individuals of any age with a cancer diagnosis, who are currently undergoing cancer treatment or who have completed cancer treatment; and (c) bereaved family members. Participants will be anonymously recruited via convenience and snowball sampling through networks of organisations related to cancer. Survey results will be analysed quantitatively per respondent group, per time from diagnosis, per disease and country. Results will be disseminated in peer-reviewed journals and at scientific conferences; a summary of results will be available on the WHO website. This study will suggest public health interventions and policy responses to support people affected by cancer and may also lead to subsequent research focusing on the needs of people affected by cancer.
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Affiliation(s)
- Julie Cayrol
- The Royal Children’s Hospital and Murdoch Children’s Research Institute, Melbourne, Australia
- Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Claire E. Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - André Ilbawi
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Mark Donoghoe
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
- Stats Central, Mark Wainwright Analytical Centre, UNSW Sydney, NSW Sydney, Australia
| | - Ruth Hoffman
- American Childhood Cancer Organization, Beltsville, Maryland, United States of America
| | | | - Clarissa Schilstra
- School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, NSW Sydney, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children’s Hospital, Randwick, Australia
| | - Roberta Ortiz
- World Health Organization, Department of Non-Communicable Diseases, Geneva, Switzerland
| | - Lori Wiener
- National Cancer Institute, Center for Cancer Research, National Institute of Health, Bethesda, Maryland, United States of America
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Parikh DA, Rodriguez GM, Ragavan M, Kerr E, Asuncion MK, Hansen J, Srinivas S, Fan AC, Shah S, Patel MI. Lay healthcare worker financial toxicity intervention: a pilot financial toxicity screening and referral program. Support Care Cancer 2024; 32:161. [PMID: 38366165 DOI: 10.1007/s00520-024-08357-x] [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: 07/14/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Financial toxicity is a source of significant distress for patients with urologic cancers, yet few studies have addressed financial burden in this patient population. METHODS We developed a financial toxicity screening program using a lay health worker (LHW) and social worker (SW) to assess and mitigate financial toxicity in a single academic medical clinic. As part of a quality improvement project, the LHW screened all newly diagnosed patients with advanced stages of prostate, kidney, or urothelial cancer for financial burden using three COST tool questions and referred patients who had significant financial burden to an SW who provided personalized recommendations. The primary outcome was feasibility defined as 80% of patients with financial burden completing the SW consult. Secondary outcomes were patient satisfaction, change in COST Tool responses, and qualitative assessment of financial resources utilized. RESULTS The LHW screened a total of 185 patients for financial toxicity; 82% (n = 152) were male, 65% (n = 120) White, and 75% (n = 139) reported annual household income >$100,000 US Dollars; 60% (n = 114) had prostate cancer. A total of 18 (9.7%) participants screened positive for significant financial burden and were referred to the SW for consultation. All participants (100%) completed and reported satisfaction with the SW consultation and had 0.83 mean lower scores on the COST Tool post-intervention assessment compared to pre-intervention (95% confidence interval [0.26, 1.41]). CONCLUSION This multidisciplinary financial toxicity intervention using an LHW and SW was feasible, acceptable, and associated with reduced financial burden among patients with advanced stages of urologic cancers. Future work should evaluate the effect of this intervention among cancer patients in diverse settings.
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Affiliation(s)
- Divya A Parikh
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA.
- Medical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Gladys M Rodriguez
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Meera Ragavan
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Elizabeth Kerr
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Mary Khay Asuncion
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Jennifer Hansen
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Sandy Srinivas
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Alice C Fan
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Sumit Shah
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Manali I Patel
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
- Medical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA
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25
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Kaddas HK, Millar MM, Herget KA, Carter ME, Ofori-Atta BS, Edwards SL, Codden RR, Sweeney C, Kirchhoff AC. Material financial hardship and insurance-related experiences among Utah's rural and urban cancer survivors. J Cancer Surviv 2024:10.1007/s11764-024-01546-x. [PMID: 38340250 DOI: 10.1007/s11764-024-01546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Describe material financial hardship (e.g., using savings, credit card debt), insurance, and access to care experienced by Utah cancer survivors; investigate urban-rural differences in financial hardship. METHODS Cancer survivors were surveyed from 2018 to 2021 about their experiences with financial hardship, access to healthcare, and job lock (insurance preventing employment changes). Weighed percentage responses, univariable and multivariable logistic regression models for these outcomes compared differences in survivors living in rural and urban areas based on Rural-Urban Commuting Area Codes. RESULTS The N = 1793 participants were predominantly Non-Hispanic White, female, and 65 or older at time of survey. More urban than rural survivors had a college degree (39.8% vs. 31.0%, p = 0.04). Overall, 35% of survivors experienced ≥ 1 financial hardship. In adjusted analyses, no differences were observed between urban and rural survivors for: material financial hardship, the overall amount of hardship reported, insurance status at survey, access to healthcare, or job lock. Hispanic rural survivors were less likely to report financial hardship than Hispanic urban survivors (odds ratio (OR) = 0.24, 95%CI = 0.08-0.73)). Rural survivors who received chemo/immune therapy as their only treatment were more likely to report at least one instance of financial hardship than urban survivors (OR = 2.72, 95%CI = 1.08-6.86). CONCLUSIONS The relationship between rurality and financial hardship among survivors may be most burdensome for patients whose treatments require travel or specialty medication access. IMPLICATIONS FOR CANCER SURVIVORS The impact of living rurally on financial difficulties after cancer diagnoses is complex. Features of rurality that may alter financial difficulty after a cancer diagnosis may vary geographically and instead of considering rurality as a stand-alone factor, these features should be investigated independently.
