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Longo CJ, Maity T, Fitch MI, Young JT. Patient and Family Financial Burden in Cancer: A Focus on Differences across Four Provinces, and Reduced Spending Including Decisions to Forego Care in Canada. Curr Oncol 2024; 31:2713-2726. [PMID: 38785487 PMCID: PMC11119025 DOI: 10.3390/curroncol31050206] [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: 11/22/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
GOAL This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada. METHODS Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes. RESULTS Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning CONCLUSIONS Levels of financial burden for patients with cancer in Canada vary provincially, including for OOPC, travel and parking costs, and lost income. Decisions to forego cancer care are highest in relation to vitamins/supplements, CAM, and drugs. Provincial differences suggest that regional health policies and demographics may impact patients' overall financial burden.
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Affiliation(s)
- Christopher J. Longo
- DeGroote School of Business—Health Policy & Management, McMaster University, Hamilton, ON L8S 4L8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Tuhin Maity
- DeGroote School of Business—Health Policy & Management, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Jesse T. Young
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada;
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia
- Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia
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ERDUR E, YILDIRIM ÖA, KÖMEK H, POYRAZ K, ÇELİK M, YAMAN M. Evaluation of caregiver burden of cancer patients and impact of this burden on caregiver's quality of life. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1025215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Longo CJ, Fitch MI, Loree JM, Carlson LE, Turner D, Cheung WY, Gopaul D, Ellis J, Ringash J, Mathews M, Wright J, Stevens C, D'Souza D, Urquhart R, Maity T, Balderrama F, Haddad E. Patient and family financial burden associated with cancer treatment in Canada: a national study. Support Care Cancer 2021; 29:3377-3386. [PMID: 33403399 PMCID: PMC8062343 DOI: 10.1007/s00520-020-05907-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/19/2020] [Indexed: 11/01/2022]
Abstract
GOAL To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. METHODS A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and "other" costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. RESULTS Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). "Worst burden" respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. CONCLUSIONS In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.
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Affiliation(s)
- Christopher J Longo
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Margaret I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M4C 4V9, Canada
| | - Jonathan M Loree
- Department of Medicine, Division of Medical Oncology, BC Cancer / University of British Columbia, 600 West 10th Avenue, Vancouver, British Columbia, V5Z4E6, Canada
| | - Linda E Carlson
- Department of Oncology, Cummings School of Medicine, University of Calgary, 2202 2nd St SW, Calgary, Alberta, T2S 3C1, Canada
| | - Donna Turner
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, R3E 0V9, Canada
| | - Winson Y Cheung
- Department of Oncology, University of Calgary, 1331-29 Street NW, Calgary, Alberta, T2N 4N2, Canada
| | - Darin Gopaul
- Grand River Regional Cancer Centre, Kitchener, Ontario, N2G 1G3, Canada
| | - Janet Ellis
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jolie Ringash
- Princess Margaret Cancer Centre/UHN, 610 University Ave, Toronto, Ontario, M5G 2M9, Canada
| | - Maria Mathews
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Jim Wright
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Christiaan Stevens
- Department of Radiation Oncology, University of Toronto, Barrie, Ontario, L4M 6M2, Canada
| | - David D'Souza
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Room 8-032, Centennial Building, 1276 South Park St., Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Tuhin Maity
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada
| | - Fanor Balderrama
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Evette Haddad
- DeGroote School of Business-Health Policy & Management, McMaster University, 4350 South Service Rd, Burlington, Ontario, L7L 5R8, Canada
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Iragorri N, de Oliveira C, Fitzgerald N, Essue B. The Out-of-Pocket Cost Burden of Cancer Care-A Systematic Literature Review. Curr Oncol 2021; 28:1216-1248. [PMID: 33804288 PMCID: PMC8025828 DOI: 10.3390/curroncol28020117] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. METHODS A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. RESULTS Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15-400 in Canada, USD 4-609 in Western Europe, and USD 58-438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40-71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. CONCLUSIONS We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care.
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Affiliation(s)
- Nicolas Iragorri
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
| | - Claire de Oliveira
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
- Centre for Health Economics and Hull York Medical School, University of York, Heslington, York YO10 5DD, UK
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Toronto, ON M6J 1H4, Canada
| | | | - Beverley Essue
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (C.d.O.); (B.E.)
