Financial Aid in Children, Adolescents and Young Adult's Cancer Care: A Scoping Review

Background: The financial burden resulting from cancers on families is higher when it arises in young people compared with older adults. Previous research has provided insight into the financial toxicities associated with childhood cancer, but less is known about the efficacy of financial aid systems in reducing the financial burden on families. We conducted a scoping review to identify the determinants of success and failure of financial aid. Methods: Five databases were searched for articles published between January 1, 2000 and December 1, 2022. Dual processes were used to screen and select studies. Through thematic content analysis, we identified barriers and enablers of financial aid, categorised by country income level. Results: From 17 articles, which were evenly split between high-income countries and upper middle- to low-income countries, four major themes emerged: (1) accessibility of support, (2) delivery of support, (3) administration, and (4) psychosocial factors. Within these themes, the enablers identified were (1) support navigators, (2) establishing a direct contact between donors and beneficiaries, (3) implementation of digital solutions to improve outreach, and (4) using cultural and community values to encourage donor engagement. Conclusions: This scoping review identified the determinants of success and failure of financial aid in supporting families in the context of childhood, adolescent, and young adult (CAYA) cancers. By understanding the barriers and enablers identified in this review, organizations could develop pragmatic evidence-based care models and policies to ensure access to assistance is equitable and appropriate for families experiencing CAYA cancers.

Temporary Financial Assistance for Housing Expenditures and Mortality and Suicide Outcomes Among US Veterans

INTRODUCTION

It is unclear whether interventions designed to increase housing stability can also lead to improved health outcomes such as reduced risk of death and suicide morbidity. The objective of this study was to estimate the potential impact of temporary financial assistance (TFA) for housing-related expenses from the US Department of Veterans Affairs (VA) on health outcomes including all-cause mortality, suicide attempt, and suicidal ideation.

METHODS

We conducted a retrospective national cohort study of Veterans who entered the VA Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the association between TFA and health outcomes using a multivariable Cox proportional hazards regression approach with inverse probability of treatment weighting. We conducted these analyses on our overall cohort as well as separately for those in the rapid re-housing (RRH) and homelessness prevention (HP) components of SSVF. Outcomes were all-cause mortality, suicide attempt, and suicidal ideation at 365 and 730 days following enrollment in SSVF.

RESULTS

Our analysis cohort consisted of 41,969 unique Veterans with a mean (SD) duration of 87.6 (57.4) days in the SSVF program. At 365 days following SSVF enrollment, TFA was associated with a decrease in the risk of all-cause mortality (HR: 0.696, p < 0.001) and suicidal ideation (HR: 0.788, p < 0.001). We found similar results at 730 days (HR: 0.811, p = 0.007 for all-cause mortality and HR: 0.881, p = 0.037 for suicidal ideation). These results were driven primarily by individuals enrolled in the RRH component of SSVF. We found no association between TFA and suicide attempts.

CONCLUSION

We find that providing housing-related financial assistance to individuals facing housing instability is associated with improvements in important health outcomes such as all-cause mortality and suicidal ideation. If causal, these results suggest that programs to provide housing assistance have positive spillover effects into other important aspects of individuals' lives.

Impact of financial assistance on stunting: Syrian refugee children under 5 in Türkiye

Despite the global decrease over the last two decades, stunting, also called 'chronic malnutrition', remains a public health issue affecting almost 150 million children under the age of 5 years globally. Defined by height-for-age, stunting is the consequence of poor nutrition, repeated infection, and inadequate psychosocial stimulation. Programmes and policies target undernutrition globally, and humanitarian and development actors invest great efforts to prevent stunting. This study uses multivariate analysis to examine the impact of financial assistance on the reduction of stunting in a refugee context, focusing on Syrian refugee children under the age of 5 years in Türkiye. Using a unique dataset, the 2018 Turkey Demographic and Health Survey Syrian Migrant Sample (2018 TDHS-SR), the findings indicate that financial assistance significantly reduces the incidence of stunting among refugee children under the control of economic, mother and children, environmental, health-related and nutritional and breastfeeding characteristics. However, having household members generate income is found to be another stronger predictor to reduce stunting. The paper also argues that the nutritional well-being of refugee children might improve if forced migration occurs towards a stable host country/region. In addition, adaptation over time also seems to have a positive influence.