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Affiliation(s)
- Heydon K Kaddas
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, Utah, 84112, USA.
| | - Morgan M Millar
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, Utah, 84112, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Sandra L Edwards
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Rachel R Codden
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah, USA
| | - Carol Sweeney
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, Utah, 84112, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Utah Cancer Registry, University of Utah, Salt Lake City, Utah, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, Utah, 84112, USA
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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Deboever N, Eisenberg MA, Antonoff MB, Hofstetter WL, Mehran RJ, Rice DC, Roth JA, Sepesi B, Swisher SG, Vaporciyan AA, Walsh GL, Rajaram R. Perspectives, risk factors, and coping mechanisms in patients with self-reported financial burden following lung cancer surgery. J Thorac Cardiovasc Surg 2024; 167:478-487.e2. [PMID: 37356476 DOI: 10.1016/j.jtcvs.2023.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/28/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE We evaluated self-reported financial burden (FB) after lung cancer surgery and sought to assess patient perspectives, risk factors, and coping mechanisms within this population. METHODS Patients with lung cancer resected at our institution between January 1, 2016, and December 31, 2021, were surveyed. Descriptive and multivariable analyses were performed to evaluate the association between clinical and financial characteristics with patient-reported major ("significant" or "catastrophic") FB. RESULTS Of 1477 patients contacted, 31.3% (n = 463) completed the survey. Major FB was reported by 62 (13.4%) patients. multivariable analyses demonstrated increasing age (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), credit score >740 (OR, 0.29; 95% CI, 0.14-0.60), and employer-based insurance (OR, 0.24; 95% CI, 0.07-0.80) were protective factors. In contrast, an out of pocket cost greater than expected (OR, 3.63; 95% CI, 1.67-7.88), decrease in work hours (OR, 4.42; 95% CI, 1.59-12.25), or cessation of work (OR, 5.13; 95% CI, 2.06-12.78), chronic obstructive pulmonary disease diagnosis (OR, 5.39, 95% CI, 1.87-15.50), and hospital readmission (OR, 4.87; 95% CI, 1.11-21.42) were risk factors for FB. To pay for care, some patients reported "often" or "always" decreasing food (n = 102 [23.4%]) or leisure spending (n = 179 [40.7%]). Additionally, use of savings (n = 246 [62.9%]), borrowing funds (n = 72 [16.6%]), and skipping clinic visits (n = 36 [8.3%]) at least once were also reported. Coping mechanisms occurred more often in patients with major FB compared with those without (P < .001). CONCLUSIONS Patients with resected lung cancer may experience major FB related to treatment with several identifiable risk factors. Targeted interventions are needed to limit the adoption of detrimental coping mechanisms and potentially affect survivorship.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Michael A Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ravi Rajaram
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
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Shao M, Yao L, Zhang M, Zhou H, Ding Y, Bai L, Ma B, Li T, Guo S, Chen C, Wang T. Post-surgery financial toxicity and its influencing factors in colorectal cancer care: A cross-sectional study. Eur J Oncol Nurs 2024; 68:102518. [PMID: 38309254 DOI: 10.1016/j.ejon.2024.102518] [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: 11/13/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE This study aimed to investigate the influence factors of financial toxicity experienced by colorectal cancer patients after surgery. The results will provide deep insights for developing effective intervention strategies to address this common issue of colorectal cancer care. METHODS In this cross-sectional study, we recruited 213 postoperative patients with colorectal cancer from February 2023 to July 2023 in two major public hospitals. Patients completed the General Information Questionnaire, Comprehensive Scores for Financial Toxicity (COST), Self-perceived Burden Scale (SPBS), Family Resilience Questionnaire (FaREQ), and Social Support Rating Scale (SSRS). A multiple linear regression model was used to investigate the influence factors of financial toxicity. RESULTS The mean score of financial toxicity was medium (18.91 ± 7.90) in this study. Financial toxicity score was negatively correlated with self-perceived burden (r = -0.333, P < 0.01) and positively associated with family resilience (r = 0.365, P < 0.01) and social support (r = 0.388, P < 0.01). Via multiple linear regression analysis, we identified seven significant factors associated with financial toxicity, including family income [(95 %CI: 1.075-3.123); P = 0.000], self-perceived burden [(95 %CI: 0.300∼-0.038); P = 0.012], stoma [(95 %CI: 5.309∼-1.682); P = 0.000], social support [(95 %CI:0.058-0.407); P = 0.009], cancer stage [(95 %CI: 2.178∼-0.170); P = 0.022], postoperative duration [(95 %CI: 1.900∼-0.332); P = 0.005], and family resilience [(95 %CI: 0.028-0.203); P = 0.010]. CONCLUSIONS Financial toxicity was prevalent among postoperative colorectal cancer patients. Additional support and early interventions should be given to high-risk patients, including those with stomas, advanced disease stages, or experiencing longer postoperative duration. Apart from demographic factors, we identified that self-perceived burden, family resilience, and social support were also associated with financial toxicity, providing a new perspective for developing effective strategies against financial toxicity.
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Affiliation(s)
- Mengwei Shao
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China.
| | - Liqun Yao
- Weifang Center for Disease Control and Prevention, Weifang, 261053, China.
| | - Menghan Zhang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Huiyue Zhou
- The Ninth People's Hospital of Zhengzhou, Zhengzhou, 450053, China
| | - Yangqing Ding
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Lin Bai
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, 6149, Australia
| | - Ting Li
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Shengjie Guo
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China; Telethon Kids Institute, Perth, WA, 6872, Australia; Medical School, University of Western Australia, Perth, WA, 6872, Australia; People' S Hospital of Hebi, Hebi, 458010, China.
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Xu B, So WKW, Choi KC. Determination of a cut-off COmprehensive Score for financial Toxicity (COST) for identifying cost-related treatment nonadherence and impaired health-related quality of life among Chinese patients with cancer. Support Care Cancer 2024; 32:136. [PMID: 38279988 PMCID: PMC10821980 DOI: 10.1007/s00520-024-08320-w] [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: 08/01/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE This study aimed to determine a cut-off for the simplified Chinese version of the COmprehensive Score for financial Toxicity (COST) that could identify cost-related treatment nonadherence among Chinese patients with cancer. The study also sought to validate this cut-off score by using it to assess impaired health-related quality of life (HRQoL) in the same population. METHODS A secondary analysis was conducted using data from a cross-sectional survey of 1208 Chinese patients with cancer who were recruited from 12 hospitals in six cities across three provinces of the Chinese mainland. Sociodemographic information and data on financial toxicity (FT), cost-related treatment nonadherence, and HRQoL were used in the analysis. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off for the simplified Chinese version of the COST. RESULTS The ROC analysis identified a COST cut-off of 18.5 for identifying cost-related treatment nonadherence, yielding a sensitivity of 76.5% and specificity of 71.4%. In the validation study, this cut-off score yielded a sensitivity of 64.2% and a specificity of 67.1% for identifying impaired HRQoL. CONCLUSION Early and dynamic assessment of cancer-related FT in routine clinical practice may play a crucial role in the early identification and management of FT. Accordingly, a COST cut-off of 18.5 was identified to indicate cost-related treatment nonadherence and impaired HRQoL in a population of patients with cancer from the Chinese mainland. This finding may facilitate the implementation of universal FT screening among patients with cancer in specific settings such as the Chinese mainland.