- The Canadian Partnership Against Cancer, Toronto, ON M5H 1J8, Canada;
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Houwing ME, Buddenbaum M, Verheul TCJ, de Pagter APJ, Philipsen JNJ, Hazelzet JA, Cnossen MH. Improving access to healthcare for paediatric sickle cell disease patients: a qualitative study on healthcare professionals' views. BMC Health Serv Res 2021; 21:229. [PMID: 33712013 PMCID: PMC7953612 DOI: 10.1186/s12913-021-06245-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/01/2021] [Indexed: 01/10/2023] Open
Abstract
Background In well-resourced countries, comprehensive care programs have increased life expectancy of patients with sickle cell disease, with almost all infants surviving into adulthood. However, families affected by sickle cell disease are more likely to be economically disenfranchised because of their racial or ethnic minority status. As every individual child has the right to the highest attainable standard of health under the United Nations Convention on the Rights of the Child, it is essential to identify both barriers and facilitators with regard to the delivery of adequate healthcare. Optimal healthcare accessibility will improve healthcare outcomes for children with sickle cell disease and their families. Healthcare professionals in the field of sickle cell care have first-hand experience of the barriers that patients encounter when it comes to effective care. We therefore hypothesised that these medical professionals have a clear picture of what is necessary to overcome these barriers and which facilitators will be most feasible. Therefore, this study aims to map best practises and lessons learnt in order to attain more optimal healthcare accessibility for paediatric patients with sickle cell disease and their families. Methods Healthcare professionals working with young patients with sickle cell disease were recruited for semi-structured interviews. An interview guide was used to ensure the four healthcare accessibility dimensions were covered. The interviews were transcribed and coded. Based on field notes, initial codes were generated, to collate data (both barriers and solutions) to main themes (such as “transportation”, or “telecommunication”). Through ongoing thematic analysis, definitive themes were formulated and best practices were reported as recommendations. Quotations were selected to highlight or illustrate the themes and link the reported results to the empirical data. Results In 2019, 22 healthcare professionals from five different university hospitals in the Netherlands were interviewed. Participants included (paediatric) haematologists, nurses and allied health professionals. Six themes emerged, all associated with best practices on topics related to the improvement of healthcare accessibility for children with sickle cell disease and their families. Firstly, the full reimbursement of invisible costs made by caregivers. Secondly, clustering of healthcare appointments on the same day to help patients seeing all required specialists without having to visit the hospital frequently. Thirdly, organisation of care according to shared care principles to deliver specialised services as close as possible to the patient’s home without compromising quality. Fourthly, optimising verbal and written communication methods with special consideration for families with language barriers, low literacy skills, or both. Fifthly, improving the use of eHealth services tailored to users’ health literacy skills, including accessible mobile telephone contact between healthcare professionals and caregivers of children with sickle cell disease. Finally, increasing knowledge and interest in sickle cell disease among key stakeholders and the public to ensure that preventive and acute healthcare measures are understood and safeguarded in all settings. Conclusion This qualitative study describes the views of healthcare professionals on overcoming barriers of healthcare accessibility that arise from the intersecting vulnerabilities faced by patients with sickle cell disease and their families. The recommendations gathered in this report provide high-income countries with a practical resource to meet their obligations towards individual children under the United Nations Convention on the Rights of the Child.
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Affiliation(s)
- Maite E Houwing
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Marit Buddenbaum
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Thijs C J Verheul
- Department of Cell Biology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Jacobus N J Philipsen
- Department of Cell Biology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Pediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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Guerriere D, Husain A, Marshall D, Zagorski B, Kennedy J, Coyte PC. Transitions in Labour Force Participation over the Palliative Care Trajectory. Healthc Policy 2020; 16:25-40. [PMID: 33337312 PMCID: PMC7710958 DOI: 10.12927/hcpol.2020.26355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Home-based palliative programs rely on family caregivers, who often miss time from employment. This article identified changes in caregivers' labour force participation over the palliative trajectory. METHODS Family caregivers (n = 262) were interviewed biweekly to measure transitions across four employment categories. RESULTS More than half of the caregivers had one employment transition and 29% had three or more. The highest proportion of transitions occurred for caregivers who were employed part-time. INTERPRETATION Understanding these transitions is critical to the development of strategies tailored to caregivers to contain labour force losses and to support caregivers during a time of high caregiving demands.