Using Real-World Data to Explore the Impact of One-Time Financial Grants Among Young Adult Cancer Survivors

Young adult (YA) cancer survivors experience worse financial outcomes than older survivors. This analysis used data from Expect Miracles Foundation to explore the impact of one-time financial grants on financial well-being and access to health care. Among 300 respondents, the average grant was $1526 (standard deviation = $587; range $300-$3000). Respondents reported improved ability to pay expenses (t = 4.45, p < 0.001), increased financial decision-making power (t = 2.79, p = 0.06), decreased medical debt impact (t = 2.1, p = 0.04), improved transportation access (t = 2.38, p = 0.02), and fewer challenges in accessing care (t = 3.0, p = 0.005) 6 months after receiving a financial grant. Financial assistance offers YAs an opportunity to meet medical and nonmedical expenses.

"I wish I knew about these programs before!" A brief report exploring barriers to financial assistance reported by gynecological oncology patients

PURPOSE

Despite widespread reports of cancer-related financial hardship, hospital financial assistance programs are underutilized.

APPROACH

Rapid qualitative research.

SAMPLE

Gynecologic oncology patients with recurrent or metastatic disease, under 65 years old, and Comprehensive Score for Financial Toxicity of 26 or under.

METHODS

Semi-structured interviews to elicit (1) financial assistance awareness/knowledge, (2) barriers to accessing assistance, and (3) suggestions for improving access. We analyzed the transcripts using thematic analysis: open coding, consensus building/codebook, and identification of salient themes.

FINDINGS

We interviewed 25 patients and identified four barriers and three suggestions for improving access. Barriers: lack of awareness, perceptions of ineligibility, fear of negative consequences, and being overwhelmed. Suggestions: simplifying financial processes, providing individualized assistance, and being more proactive by intervening earlier.

CONCLUSION

Increase access by reducing stigma, misconceptions, and more proactively engaging at-risk patients.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Patients may be too afraid or overwhelmed to ask for help. A more proactive, psychosocial approach is needed.

Barriers and solutions to improve access for chimeric antigen receptor therapies

Chimeric antigen receptor T cells are a potentially curative new therapeutic option, but access challenges remain. The limited number of certified treatment centers and the need to travel to these centers, the expenses of travel and lodging and the out-of-pocket costs associated with treatment pose a challenge for patients. Further, the logistics of follow-up coupled with an ad hoc reimbursement environment make chimeric antigen receptor T-cell treatment an unattractive proposition for many providers. The patient-specific nature of these gene therapies has made scaling up production difficult for manufacturers. Providing expanded financial assistance for patients and education for community oncologists, and addressing reimbursement challenges, can alleviate some of these access barriers.

Examining the Influence of Financial Assistance and Employment Services on the Criminal Justice Outcomes of Women on Probation

Although low income is common across the U.S. probation population, women offenders experience it more than men. However, despite the connection between income and probation outcomes, limited research has been conducted on programs that could improve the financial circumstances of female probationers. This study examined the influence on probation outcomes of receiving government financial assistance programs and employment services. The findings indicated that participants who received Social Security Disability Insurance more often were less likely to become incarcerated. Implications include expanding cash assistance programs to provide more substantial monthly incomes for women probationers, particularly those with disabilities, in order to increase financial stability and improve criminal justice outcomes.