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Affiliation(s)
- Binbin Xu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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Rahman R, Mariam L, Su R, Malhotra C, Ozdemir S. Quality of life and its predictors among patients with metastatic cancer in Bangladesh: the APPROACH survey. BMC Palliat Care 2024; 23:2. [PMID: 38166890 PMCID: PMC10762837 DOI: 10.1186/s12904-023-01301-6] [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: 01/11/2023] [Accepted: 10/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND This study aimed to assess the health-related quality of life (HRQOL) (physical, functional, emotional, social, spiritual) and psychological (anxiety and depression) well-being and their associations with patient characteristics among patients with metastatic cancer in Bangladesh. METHODS A convenience sample of 386 Bangladeshi patients with stage IV solid cancers was recruited from a palliative care outpatient department and an inpatient palliative center. Dependent variables included the physical, functional, emotional, social, and overall scores of the Functional Assessment of Cancer Therapy-General (FACT-G) scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale, the anxiety, depression, and overall scores of the Hospital Anxiety and Depression (HADS) scale. Linear regressions examined the association between dependent variables and patient characteristics. RESULTS A substantial proportion of Bangladeshi patients reported anxiety (59% of outpatients and 55% of inpatients) and depression (60% of outpatients and 73% of inpatients) symptoms. Generally, greater financial difficulty and symptom burden scores were associated with worse health outcomes. Older patients reported poorer functional and spiritual well-being but better anxiety scores. Females reported worse anxiety and depressive symptoms and physical well-being but better spiritual outcomes. CONCLUSIONS Additional efforts must be directed at improving the HRQOL of patients with metastatic cancer in Bangladesh. Furthermore, assistance should be made more accessible to vulnerable groups, including women, the elderly, and those with financial difficulty.
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Affiliation(s)
- Rubayat Rahman
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Lubna Mariam
- Department of Radiation Oncology, National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | - Rebecca Su
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Signature Programme in Health Services and System Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Chen L, Wang C, Smith GL, Dawkins-Moultin L, Shin LJ, Lu Q. Job Loss and Well-Being Among Chinese American Breast Cancer Survivors: The Mediating Role of Income and Perceived Stress. Int J Behav Med 2024:10.1007/s12529-023-10245-3. [PMID: 38169050 DOI: 10.1007/s12529-023-10245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND A growing number of studies suggest that job loss has detrimental effects on cancer survivors. However, the underlying mechanisms are not well understood. Furthermore, minorities including Asian American cancer survivors remain understudied, yet they suffer from job loss more often. The present study examined the prevalence of job loss in Chinese American breast cancer survivors (CABCS) and investigated the relationship between job loss and well-being in this group and the underlying mechanisms. METHOD CABCS completed a questionnaire that included demographic, employment, and clinical information, as well as measures of psychosocial well-being. Descriptive analyses were conducted to gauge the prevalence of job loss, linear regressions were used to test associations between job loss and well-being, and path analyses were conducted to test mediations. RESULTS About 45.4% of survivors lost their job after being diagnosed with cancer, and only 35.2% of those who lost their job regained employment up to the assessment time. Job loss was associated with reduced income, which was associated with higher perceived stress, which, in turn, was associated with lower overall quality of life (QoL) and greater depressive symptoms. CONCLUSIONS Findings highlight the high prevalence of job loss and its negative effects on QoL and depression among CABCS. It is important for health care professionals to be sensitive to adverse financial events affecting minority BCS. In addition to offering BCS necessary practical assistance, psychosocial interventions focusing on reducing perceived stress associated with the cancer experience may be effective in mitigating some long-term consequences of job loss.
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Affiliation(s)
- Lingjun Chen
- School of Education, Shanghai Jiao Tong University, Chan Suikau Hall, Room 227, 800 Dongchuan Road, Shanghai, 200240, China.
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
| | - Carol Wang
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Grace L Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lenna Dawkins-Moultin
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA
| | - Lilian J Shin
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA
| | - Qian Lu
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX, 77030, USA.
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Tesfaye EA, O'Neill RC, McGregor T, Clemens MW. Financial Toxicity in Breast Implant-Associated Anaplastic Large Cell Lymphoma. Ann Plast Surg 2024; 92:34-40. [PMID: 37994417 DOI: 10.1097/sap.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Financial toxicity is a growing concern due to its considerable effects on medical adherence, quality of life, and mortality. The cost associated with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is substantial from diagnosis to treatment, including adjuvant therapy and surgery. This study aims to assess the prevalence of financial toxicity in BIA-ALCL patients. METHODS We performed a cross-sectional, survey-based study on women with confirmed cases of BIA-ALCL from December 2019 to March 2023. The primary study outcomes were financial toxicity measured by Comprehensive Score for Financial Toxicity (COST) score and patient-reported financial burden measured by the responses to the Evaluation of the Financial Impact of BIA-ALCL survey. Lower COST scores signify higher financial toxicity. Responses were linked to patient data extracted from the medical records. RESULTS Thirty-two women treated for confirmed BIA-ALCL were included. Patients were all White and were diagnosed at a median age of 51 years (range, 41-65 years). The mean COST score was 27.9 ± 2.23. Lower COST scores were associated with receipt of radiotherapy ( P = 0.033), exceeding credit card limits ( P = 0.036), living paycheck to paycheck ( P = 0.00027), requiring financial support from friends and family ( P = 0.00044), and instability in household finances ( P = 0.034). CONCLUSIONS Financial toxicity is prevalent in BIA-ALCL patients and has a substantial impact on patient reported burden. Insurance denial is frequent for patients with a prior history of cosmetic augmentation. Risk assessments and cost discussions should occur throughout the care continuum to minimize financial burden.