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Affiliation(s)
- Denise Guerriere
- Adjunct Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Amna Husain
- Clinician Scientist, Temmy Latner Centre for Palliative Care, Lunenfeld Tanenbaum Research Institute, Sinai Health System, Toronto, ON
| | - Denise Marshall
- Medical Director, Niagara West Palliative Care Team and McNally House Hospice, Grimsby, ON; Professor, Department of Family Medicine, Division of Palliative Care, David Braley Health Sciences Centre, McMaster University, Hamilton, ON
| | - Brandon Zagorski
- Adjunct Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Julia Kennedy
- Consultant, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Peter C Coyte
- Professor of Health Economics, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
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Mercadante S, Aielli F, Adile C, Bonanno G, Casuccio A. Financial distress and its impact on symptom expression in advanced cancer patients. Support Care Cancer 2020; 29:485-490. [DOI: 10.1007/s00520-020-05507-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
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LaRocca CJ, Li A, Lafaro K, Clark K, Loscalzo M, Melstrom LG, Warner SG. The impact of financial toxicity in gastrointestinal cancer patients. Surgery 2020; 168:167-172. [PMID: 32197785 DOI: 10.1016/j.surg.2020.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Biopsychosocial distress screening is a critical component of comprehensive cancer care. Financial issues are a common source of distress in this patient population. This study uses a biopsychosocial distress screening tool to determine the factors associated with financial toxicity and the impact of these stressors on gastrointestinal cancer patients. METHODS A 48-question, proprietary distress screening tool was administered to patients with gastrointestinal malignancies from 2009 to 2015. This validated, electronically-administered tool is given to all new patients. Responses were recorded on a 5-point Likert scale from 1 (not a problem) to 5 (very severe problem), with responses rated at ≥3 indicative of distress. Univariate and multivariate logistic regressions were used to analyze the data. RESULTS Most of the 1,027 patients had colorectal (50%) or hepatobiliary (31%) malignancies. Additionally, 34% of all patients expressed a high level of financial toxicity. Age greater than 65 (odds ratio: 0.63, 95% confidence interval: 0.47-0.86, P < .01), college education (odds ratio: 0.53, 95% confidence interval: 0.38-0.73, P < .0001), being partnered (odds ratio: 0.61, 95% confidence interval: 0.44-0.84, P < .01), and annual income greater than $40,000 (odds ratio: 0.27, 95% confidence interval: 0.19-0.38, P < .0001) were all protective against financial toxicity on univariate analysis. Also, heavy tobacco use was associated significantly with increased distress on univariate analysis (odds ratio: 2.79, 95% confidence interval: 1.38-5.78, P < .01). With the exception of partnered status (odds ratio: 1.18, 95% confidence interval: 0.76-1.85, P = .46), all these variables retained their significant association with financial toxicity in the multivariate model. CONCLUSION Financial toxicity impacts a large number of cancer patients. Further study of at-risk populations may identify patients who would benefit from pre-emptive education and counseling interventions as part of their routine cancer care.
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Affiliation(s)
- Christopher J LaRocca
- Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN
| | - Arthur Li
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Karen Clark
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Matthew Loscalzo
- Department of Supportive Medicine, City of Hope National Medical Center, Duarte, CA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA.
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Humphries B, Lauzier S, Drolet M, Coyle D, Mâsse B, Provencher L, Robidoux A, Maunsell E. Wage losses among spouses of women with nonmetastatic breast cancer. Cancer 2020; 126:1124-1134. [PMID: 31821547 DOI: 10.1002/cncr.32638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/22/2019] [Accepted: 10/30/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the wage losses incurred by spouses of women with nonmetastatic breast cancer in the 6 months after the diagnosis. METHODS A prospective cohort study of spouses of women diagnosed with nonmetastatic breast cancer who were recruited in 8 hospitals in the province of Quebec (Canada) was performed. Information for estimating wage losses was collected by telephone interviews conducted 1 and 6 months after the diagnosis. Log-binomial regressions were used to identify personal, medical, and employment characteristics associated with experiencing wage losses, and generalized linear models were used to identify characteristics associated with the proportion of usual wages lost. RESULTS Overall, 829 women (86% participation) and 406 spouses (75% participation) consented to participate. Among the 279 employed spouses, 78.5% experienced work absences because of breast cancer. Spouses were compensated for 66.3% of their salary on average during their absence. The median wage loss was $0 (mean, $1820) (2003 Canadian dollars). Spouses were more likely to experience losses if they were self-employed or lived 50 km or farther from the hospital. Among spouses who experienced wage losses, those who were self-employed or whose partners had invasive breast cancer lost a higher proportion of wages. CONCLUSIONS Although spouses took some time off work, for many, the resulting wage losses were modest because of compensation received. Still, the types of compensation used may hide other forms of burden for families facing breast cancer.
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Affiliation(s)
- Brittany Humphries
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Sophie Lauzier
- Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Université Laval, Quebec City, Quebec, Canada.,Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada
| | - Mélanie Drolet
- Population Health and Optimal Health Practices Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada
| | - Douglas Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Benoît Mâsse
- CHU Sainte-Justine Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Louise Provencher
- Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada.,Oncology Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - André Robidoux
- Centre Intégré du Cancer du Sein CHUM, Montreal, Quebec, Canada
| | - Elizabeth Maunsell
- Centre des Maladies du Sein (Center for Breast Diseases) CHU de Québec-Université Laval, Saint-Sacrement Hospital, Quebec City, Quebec, Canada.,Oncology Research Axis, CHU de Québec-Université Laval Research Centre, Quebec City, Quebec, Canada.,Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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Zhao Y, Zhang L, Fu Y, Wang M, Zhang L. Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1327. [PMID: 32092913 PMCID: PMC7068279 DOI: 10.3390/ijerph17041327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/31/2020] [Accepted: 02/11/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. METHODS We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. RESULTS The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. CONCLUSION Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.
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Affiliation(s)
- Yang Zhao
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia; (Y.Z.); (Y.F.)