Parental Income and Wealth Loss and Transfers to their Young Adult Children

As young people transition to adulthood, many rely on financial support from their parents to complete schooling and to live independently. Evidence suggests that there has been a gradual lengthening of the time young adults take to transition to adulthood. Young people attempting to move out of their parents' home, complete college, or enter the workforce during the Great Recession faced uncertain economic times, increasing their need for financial support. At the same time, the income and wealth losses experienced by young adults' parents may have disrupted transfers from them. We analyze the impact of large and unexpected declines in parents' income and wealth during and immediately after the Great Recession on monetary transfers to their young adult children using data from the Panel Study of Income Dynamics (PSID) and the PSID Transition to Adulthood study. We find parents' financial support of their young adult children declined during the Great Recession. The likelihood of receiving a transfer declined from 74% in 2005 to 57% in 2009. Parents' loss of income was a factor in the amount of decrease but on average was relatively modest - a $10,000 parental income loss decreased transfers to their adult children by $109. However, parents experiencing large declines in income, those at the 75^th and 95^th percentile of income loss, reduced transfers to adult children by $1,150 and $1,700, respectively. Declines in parental transfers that reduce college completion rates, increase student loan debt and decrease likelihood of homeownership may have long term consequences for financial well-being.

Demystifying pharmaceutical patient assistance programs

Prescription drug costs impose a significant financial burden on the United States healthcare system. Patients with chronic dermatologic diseases often require long-term and expensive prescription drugs. In an effort to expand drug availability, pharmaceutical companies fund patient assistance programs (PAPs) to assist disadvantaged patients in gaining access to high-priced brand name medications with no suitable therapeutic alternative. Patients and clinical staff often face difficulty navigating the various PAPs. Herein, we seek to explore the utility, criteria, and challenges in PAPs and provide a practical discourse for dermatologists caring for medically indigent patients.

Complete Response to Dual Immunotherapy in a Young Adult with Metastatic Alveolar Soft Part Sarcoma Enabled by a Drug Recovery Program in a Community Practice

Alveolar soft part sarcoma (ASPS) is an extremely rare tumor that frequently occurs in adolescent and young adults (AYA). Survival is poor for patients with metastatic and/or relapsed disease not amenable to local control, and limited therapeutic options are available. A major barrier to cancer care in the United States AYA population is lack of access to coordinated care and appropriate therapies for those who lack insurance or who are underinsured. We report a 25-year-old unemployed, uninsured, single mother who presented with a 12.8 × 21 cm soft tissue thigh mass with heterogeneous avidity, max standardized uptake value of 9, with metastatic disease to the ipsilateral inguinal lymph nodes and to the bilateral lungs. After local control of the primary mass was obtained, a recently developed, comprehensive drug replacement program (DRP) was used to gain access to nivolumab, and after frank progression was noted, ipilimumab was added every 6 weeks. No biomarkers associated with response to immunotherapy were identified. After four cycles, a complete response was observed and patient remains disease free 36 months after beginning dual immunotherapy treatment. We obtained immunotherapy agents through a DRP and describe the development and the utility of this program in the community setting. Our report highlights both first documented sustained complete response to sequenced immunotherapy in an AYA with ASPS as well as a comprehensive DRP, which enabled access to therapy for our patient.

Financial Assistance for Patients Who Relocate for Specialist Care in Hematology: Practical Findings to Inform Nursing Supportive Care

AIMS

This article examines findings on the need for, awareness of, and critical time for referral to financial assistance for patients who have to relocate for specialist care for hematological malignancies.

DESIGN

The study involved descriptive qualitative research based on in-depth interviews that were audio-recorded, transcribed verbatim, coded, and thematically analyzed.

PARTICIPANTS

Forty-five hematology patients purposively selected from the client database of the Leukaemia Foundation of Queensland were interviewed for the study.

RESULTS AND CONCLUSION

The findings indicate that there is a critical period at the initial point of diagnosis and start of treatment when patients are experiencing shock, confusion, and a sense of being overwhelmed by stress, fear, and uncertainty about the future. The stress can be exacerbated by the loss of work and a period of waiting to access income (e.g., from superannuation or approval to receive a pension). For some patients, this is a critical period when individuals need support and advice to avoid long-term financial problems. However, at this point in time, many individuals do not know how to access financial advice or assistance from leading cancer supportive care organizations. The findings have practical implications to inform the work by many nurses who provide psychosocial care to hematology patients.