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Affiliation(s)
- Eliora A Tesfaye
- From the Department of Plastic Surgery, Virginia Commonwealth University, Richmond, VA
| | - Rebecca C O'Neill
- Division of Plastic Surgery, Baylor College of Medicine, Houston, TX
| | - Terri McGregor
- Breast Implant Safety Alliance (BISA), North Bay, Ontario, Canada
| | - Mark W Clemens
- Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX
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Sturgeon C. Addressing financial toxicity in thyroid cancer survivors in the United States. Surgery 2024; 175:2-7. [PMID: 37953147 DOI: 10.1016/j.surg.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Cord Sturgeon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Majem M, Basch E, Cella D, Garon EB, Herbst RS, Leighl NB. Understanding health-related quality of life measures used in early-stage non-small cell lung cancer clinical trials: A review. Lung Cancer 2024; 187:107419. [PMID: 38070301 DOI: 10.1016/j.lungcan.2023.107419] [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: 06/02/2023] [Revised: 08/30/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024]
Abstract
Health-related quality of life (HRQoL) is an important consideration in cancer clinical research, which can be substantially influenced by cancer treatment procedures and medications. The treatment landscape for early-stage (stage I-III) non-small cell lung cancer (NSCLC) is rapidly evolving. In this light, it is important to evaluate the most suitable instruments for HRQoL assessment and timing. Given there is often a requirement for patients with early-stage disease to receive long-term treatment to reduce the risk of disease recurrence after surgery, maintenance or improvement in HRQoL is an important goal of both neoadjuvant and adjuvant treatments. Key challenges with assessing HRQoL relate to the suitability of existing instruments to measure relevant treatment-related adverse effects, consistency in HRQoL assessment approach between similar studies, gaps in data collection and reporting, and interpretation of longitudinal data. Frequent assessments during and after treatment are warranted to capture the true impact of treatment and disease progression on HRQoL, and changes in the relative importance of these factors over time. There is scope for improving existing HRQoL approaches, including ease of use and integration of digital tools to facilitate analysis and interpretation, to enhance the experience of both patients and healthcare professionals. In this narrative review, we discuss key considerations for HRQoL assessment and evaluate the tools currently available to measure HRQoL in NSCLC, many of which were designed with advanced disease in mind. We focus on the key challenges of measuring HRQoL for the specific needs of patients with early-stage disease, and consider future perspectives, to determine the most appropriate HRQoL instruments and analysis methods to use in early-stage NSCLC clinical trials.1.
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Affiliation(s)
- Margarita Majem
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Ethan Basch
- Division of Oncology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Feinberg School of Medicine and Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology / Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Roy S Herbst
- Medical Oncology, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Natasha B Leighl
- Division of Medical Oncology/Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Lee S, Olvera RG, Shiu-Yee K, Rush LJ, Tarver WL, Blevins T, McAlearney AS, Andersen BL, Paskett ED, Carson WE, Chen JC, Obeng-Gyasi S. Short-term and long-term financial toxicity from breast cancer treatment: a qualitative study. Support Care Cancer 2023; 32:24. [PMID: 38095729 DOI: 10.1007/s00520-023-08199-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE The rising cost of breast cancer treatment has increased patients' financial burden, intensifying an already stressful treatment process. Although researchers increasingly recognize the harmful impact of medical and nonmedical costs associated with cancer treatment, understanding patients' perspectives of financial toxicity is limited. We aimed to explore the topic of financial toxicity through the lived experiences of patients with breast cancer from groups at risk of social and economic marginalization. METHODS We conducted semi-structured interviews with 50 women with breast cancer from four specific groups: Black women, Medicaid enrollees, rural residents, and women age ≤ 40. We transcribed, coded, and analyzed the data using deductive and inductive approaches. RESULTS Two overarching themes captured patients' experiences of financial toxicity: short-term and long-term impacts. Short-term stressors included direct medical (e.g., co-pays, premiums), nonmedical (e.g., transportation, lodging), and indirect (e.g., job loss, reduced work hours) costs. Early in their treatments, patients' focus on survival took precedence over financial concerns. However, as the treatment course progressed, fear of consequences from compounding costs of care and financial distress negatively impacted patients' lifestyles and outlooks for the future. CONCLUSION Programs addressing financial toxicity that look beyond early-phase interventions are needed. Specifically, patients struggling with the accumulation of treatment costs and the resultant stress require ongoing support. Long-term support is especially needed for groups vulnerable to financial instability and social marginalization.
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Affiliation(s)
- Sandy Lee
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Ramona G Olvera
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Karen Shiu-Yee
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Tessa Blevins
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Electra D Paskett
- Department of Internal Medicine, College of Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
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Thronicke A, Oei SL, Grieb G, Grabowski P, Roos J, Schad F. Self-Reported Baseline Quality of Life Mirrors Treatment-Specific Characteristics of Cancer Patients. Cancers (Basel) 2023; 15:5763. [PMID: 38136309 PMCID: PMC10742018 DOI: 10.3390/cancers15245763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Baseline quality of life (bQL) has been shown to be a predictor of the clinical outcome of oncological patients. The primary objective of the present study was to examine the role of bQL as a treatment predictor in oncological patients. METHODS In this prospective study, all-stage cancer patients registered in the Network Oncology registry were enrolled, and their bQL at diagnosis was evaluated. RESULTS Five hundred and thirty-eight oncological patients were eligible (median age 64 years). We show that survival-predicting bQL variables such as pain, low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment (p = 0.03), reduced surgery (p = 0.007) or reduced oncological treatment compliance (0.01), respectively. Lastly, female gender and older cancer patients exhibited a tempered bQL. CONCLUSION Our study is one of the first to reveal that bQL at tumor diagnosis is significantly associated with the prediction of oncological treatment with distinctive age- and gender-related patterns. Our results emphasize the need to address the physical, psychosocial, and financial burden of cancer patients prior to their oncological treatment with respect to age and gender. The associations found here pave the way for early integration of patient-reported outcomes into oncological supportive concepts.
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Affiliation(s)
- Anja Thronicke
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
| | - Shiao Li Oei
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Patricia Grabowski
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Juliane Roos
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
| | - Friedemann Schad
- Research Institute Havelhöhe gGmbH, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany; (A.T.)
- Interdisciplinary Oncology and Palliative Care, Hospital Gemeinschaftskrankenhaus Havelhöhe, 14089 Berlin, Germany
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Killela M, Biddell C, Keim-Malpass J, Schwartz TA, Soto S, Williams J, Santacroce S. The Use of Medical Crowdfunding to Mitigate the Personal Costs of Serious Chronic Illness: Scoping Review. J Med Internet Res 2023; 25:e44530. [PMID: 38048149 PMCID: PMC10697184 DOI: 10.2196/44530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/11/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. OBJECTIVE This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes. METHODS This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology. RESULTS Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples' experiences with MCF. CONCLUSIONS The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking.