- WHO Collaborating Centre on Implementation Research for Prevention & Control of NCDs, Melbourne, Victoria 3010, Australia
| | - Lin Zhang
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia;
- The University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Yu Fu
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria 3010, Australia; (Y.Z.); (Y.F.)
| | - Minyu Wang
- Cancer Immunology Program, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000 Australia;
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria 3052, Australia
- Centre for Cancer Immunotherapy, Peter Mac and VCCC Alliance, Melbourne, Victoria 3000, Australia
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou 500000, Guangdong, China
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Informal caregiver quality of life in a palliative oncology population. Support Care Cancer 2019; 28:1695-1702. [DOI: 10.1007/s00520-019-04970-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/26/2019] [Indexed: 12/26/2022]
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12
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Affiliation(s)
| | - Linda Kristjanson
- Faculty of Health and Human Sciences, Edith Cowan University, Churchlands, Western Australia, Australia
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Jacobs P, Dumont S, Turcotte V, Anderson D. Evaluating the Economic loss of Caregiving for Palliative Care Patients. J Palliat Care 2018. [DOI: 10.1177/082585971102700305] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Our aim is to provide a unified measure of the economic burden faced by families during the palliative phase of care and to compare this measure to Statistics Canada's low-income cut-off. Methods: Samples of palliative care patients living at home and their main informal caregivers were recruited in five Canadian urban regions. Interviews were performed every two weeks until the patient's passing, up to a maximum of six months. Participants were asked to provide details about their expenses and their absences from work that related specifically to the patient's condition. Income loss was evaluated for 192 family units. Results: About 9 percent of families incurred economic losses in excess of 10 percent of their pre-study gross annual income; low-income status increased from 27 (before) to 40 (after). Conclusion: This is the first study to provide a unified measure of economic losses of caregiving that can be related to a publicly designated low-income threshold.
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Affiliation(s)
- Philip Jacobs
- S Dumont (corresponding author) Laval University Cancer Research Center, and School of Social Work, Laval University, Pavillon Charles-De Koninck, 1030 avenue des Sciences Humaines, Quebec City, Quebec, Canada G1R 2J6
| | - Serge Dumont
- Department of Medicine, University of Alberta, and Institute of Health Economics, Edmonton, Alberta, Canada; V Turcotte: Laval University Cancer Research Center, Quebec City, Quebec, Canada
| | - Véronique Turcotte
- School of Social Work, Laval University, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
| | - Donna Anderson
- School of Social Work, Laval University, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
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14
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Meunier-Beillard N, Ponthier N, Lepage C, Gagnaire A, Gheringuelli F, Bengrine L, Boudrant A, Rambach L, Quipourt V, Devilliers H, Lejeune C. Identification of resources and skills developed by partners of patients with advanced colon cancer: a qualitative study. Support Care Cancer 2018; 26:4121-4131. [PMID: 29872944 DOI: 10.1007/s00520-018-4283-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/21/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Family caregivers play an important role in caring for patients with advanced cancer. To become competent, individuals must draw on and mobilise an adequate combination of resources. Our goal was to identify the skills developed by caregivers of patients with advanced cancer and the associated resources mobilised. We chose to do it with partners of patients with colon cancer. METHODS The study used a cross-sectional qualitative design based on 20 individual interviews and a focus group. Partners were recruited from patients treated in three hospitals of France. Semi-structured interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes. RESULTS Results from the individual and focus group interviews showed that the skills implemented by the partners (in domains of social relationships and health, domestic, organisational, emotional and well-being dimensions) were singular constructs, dependant on if resources (personal, external and schemes) may have been missing and insufficient. In addition, partners may have had these resources but not mobilised them. CONCLUSION The identification of the skills and associated resources could allow healthcare professionals better identifying and understanding of the difficulties met by partners in taking care of patients. This could enable them to offer appropriate support to help the caregivers in their accompaniment.
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Affiliation(s)
- N Meunier-Beillard
- Centres Georges Chevrier UMR 7366 CNRS-Univ. Bourgogne Franche-Comte, Dijon, France
| | | | - C Lepage
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France.,Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - A Gagnaire
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, BP 87900 21079 Dijon, EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - F Gheringuelli
- Department of Medical Oncology, Center Georges Francois Leclerc Dijon, Dijon, France.,CADIR LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - L Bengrine
- Department of Medical Oncology, Center Georges Francois Leclerc Dijon, Dijon, France
| | - A Boudrant
- Department of Hepato-gastroenterology, Wiliam Morey Hospital, Chalon-sur-Saône, France
| | - L Rambach
- CADIR LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France
| | - V Quipourt
- Hopital de jour gériatrique, centre de Champmaillot, CHU, Dijon, France
| | - H Devilliers
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France.,Inserm CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 7 bd Jeanne d'Arc, BP 87900, 21079, Dijon Cedex, France
| | - Catherine Lejeune
- EPICAD LNC-UMR1231, Burgundy and Franche-Comte University, Dijon, France. .,Inserm CIC1432, Clinical Epidemiology Unit, Dijon University Hospital, 7 bd Jeanne d'Arc, BP 87900, 21079, Dijon Cedex, France.