The National Living Donor Assistance Center perspective on barriers to the use of federal travel grants for living donors

Recent research has identified important barriers that potential living organ donors face in utilizing travel reimbursement funds from the National Living Donor Assistance Center (NLDAC). In this article, we provide clarification and comment on these potential barriers from the NLDAC program perspective. The goal of financial neutrality for living donors requires further action. We discuss recent developments and further steps that may help achieve this goal and ultimately affect the shortage of donor organs.

The undue burden of paying for abortion: An exploration of abortion fund cases

The results of a secondary data analysis of 3,999 administrative cases from a national abortion fund, representing patients who received pledges for financial assistance to pay for an abortion from 2010 to 2015, are presented. Case data from the fund's national call center was analyzed to assess the impact of the fund and examine sample demographics which were compared to the demographics of national abortion patients. Procedure costs, patient resources, funding pledges, additional aid, and changes over time in financial pledges for second-trimester procedures were also examined. Results indicate that the fund sample differed from national abortion patients in that fund patients were primarily single, African American, and seeking funding for second trimester abortions. Patients were also seeking to fund expensive procedures, costing an average of over $2,000; patients were receiving over $1,000 per case in pledges and other aid; and funding pledges for second trimester procedures were increasing over time. Abortion funding assistance is essential for women who are not able to afford abortion costs, and it is particularly beneficial for patients of color and those who are younger and single. Repeal of policy banning public funding of abortion would help to eliminate financial barriers that impede abortion access.

Financial Care for Older Adults With Dementia

This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

An update on finances and financial support for medical students in Yong Loo Lin School of Medicine

INTRODUCTION

Increasing financial challenges have resulted in great debt among medical graduates worldwide. In Singapore, more scholarships and bursaries have been disbursed in recent years to support students who are financially challenged. We aimed to study the financial status of medical students in National University of Singapore (NUS) Yong Loo Lin School of Medicine (i.e. NUS Medicine), Singapore, and the financial support available to them.

METHODS

A cross-sectional quantitative study was performed. Surveys were distributed and completed by medical students of NUS Medicine. Information regarding household income, financial assistance, monthly allowance and expense, and concurrent occupations was collected. We compared our findings with the results of a similar study performed in 2007 and national income data.

RESULTS

A total of 956 (66.2%) out of 1,445 medical students completed the survey. 19.5% and 58.5% of respondents came from households with monthly incomes < SGD 3,000 and > SGD 7,000, respectively. 20.6% of students had loans, 18.9% had scholarships and bursaries, and 14.4% worked to support themselves.

CONCLUSION

Medical school fees have risen by more than 50% over the past ten years. Our study found that there were increases in the proportion of students from both the lower- and higher-income segments, with proportionally fewer students from the middle-income segment. A large number of students were working and/or had some form of financial support. More should be done to meet the needs of financially challenged medical students to ensure equal access to quality medical education.

Parental Financial Assistance and Young Adults' Relationships With Parents and Well-Being

Drawing on data from the National Longitudinal Study of Adolescent Health, this study examined the impact of parental financial assistance on young adults' relationships with parents and well-being. Conditional change models were estimated to evaluate the effects of parental financial assistance reported in Wave 3 (ages 18 - 26) and Wave 4 (ages 24 - 32) of the study. The results (Ns ranged from 9,128 to 13,389 across outcomes) indicated that financial assistance was positively associated with changes in depressive symptoms and closeness to both mothers and fathers in both periods. Changes in self-esteem were less robustly linked to parental financial assistance. Although the observed pattern with respect to parent - child relations held regardless of the progress young people had made in the transition to adulthood, the effects for well-being, which were also relatively small in magnitude, did not. In particular, changes in depressive symptoms associated with financial assistance were concentrated among individuals occupying adult social roles.