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Affiliation(s)
- Mary Killela
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Todd A Schwartz
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandra Soto
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jessica Williams
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sheila Santacroce
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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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: 0] [Impact Index Per Article: 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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Waters AR, Biddell CB, Killela M, Kasow KA, Page K, Wheeler SB, Drier SW, Kelly MS, Robles J, Spees LP. Financial burden and recommended multilevel solutions among caregivers of pediatric hematopoietic stem cell transplant recipients. Pediatr Blood Cancer 2023; 70:e30700. [PMID: 37776093 PMCID: PMC10615841 DOI: 10.1002/pbc.30700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The healthcare costs of patients who receive hematopoietic stem cell transplantation (HSCT) are substantial. At the same time, the increasing use of pediatric HSCT leaves more caregivers of pediatric HSCT recipients at risk for financial burden-an understudied area of research. METHODS Financial burden experienced by caregivers of recipients who received autologous or allogeneic transplants was assessed using an explanatory mixed-methods design including a one-time survey and semi-structured interviews. Financial burden was assessed through an adapted COmprehensive Score for financial Toxicity (COST) as well as questions about the types of out-of-pocket costs and cost-coping behaviors. Chi-squared or Fisher's exact tests were used to assess differences in costs incurred and coping behaviors by financial toxicity and financial toxicity by demographic factors. Interviews were audio recorded, transcribed, and analyzed using directed content analysis. RESULTS Of 99 survey participants, 64% experienced high financial toxicity (COST ≤ $ \le \;$ 22). Caregivers with high financial toxicity were more likely to report costs related to transportation and diet. High financial toxicity was associated with nearly all cost-coping behaviors (e.g., borrowed money). High financial toxicity was also associated with increased use of hospital financial support and transportation assistance. Qualitative analysis resulted in four categories that were integrated with quantitative findings: (1) care-related out-of-pocket costs incurred, (2) cost-coping behaviors, (3) financial support resources used, and (4) multilevel recommendations for reducing financial burden. CONCLUSIONS Considering the substantial, long-term financial burden among pediatric HSCT patients and their caregivers, this population would benefit from adapted and tailored financial burden interventions.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
| | - Mary Killela
- School of Nursing, UNC-CH, Chapel Hill, North Carolina, USA
| | - Kimberly A Kasow
- Department of Pediatrics, UNC-CH, Chapel Hill, North Carolina, USA
| | - Kristin Page
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Sarah W Drier
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
| | - Matthew S Kelly
- Department of Pediatrics, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joanna Robles
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa P Spees
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, North Carolina, USA
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Rahimi S, Ononogbu O, Mohan A, Moussa D, Abughosh S, Trivedi MV. Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic. Int J Clin Pharm 2023; 45:1396-1404. [PMID: 37380914 PMCID: PMC10682303 DOI: 10.1007/s11096-023-01609-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in the prevention and treatment of hormone receptor-positive (HR +) breast cancer (BC). Medication use behavior is suboptimal especially in racial/ethnic minorities with lower socioeconomic status (SES). AIM We aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on OET adherence and identify demographic and/or clinical characteristics associated with nonadherence in racial/ethnic minorities with lower SES. METHOD A retrospective study was conducted at the Harris Health System in Houston, Texas. Data were collected during the 6 months before and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. A multivariable logistic regression model was used to identify demographic/clinical characteristics associated with nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. RESULTS In 258 patients, adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The demographic/clinical characteristics associated with OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. CONCLUSION OET adherence was significantly reduced during the COVID-19 pandemic in racial/ethnic minority patients with low SES. Patient-centered interventions are necessary to improve OET adherence in these patients.
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Affiliation(s)
- Sama Rahimi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Onyebuchi Ononogbu
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Anjana Mohan
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Daniel Moussa
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Susan Abughosh
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA.
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Doherty M, Thom B, Gardner DS. Administrative Burden Associated with Cost-Related Delays in Care in U.S. Cancer Patients. Cancer Epidemiol Biomarkers Prev 2023; 32:1583-1590. [PMID: 37644659 DOI: 10.1158/1055-9965.epi-23-0119] [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: 02/07/2023] [Revised: 05/12/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND U.S. cancer patients engage in administrative tasks to pay for their healthcare. This study investigated the relationship between payment tasks and timely access to cancer care. METHODS We analyzed online survey data from 510 U.S. cancer patients and survivors to understand the relationship between administrative payment tasks and cost-related delays and nonadherence. Two-part modelling was used to determine if, and to what extent, there was a relationship between administrative burden and cost-related delays/nonadherence. RESULTS Younger patients (≤44 years) reported more payment tasks and cost-related delays/nonadherence than older patients (≥ 55 years); African American patients reported more payment tasks and cost-related delays/nonadherence than white patients. After accounting for age, race/ethnicity, education, and out-of-pocket costs, patients who reported engaging in more tasks had greater log odds of delaying/forgoing care [b = 0.18; 95% confidence interval (CI), 0.12-0.24]. Cost-related delays/nonadherence increased by 32% for every unit increase in administrative payment burden (b = 0.32; 95% CI, 0.18-0.46). CONCLUSIONS Administrative payment burden increased the odds of cost-related delays and nonadherence by 49%, taking the form of delayed or skipped doctor appointments, tests and bloodwork, and prescription fulfillment. Younger patients and those identifying as African American were more likely to engage in payment tasks and to delay or forgo care due to cost. Administrative burdens can disrupt access to care and traditionally underserved patient populations are disproportionately exposed to these hardships. IMPACT Reducing the complexity of healthcare through universal, human-centered design could reduce burdens and increase access.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center Affordability Working Group, New York, New York
| | - Daniel S Gardner
- Silberman School of Social Work, Hunter College, City University of New York, New York