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15
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Patient-reported outcome measures of the impact of cancer on patients' everyday lives: a systematic review. J Cancer Surviv 2016; 11:211-232. [PMID: 27834041 PMCID: PMC5357497 DOI: 10.1007/s11764-016-0580-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 10/22/2016] [Indexed: 11/25/2022]
Abstract
Purpose Patients with advanced disease are living longer and commonly used patient-reported outcome measures (PROMs) may miss relevant elements of the quality of extended survival. This systematic review examines the measures used to capture aspects of the quality of survival including impact on patients’ everyday lives such as finances, work and family roles. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL and PsycINFO restricted to English language articles. Information on study characteristics, instruments and outcomes was systematically extracted and synthesised. A predefined set of criteria was used to rate the quality of studies. Results From 2761 potentially relevant articles, 22 met all inclusion criteria, including 10 concerning financial distress, 3 on roles and responsibilities and 9 on multiple aspects of social well-being. Generally, studies were not of high quality; many lacked bias free participant selection, had confounding factors and had not accounted for all participants. High levels of financial distress were reported and were associated with multiple demographic factors such as age and income. There were few reports concerned with impacts on patients’ roles/responsibilities in everyday life although practical and emotional struggles with parenting were identified. Social difficulties were common and associated with multiple factors including being a caregiver. Many studies were single time-point surveys and used non-validated measures. Exceptions were employment of the COST and Social Difficulties Inventory (SDI), validated measures of financial and social distress respectively. Conclusions Impact on some important parts of patients’ everyday lives is insufficiently and inconsistently captured. Further PROM development focussing on roles and responsibilities, including work and caring for dependents, is warranted. Implications for Cancer Survivors Factors such as finances, employment and responsibility for caring for dependants (e.g. children and elderly relatives) can affect the well-being of cancer survivors. There is a need to ensure that any instruments used to assess patients’ social well-being are broad enough to include these areas so that any difficulties arising can be better understood and appropriately supported.
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16
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Shnoor Y, Szlaifer M, Aoberman AS, Bentur N. The Cost of Home Hospice Care for Terminal Patients in Israel. Am J Hosp Palliat Care 2016; 24:284-90. [PMID: 17601831 DOI: 10.1177/1049909107300212] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined and compared the cost of care provided to terminal metastatic cancer patients by home hospices and by conventional health services. The study population included 146 patients with metastatic cancer. Half received home hospice services, and the other half received conventional services. The average overall per-patient cost of care was, respectively, $4761 (operating costs included) and $12 434. On average, the costs were lower for older patients. A multiple regression analysis revealed that treatment units per patient, care framework, and patient age significantly contributed to explaining the cost variance. The findings suggest a financial advantage for home hospice care for terminal patients. This should be investigated further, as should the cost of informal caregivers and patient and caregiver satisfaction with the quality of care in both frameworks.
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Affiliation(s)
- Yitschak Shnoor
- Myers-JDC-Brookdale Institute, JDC Hill, Jerusalem 91037, Israel
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17
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Economic Impact Among Family Caregivers of Patients With Advanced Ovarian Cancer. Int J Gynecol Cancer 2016; 25:1541-6. [PMID: 26270119 DOI: 10.1097/igc.0000000000000512] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The life of a family caregiver changes in many ways when cancer is diagnosed. Changes regard also financial costs. To the authors' knowledge, little work has been done to estimate the costs associated with caregiving for cancer patients. The aim of the present study is to evaluate for the first time in literature the economic changes among family caregivers of advanced ovarian cancer during the first-line treatment in an Italian survey. METHODS Between January 2009 and June 2014, the primary family caregivers of patients with advanced ovarian cancer (N = 172) were recruited from to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome within 4 weeks of the patient's new diagnosis. Caregivers reported demographic, medical information, and economic cost, such as traveling to and from medical appointments, waiting with patients for appointments, missing work, and attending to patients who are hospitalized. RESULTS Between January 2009 and June 2014, 172 primary family caregivers of patients with advanced ovarian cancer were enrolled in the study. The mean age of the study cohort was 54.01 years. They reported 3% of missing workdays. The mean cost for all caregivers was &OV0556;1,888,732 per year. Therefore, the mean cost for each caregiver was &OV0556;10,981 annually. CONCLUSIONS This economic analysis of caregiving in patients with advanced ovarian cancer reports the significant burden that cancer treatment places on both families and society. These findings underscore the importance, when appropriate, of including valid estimates of the cost of informal caregiving when evaluating the cost-effectiveness of cancer treatments.