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Petermann VM, Biddell CB, Planey AM, Spees LP, Rosenstein DL, Manning M, Gellin M, Padilla N, Samuel-Ryals CA, Birken SA, Reeder-Hayes K, Deal AM, Cabarrus K, Bell RA, Strom C, Young TH, King S, Leutner B, Vestal D, Wheeler SB. Assessing the pre-implementation context for financial navigation in rural and non-rural oncology clinics. FRONTIERS IN HEALTH SERVICES 2023; 3:1148887. [PMID: 37941608 PMCID: PMC10627810 DOI: 10.3389/frhs.2023.1148887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
Background Financial navigation (FN) is an evidence-based intervention designed to address financial toxicity for cancer patients. FN's success depends on organizations' readiness to implement and other factors that may hinder or support implementation. Tailored implementation strategies can support practice change but must be matched to the implementation context. We assessed perceptions of readiness and perceived barriers and facilitators to successful implementation among staff at nine cancer care organizations (5 rural, 4 non-rural) recruited to participate in the scale-up of a FN intervention. To understand differences in the pre-implementation context and inform modifications to implementation strategies, we compared findings between rural and non-rural organizations. Methods We conducted surveys (n = 78) and in-depth interviews (n = 73) with staff at each organization. We assessed perceptions of readiness using the Organizational Readiness for Implementing Change (ORIC) scale. In-depth interviews elicited perceived barriers and facilitators to implementing FN in each context. We used descriptive statistics to analyze ORIC results and deductive thematic analysis, employing a codebook guided by the Consolidated Framework for Implementation Research (CFIR), to synthesize themes in barriers and facilitators across sites, and by rurality. Results Results from the ORIC scale indicated strong perceptions of organizational readiness across all sites. Staff from rural areas reported greater confidence in their ability to manage the politics of change (87% rural, 76% non-rural) and in their organization's ability to support staff adjusting to the change (96% rural, 75% non-rural). Staff at both rural and non-rural sites highlighted factors reflective of the Intervention Characteristics (relative advantage) and Implementation Climate (compatibility and tension for change) domains as facilitators. Although few barriers to implementation were reported, differences arose between rural and non-rural sites in these perceived barriers, with non-rural staff more often raising concerns about resistance to change and compatibility with existing work processes and rural staff more often raising concerns about competing time demands and limited resources. Conclusions Staff across both rural and non-rural settings identified few, but different, barriers to implementing a novel FN intervention that they perceived as important and responsive to patients' needs. These findings can inform how strategies are tailored to support FN in diverse oncology practices.
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Affiliation(s)
- Victoria M. Petermann
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caitlin B. Biddell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Arrianna Marie Planey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa P. Spees
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Donald L. Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Neda Padilla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Cleo A. Samuel-Ryals
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah A. Birken
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United States
| | - Katherine Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kendrel Cabarrus
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ronny A. Bell
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United States
| | - Carla Strom
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Wake Forest Baptist Comprehensive Cancer Center, Wake Forest University, Winston-Salem, NC, United States
| | - Tiffany H. Young
- Buddy Kemp Support Center, Novant Health Cancer Institute, Charlotte, NC, United States
| | - Sherry King
- Carteret Health Care Cancer Center, Carteret, NC, United States
| | - Brian Leutner
- Pardee UNC Health Care, Hendersonville, NC, United States
| | - Derek Vestal
- UNC Lenoir Health Care, Kinston, NC, United States
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Su M, Liu S, Liu L, Wang F, Lao J, Sun X. Heterogeneity of financial toxicity and associated risk factors for older cancer survivors in China. iScience 2023; 26:107768. [PMID: 37731611 PMCID: PMC10507189 DOI: 10.1016/j.isci.2023.107768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
In China, older cancer survivors may show heterogeneity in financial toxicity (FT). We aimed to identify FT profiles among older Chinese cancer survivors and examine the association between FT profiles and individual characteristics. We used a latent profile analysis to categorize participants and a multinomial logistic regression to examine the associations. We identified three distinct FT profiles: high, moderate, and low. Participants aged 65-69 years, with a monthly household income ≥ 5,000 CNY and a high school education or above were more likely to be classified into the moderate than high FT profile, a monthly household income ≥ 5,000 CNY increased the likelihood of being in the low FT profile and living alone negatively affected the odds of being in the low FT profile. The findings identified heterogeneity in FT among this population, may help identify high-risk groups, and may enable early intervention.
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Affiliation(s)
- Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Fang Wang
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Jiahui Lao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan Shandong, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
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Scheidegger A, Bernhardsgrütter D, Kobleder A, Müller M, Nestor K, Richle E, Baum E. Financial toxicity among cancer survivors: a conceptual model based on a feedback perspective. Support Care Cancer 2023; 31:618. [PMID: 37804425 PMCID: PMC10560155 DOI: 10.1007/s00520-023-08066-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Experiencing financial toxicity following a cancer diagnosis is a circular and complex process. We investigate the circular causal mechanisms that either reinforce or balance financial toxicity dynamics. METHODS We conducted a literature review, expert interviews, a participatory modeling process, and exploratory interviews with N = 11 adults with cancer living in Switzerland. We sampled participants purposively based on health-related and sociodemographic characteristics. RESULTS We describe a conceptual model based on the triangulation of cancer survivor narratives, expert perspectives, and a literature review. This model distinguishes between the reinforcing and balancing feedback loops that drive the dynamics of financial toxicity. It includes the topics "Coping with cancer and employment," "Coping with limited economic resources," and "Maintaining care resources while facing economic pressure." For each topic, we identify a necessary condition for cancer survivors to avoid reinforcing financial toxicity. CONCLUSIONS The results allow us to reconstruct participant narratives regarding cancer-related financial toxicity. Based on comparison with scientific literature from Western Europe and North America, we hypothesize the validity of the model beyond the population covered by the sample. The results highlight the importance of screening for the risk of financial toxicity in the clinical context and individual risk and resource assessment in social counseling. IMPLICATIONS FOR CANCER SURVIVORS These results can raise cancer survivors' awareness of risks related to financial toxicity and strengthen their resources for coping with financial burden successfully.
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Affiliation(s)
| | | | - Andrea Kobleder
- Ostschweizer Fachhochschule, Oberseestrasse 10, 8640, Rapperswil, Switzerland
| | - Martin Müller
- Ostschweizer Fachhochschule, Oberseestrasse 10, 8640, Rapperswil, Switzerland
| | - Karen Nestor
- Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Ernst Richle
- Krebsliga Ostschweiz, Flurhofstrasse 7, 9000, St. Gallen, Switzerland
| | - Eleonore Baum
- Ostschweizer Fachhochschule, Oberseestrasse 10, 8640, Rapperswil, Switzerland
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Hall AG, Syrjala KL, Ketterl TG, Ganz PA, Jacobs LA, Palmer SC, Partridge A, Rajotte EJ, Mueller BA, Baker KS. Socioeconomic Factors and Adherence to Health Care Recommendations in Adolescent and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:701-709. [PMID: 36779982 PMCID: PMC10611968 DOI: 10.1089/jayao.2022.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Purpose: The majority of adolescent and young adult (AYA) cancer survivors do not receive recommended health care surveillance after therapy. We used cross-sectional survey data to evaluate the impact of income, education, marital status, and insurance on health care adherence among AYA survivors. Methods: Eligible survivors were 18-39 years at diagnosis with invasive malignancy, 1-5 years from therapy completion. Online surveys assessed sociodemographic factors and self-report of completion of recommended health care services. Diagnosis and treatment data were abstracted from medical records. Multivariable logistic regression calculated odds ratios (ORs) and 95% confidence intervals (CIs) for adherence in relation to socioeconomic status and support. Results: Of 344 participants, 36% were adherent to at least 80% of recommendations. Adherence varied by cancer type: 34% for breast cancer, 52% for leukemia/lymphoma, 23% for other tumors. Adherence rates were similar among White, Asian, and Hispanic/Latinx patients. Lower adherence was associated with lower education (OR: 0.43; 95% CI: 0.23-0.80 for <4-year college degree) and lower annual income (OR: 0.51; 95% CI: 0.28-0.95 for $41,000-$80,000; OR: 0.40; 95% CI: 0.19-0.86 for ≤$40,000). Adherence decreased with decreasing income levels among those who were 1 to less than 3 years after diagnosis (OR: 0.25; 95% CI: 0.07-0.93 for $81,000-$120,000; OR: 0.24; 95% CI: 0.07-0.84 for $41,000-$80,000; OR: 0.13; 95% CI: 0.03-0.60 for ≤$40,000). Conclusion: Risk of nonadherence to health care guidelines was associated with lower income and lower education among AYA cancer survivors. Identification of these risks and related barriers to adherence in AYA survivors will inform interventions designed to meet needs of these high-risk groups, particularly during the first years after diagnosis. Trial Registration: NCT02192333.
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Affiliation(s)
- Anurekha G Hall
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Tyler G Ketterl
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patricia A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Linda A Jacobs
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven C Palmer
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily Jo Rajotte
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Beth A Mueller
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - K Scott Baker
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Bogdanovski AK, Sturgeon C, James BC. Financial toxicity in thyroid cancer survivors. Curr Opin Endocrinol Diabetes Obes 2023; 30:238-243. [PMID: 37470486 DOI: 10.1097/med.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW Financial burden and distress are high in patients with thyroid cancer. However, little has been done to evaluate potential interventions to mitigate financial toxicity in survivors. This review will cover current data on the impact of financial toxicity on quality of life and clinical outcomes in patients with thyroid cancer and highlight areas for future study. RECENT FINDINGS Thyroid cancer incidence has nearly tripled in the past decades, and cost of treatment is predicted to rise more than other cancers over the next decade. With mean age of diagnosis at 51 years, most patients begin treatment while still working, do not qualify for Medicare or Social Security, and are susceptible to higher financial burden. Though thyroid cancer has high survival rates, some studies suggest patients have worse quality of life and higher financial burden than more morbid cancers. SUMMARY Thyroid cancer survivors have high rates of financial toxicity, and there remains need for longitudinal studies to evaluate how financial burden may change during the treatment process while also assessing potential tools to mitigate this burden.
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Affiliation(s)
- Anastasia K Bogdanovski
- Harvard Medical School
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Cord Sturgeon
- Northwestern University Feinberg School of Medicine
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Benjamin C James
- Harvard Medical School
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Sinaiko AD, Lewis DM, Ho YX, Dusetzina SB, Packer S, Kumar VS, Keating NL. Designing a Digital Tool to Inform Oncology Practices About Cancer Treatment Cost Burdens. JCO Clin Cancer Inform 2023; 7:e2300022. [PMID: 38086014 PMCID: PMC10715805 DOI: 10.1200/cci.23.00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Paper describes our development of a web-based tool to make Medicare patient prices for cancer drugs known to their care teams.
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Affiliation(s)
- Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - Stacie B. Dusetzina
- Department of Health Policy and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Stuart Packer
- Department of Oncology, Montefiore Medical Center, New York, NY
| | | | - Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, MA
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
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Tak HJ, Horner RD, Lee MS, Shih YCT. Impact of functional disability on health-care use and medical costs among cancer survivors. JNCI Cancer Spectr 2023; 7:pkad059. [PMID: 37584678 PMCID: PMC10505255 DOI: 10.1093/jncics/pkad059] [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: 04/12/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies health-care use and costs. This study examined the association between functional disability among cancer survivors and their health-care utilization and medical costs. METHODS We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included use of 6 service types (inpatient, outpatient, office-based physician, office-based nonphysician, emergency department, and prescription) and medical costs of aggregate services and by each of 6 service types. The primary independent variable was a categorical variable for the total number of functional disabilities. We employed multivariable generalized linear models and 2-part models, adjusting for sociodemographics and health conditions and accounting for survey design. RESULTS Among cancer survivors (n = 9359; weighted n = 21 046 285), 38.8% reported at least 1 disability. Compared with individuals without a disability, cancer survivors with 4 or more disabilities experienced longer hospital stays (adjusted average marginal effect = 1.14 days, 95% confidence interval [CI] = 0.55 to 1.73), more visits to an office-based physician (average marginal effect = 1.43 visits, 95% CI = 0.51 to 2.35), and a greater number of prescriptions (average marginal effect = 12.1 prescriptions, 95% CI = 9.27 to 15.0). Their total (average marginal effect = $9537, 95% CI = $5713 to $13 361) and out-of-pocket (average marginal effect = $639, 95% CI = $79 to $1199) medical costs for aggregate services were statistically significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services. CONCLUSIONS Cancer survivors with a disability experienced greater health-care use and higher costs. Cancer survivorship planning for health care and financial stability should consider the patients' disability profile.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ronnie D Horner