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18
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Khan SA, Waqas M, Ujjan BU, Salim A, Javed G, Ahmed SI, Surani M, Khan M. Providing Care Beyond the Hospital: Perspective of a Tertiary Care Hospital from a Developing Country. World Neurosurg 2016; 88:370-373. [PMID: 26752090 DOI: 10.1016/j.wneu.2015.12.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurorehabilitation is an important aspect of continuing care for neurosurgical patients with functional disability. In developing countries, where formal home nursing frequently is unavailable, ensuring care after discharge is a difficult task. Training attendants to provide nursing care is an alternate option. In this study, we compared the outcomes of patients nursed by family members versus those looked after by a professional nurse. METHODS This was a retrospective observational study conducted at the Aga Khan University Hospital Karachi. The study consisted of 2 groups. Group 1 (consisting of patients cared for by a professional nurse) included 94 patients and group 2 (patients cared for by family members) included 102. All these patients had activity of daily living score of ≥3. Glasgow Outcomes Scale score, time to decannulation, development/worsening of bedsores, and mortality were recorded and compared between the groups at follow-up. RESULTS The study included 196 patients. Traumatic brain injury was the most common diagnosis. Nursing requirements were similar between the 2 groups and included tracheostomy care, percutaneous endoscopic gastrostomy tube care, peripherally inserted central catheter line care, care of patients with no bone flap, and log-rolling. The outcomes of the 2 groups were comparable and included bedsore development/worsening of grade, Glasgow Outcomes Scale score at follow-up, time to decannulation, and 30-day mortality. CONCLUSIONS There was no statistically significant difference in outcomes of patients nursed by family members compared with the patients looked after by professional nurses.
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Affiliation(s)
- Saad Akhtar Khan
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Waqas
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Badar Uddin Ujjan
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Adnan Salim
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Gohar Javed
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Syed Ijlal Ahmed
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Malikah Surani
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Marium Khan
- Section of Neurosurgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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19
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Ding Y, Sauerborn R, Xu B, Shaofa N, Yan W, Diwan VK, Dong H. A cost-effectiveness analysis of three components of a syndromic surveillance system for the early warning of epidemics in rural China. BMC Public Health 2015; 15:1127. [PMID: 26577518 PMCID: PMC4650097 DOI: 10.1186/s12889-015-2475-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Syndromic surveillance systems (SSSs) collect non-specific syndromes in early stages of disease outbreaks. This makes an SSS a promising tool for the early detection of epidemics. An Integrated Surveillance System in rural China (ISSC project), which added an SSS to the existing Chinese surveillance system for the early warning of epidemics, was implemented from April 2012 to March 2014 in Jiangxi and Hubei Provinces. This study aims to measure the costs and effectiveness of the three components of the SSS in the ISSC project. METHODS The central measures of the cost-effectiveness analysis of the three components of the syndromic surveillance system were: 1) the costs per reported event, respectively, at the health facilities, the primary schools and the pharmacies; and 2) the operating costs per surveillance unit per year, respectively, at the health facilities, the primary schools and the pharmacies. Effectiveness was expressed by reporting outputs which were numbers of reported events, numbers of raw signals, and numbers of verified signals. The reported events were tracked through an internal data base. Signal verification forms and epidemiological investigation reports were collected from local country centers for disease control and prevention. We adopted project managers' perspective for the cost analysis. Total costs included set-up costs (system development and training) and operating costs (data collection, quality control and signal verification). We used self-designed questionnaires to collect cost data and received, respectively, 369 and 477 facility and staff questionnaires through a cross-sectional survey with a purposive sampling following the ISSC project. All data were entered into Epidata 3.02 and exported to Stata for descriptive analysis. RESULTS The number of daily reported events per unit was the highest at pharmacies, followed by health facilities and finally primary schools. Variances existed within the three groups and also between Jiangxi and Hubei. During a 15-month surveillance period, the number of raw signals for early warning in Jiangxi province (n = 36) was nine times of that in Hubei. Health facilities and primary schools had equal numbers of raw signals (n = 19), which was 9.5 times of that from pharmacies. Five signals were confirmed as outbreaks, of which two were influenza, two were chicken pox and one was mumps. The cost per reported event was the highest at primary schools, followed by health facilities and then pharmacies. The annual operating cost per surveillance unit was the highest at pharmacies, followed by health facilities and finally primary schools. Both the cost per reported event and the annual operating cost per surveillance unit in Jiangxi in each of the three groups were higher than their counterparts in Hubei. CONCLUSIONS Health facilities and primary schools are better sources of syndromic surveillance data in the early warning of outbreaks. The annual operating costs of all the three components of the syndromic surveillance system in the ISSC Project were low compared to general government expenditures on health and average individual income in rural China.
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Affiliation(s)
- Yan Ding
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Rainer Sauerborn
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Nie Shaofa
- Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Weirong Yan
- Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
- Institute for Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Vinod K Diwan
- Institute for Global Health, Karolinska Institutet, Stockholm, Sweden
| | - Hengjin Dong
- Institute of Public Health, Heidelberg University, Heidelberg, Germany.
- Center for Health Policy Studies, Zhejiang University School of Medicine, Hangzhou, China.
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20
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Harding R, Gao W, Jackson D, Pearson C, Murray J, Higginson IJ. Comparative Analysis of Informal Caregiver Burden in Advanced Cancer, Dementia, and Acquired Brain Injury. J Pain Symptom Manage 2015; 50:445-52. [PMID: 25912274 DOI: 10.1016/j.jpainsymman.2015.04.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Measurement and improvement of informal caregiver burden are central aims of policy and intervention. Burden itself is a complex construct, and total burden can differ by patient diagnosis, although how diagnosis affects different aspects of caregiver subjective burden is unclear. OBJECTIVES To compare the subjective burden of caregivers across three diagnostic groups using the 22-item Zarit Burden Inventory. METHODS We performed a secondary analysis of pooled cross-sectional data from four U.K. studies of informal caregivers of patients with advanced cancer (n = 105), dementia (n = 131), and acquired brain injury (ABI) (n = 215). Zarit Burden Inventory totals, subscales (personal and role strain), and individual mean scores were compared between diagnostic groups using the general linear model, adjusting for caregiver characteristics. RESULTS Caregiver age (mean years [SD]: cancer 66.1 [12.0]; dementia 61.9 [13.4]; and ABI 53.8 [10.9]) differed significantly across diagnostic groups (P < 0.001); 81.9%, 36.6%, and 59.1% of caregivers were spouse/partners, respectively (P < 0.001). Total burden was highest in ABI caregivers and lowest in cancer (mean total score [SD]: cancer 23.3 [13.4]; dementia 27.9 [16.4]; and ABI 39.1 [17.3]) (P < 0.001). Subscale scores showed similar patterns (mean personal and role subscale scores [SD]: cancer 11.8 [6.9], 5.8 [4.8]; dementia 14.4 [8.8], 7.3 [5.7]; and ABI 18.7 [9.1], 11.8 [6.0]) (P < 0.001 for both subscales). Most (17 of 22) individual item scores differed by diagnosis group (P < 0.05), except concepts of duty, responsibility, and perception of financial situation. CONCLUSION Our data show that total, subscale, and most individual elements of caregiver subjective burden differ between cancer, dementia, and ABI caregivers. This should be considered when designing future intervention strategies to reduce caregiver burden in these groups.
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Affiliation(s)
- Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom.
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Diana Jackson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Clare Pearson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
| | - Joanna Murray
- Health Service & Population Research, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, United Kingdom
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21
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Ding Y, Fei Y, Xu B, Yang J, Yan W, Diwan VK, Sauerborn R, Dong H. Measuring costs of data collection at village clinics by village doctors for a syndromic surveillance system-a cross sectional survey from China. BMC Health Serv Res 2015; 15:287. [PMID: 26208506 PMCID: PMC4515002 DOI: 10.1186/s12913-015-0965-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 07/16/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies into the costs of syndromic surveillance systems are rare, especially for estimating the direct costs involved in implementing and maintaining these systems. An Integrated Surveillance System in rural China (ISSC project), with the aim of providing an early warning system for outbreaks, was implemented; village clinics were the main surveillance units. Village doctors expressed their willingness to join in the surveillance if a proper subsidy was provided. This study aims to measure the costs of data collection by village clinics to provide a reference regarding the subsidy level required for village clinics to participate in data collection. METHODS We conducted a cross-sectional survey with a village clinic questionnaire and a staff questionnaire using a purposive sampling strategy. We tracked reported events using the ISSC internal database. Cost data included staff time, and the annual depreciation and opportunity costs of computers. We measured the village doctors' time costs for data collection by multiplying the number of full time employment equivalents devoted to the surveillance by the village doctors' annual salaries and benefits, which equaled their net incomes. We estimated the depreciation and opportunity costs of computers by calculating the equivalent annual computer cost and then allocating this to the surveillance based on the percentage usage. RESULTS The estimated total annual cost of collecting data was 1,423 Chinese Renminbi (RMB) in 2012 (P25 = 857, P75 = 3284), including 1,250 RMB (P25 = 656, P75 = 3000) staff time costs and 134 RMB (P25 = 101, P75 = 335) depreciation and opportunity costs of computers. CONCLUSIONS The total costs of collecting data from the village clinics for the syndromic surveillance system was calculated to be low compared with the individual net income in County A.
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Affiliation(s)
- Yan Ding
- Institute of Public Health, Heidelberg University, Heidelberg, Germany.
| | - Yang Fei
- Institute of Public Health, Heidelberg University, Heidelberg, Germany.
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai, China.
| | - Jun Yang
- Yongxiu County center for Disease Control and Prevention, Yongxiu, China.
| | - Weirong Yan
- Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
- Institute for Global Health, Karolinska Institutet, Stockholm, Sweden.
| | - Vinod K Diwan
- Institute for Global Health, Karolinska Institutet, Stockholm, Sweden.
| | - Rainer Sauerborn
- Institute of Public Health, Heidelberg University, Heidelberg, Germany.
| | - Hengjin Dong
- Institute of Public Health, Heidelberg University, Heidelberg, Germany.
- Center for Health Policy Studies, Zhejiang University School of Medicine, Hangzhou, China.