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Min Sok Lee
- Department of Economics, University of Chicago, Chicago, IL, USA
| | - Ya-Chen Tina Shih
- Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Shi JJ, Maldonado JA, Wu CF, Peterson SK, Chen YS, Diao K, Volk RJ, Giordano SH, Shih YCT, Kaiser K, Smith GL. Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization. Front Psychol 2023; 14:1209526. [PMID: 37663351 PMCID: PMC10469858 DOI: 10.3389/fpsyg.2023.1209526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Acute care (AC) visits by cancer patients are costly sources of healthcare resources and can exert a financial burden of oncology care both for individuals with cancer and healthcare systems. We sought to identify whether cancer patients who reported more severe initial financial toxicity (FT) burdens shouldered excess risks for acute care utilization. Methods In 225 adult patients who participated in the Economic Strain and Resilience in Cancer (ENRICh) survey study of individuals receiving ambulatory cancer care between March and September 2019, we measured the baseline FT (a multidimensional score of 0-10 indicating the least to most severe global, material, and coping FT burdens). All AC visits, including emergency department (ED) and unplanned hospital admissions, within 1-year follow-up were identified. The association between the severity of FT and the total number of AC visits was tested using Poisson regression models. Results A total of 18.6% (n = 42) of patients had any AC visit, comprising 64.3% hospital admissions and 35.7% ED visits. Global FT burden was associated with the risk of repeat AC visits within 1-year follow-up (RR = 1.17, 95% CI 1.07-1.29, P < 0.001 for every unit increase), even after adjusting for sociodemographic and disease covariates. When examining subdimensions of FT, the burden of depleted FT coping resources (coping FT) was strongly associated with the risk of repeat AC visits (RR = 1.27, 95% CI 1.15-1.40, P < 0.001) while material FT burden showed a trend toward association (RR = 1.07, 95% CI 0.99-1.15, P = 0.07). Conclusion In this prospective study of acute oncology care utilization outcomes among adult cancer patients, FT was a predictor of a higher burden of acute care visits. Patients with severely depleted material and also practical and social coping resources were at particular risk for repeated visits. Future studies are needed to identify whether early FT screening and intervention efforts may help to mitigate urgent acute care utilization burdens.
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Affiliation(s)
- Julia J. Shi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Alberto Maldonado
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kelsey Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Sanyal S, Ravula V. Mitigation of pesticide-mediated ocular toxicity via nanotechnology-based contact lenses: a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-28904-z. [PMID: 37542697 DOI: 10.1007/s11356-023-28904-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/17/2023] [Indexed: 08/07/2023]
Abstract
The xenobiotic stress exerted by pesticides leads to the deterioration of human and animal health including ocular health. Acute or prolonged exposure to these agricultural toxicants has been implicated in a number of pathological conditions of the eye such as irritation, epiphora or hyper-lacrimation, abrasions on the ocular surface, and decreased visual acuity. The issue is compounded by the fact that tissues of the eye absorb pesticides faster than other organs of the body and are more susceptible to damage as well. However, there is a lacuna in our knowledge regarding the ways by which pesticide exposure-mediated ocular insult might be counteracted. Topical instillation of drugs known to combat the pesticide induced toxicity has been explored to mitigate the detrimental impact of pesticide exposure. However, topical eye drop solutions exhibit very low bioavailability and limited drug residence duration in the tear film decreasing their efficacy. Contact lenses have been explored in this respect to increase bioavailability of ocular drugs, while nanoparticles have lately been utilized to increase drug bioavailability and increase drug residence duration in different tissues. The current review focuses on drug delivery and futuristic aspects of corneal protection from ocular toxicity using contact lenses.
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Affiliation(s)
- Shalini Sanyal
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India.
| | - Venkatesh Ravula
- Laboratory of Self Assembled Biomaterials and Translational Science, Institute for Stem Cell Science and Regenerative Medicine (DBT-inStem), GKVK Post, Bellary Road, Bengaluru, 560065, Karnataka, India
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Islam N, Atreya A, Nepal S, Uddin KJ, Kaiser MR, Menezes RG, Lasrado S, Abdullah‐Al‐Noman M. Assessment of quality of life (QOL) in cancer patients attending oncology unit of a Teaching Hospital in Bangladesh. Cancer Rep (Hoboken) 2023; 6:e1829. [PMID: 37204133 PMCID: PMC10432493 DOI: 10.1002/cnr2.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The quality of life (QoL) of a cancer patient is their perception of their physical, functional, psychological, and social well-being. QoL is one of the most important factors to consider when treating someone with cancer and during follow-up. The aim of this study was to understand the state of QoL among cancer patients in Bangladesh and to determine the factors that affect it. METHODS This cross-sectional study was conducted on 210 cancer patients who attended the oncology unit of Delta Medical College & Hospital, Dhaka during the period between 1 May 2022 and 31 August 2022. Data were collected using the Bengali version of the European Organization for Research and Treatment of Cancer (EORTC) questionnaire. RESULTS The study reported a high number of female cancer patients (67.6%), who were married, Muslims by religion, and non-residents of Dhaka. Breast cancer was more common among women (31.43%), while lung and upper respiratory tract cancer was more prevalent among men (19.05%). The majority of the patients (86.19%) were diagnosed with cancer in the past year. The overall mean score for functional scales was higher for physical functioning (54.92) whereas it was lower for social functioning (38.89). The highest score on the symptom scale was for financial problems (63.02), while the lowest was for diarrhea (33.01). The overall QoL score of cancer patients in the study was 47.98 and it was lower for males (45.71) compared to females (49.10). CONCLUSIONS The overall QoL was poor among Bangladeshi cancer patients compared to those in developed countries. A low QoL score was observed for social and emotional functions. Financial difficulty was the main reason behind the lower QoL score on the symptom scale.
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Affiliation(s)
- Nazmul Islam
- Department of OncologyDelta Medical College & HospitalDhakaBangladesh
| | - Alok Atreya
- Department of Forensic MedicineLumbini Medical CollegePalpaNepal
| | - Samata Nepal
- Department of Community MedicineLumbini Medical CollegePalpaNepal
| | - Kazi Jashim Uddin
- Department of OncologyDelta Medical College & HospitalDhakaBangladesh
| | - Md. Rashed Kaiser
- Department of OncologyDelta Medical College & HospitalDhakaBangladesh
| | - Ritesh G. Menezes
- Department of Pathology, College of MedicineImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
| | - Savita Lasrado
- Department of Otorhinolaryngology and Head & Neck SurgeryFather Muller Medical CollegeMangaloreIndia
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