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Delgado-Guay M, Ferrer J, Rieber AG, Rhondali W, Tayjasanant S, Ochoa J, Cantu H, Chisholm G, Williams J, Frisbee-Hume S, Bruera E. Financial Distress and Its Associations With Physical and Emotional Symptoms and Quality of Life Among Advanced Cancer Patients. Oncologist 2015. [PMID: 26205738 DOI: 10.1634/theoncologist.2015-0026] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE There are limited data on the effects of financial distress (FD) on overall suffering and quality of life (QOL) of patients with advanced cancer (AdCa). In this cross-sectional study, we examined the frequency of FD and its correlates in AdCa. PATIENTS AND METHODS We interviewed 149 patients, 77 at a comprehensive cancer center (CCC) and 72 at a general public hospital (GPH). AdCa completed a self-rated FD (subjective experience of distress attributed to financial problems) numeric rating scale (0 = best, 10 = worst) and validated questionnaires assessing symptoms (Edmonton Symptom Assessment System [ESAS]), psychosocial distress (Hospital Anxiety and Depression Scale [HADS]), and QOL (Functional Assessment of Cancer Therapy-General [FACT-G]). RESULTS The patients' median age was 60 years (95% confidence interval [CI]: 58.6-61.5 years); 74 (50%) were female; 48 of 77 at CCC (62%) versus 13 of 72 at GPH (18%) were white; 21 of 77 (27%) versus 32 of 72 (38%) at CCC and GPH, respectively, were black; and 7 of 77 (9%) versus 27 of 72 (38%) at CCC and GPH, respectively, were Hispanic (p < .0001). FD was present in 65 of 75 at CCC (86%; 95% CI: 76%-93%) versus 65 of 72 at GPH (90%; 95% CI: 81%-96%; p = .45). The median intensity of FD at CCC and GPH was 4 (interquartile range [IQR]: 1-7) versus 8 (IQR: 3-10), respectively (p = .0003). FD was reported as more severe than physical distress, distress about physical functioning, social/family distress, and emotional distress by 45 (30%), 46 (31%), 64 (43%), and 55 (37%) AdCa, respectively (all significantly worse for patients at GPH) (p < .05). AdCa reported that FD was affecting their general well-being (0 = not at all, 10 = very much) with a median score of 5 (IQR: 1-8). FD correlated (Spearman correlation) with FACT-G (r = -0.23, p = .0057); HADS-anxiety (r = .27, p = .0014), ESAS-anxiety (r = .2, p = .0151), and ESAS-depression (r = .18, p = .0336). CONCLUSION FD was very frequent in both groups, but median intensity was double among GPH patients. More than 30% of AdCa rated FD to be more severe than physical, family, and emotional distress. More research is needed to better characterize FD and its correlates in AdCa and possible interventions. IMPLICATIONS FOR PRACTICE Financial distress is an important and common factor contributing to the suffering of advanced cancer patients and their caregivers. It should be suspected in patients with persistent, refractory symptom expression. Early identification, measurement, and documentation will allow clinical teams to develop interventions to improve financial distress and its impact on quality of life of advanced cancer patients.
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Affiliation(s)
- Marvin Delgado-Guay
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jeanette Ferrer
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alyssa G Rieber
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Wadih Rhondali
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Supakarn Tayjasanant
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jewel Ochoa
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Hilda Cantu
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Gary Chisholm
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Janet Williams
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Susan Frisbee-Hume
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Eduardo Bruera
- Departments of Palliative Care and Rehabilitation Medicine, General Oncology, and Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; The University of Texas Health Science, Medical School, Division of Geriatrics and Palliative Medicine, Lyndon B. Johnson General Hospital, Harris Health System, Houston, Texas, USA; Centre de Soins Palliatifs, Centre Hospitalier de Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Choi JW, Cho KH, Choi Y, Han KT, Kwon JA, Park EC. Changes in economic status of households associated with catastrophic health expenditures for cancer in South Korea. Asian Pac J Cancer Prev 2015; 15:2713-7. [PMID: 24761890 DOI: 10.7314/apjcp.2014.15.6.2713] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer imposes significant economic challenges for individuals, families, and society. Households of cancer patients often experience income loss due to change in job status and/or excessive medical expenses. Thus, we examined whether changes in economic status for such households is affected by catastrophic health expenditures. MATERIALS AND METHODS We used the Korea Health Panel Survey (KHPS) Panel 1st-4th (2008- 2011 subjects) data and extracted records from 211 out of 5,332 households in the database for this study. To identify factors associated with catastrophic health expenditures and, in particular, to examine the relationship between change in economic status and catastrophic health expenditures, we conducted a generalized linear model analysis. RESULTS Among 211 households with cancer patients, 84 (39.8%) experienced catastrophic health expenditures, while 127 (40.2%) did not show evidence of catastrophic medical costs. If a change in economic status results from a change in job status for head of household (job loss), these households are more likely to incur catastrophic health expenditure than households who have not experienced a change in job status (odds ratios (ORs)=2.17, 2.63, respectively). A comparison between households with a newly-diagnosed patient versus households with patients having lived with cancer for one or two years, showed the longer patients had cancer, the more likely their households incurred catastrophic medical costs (OR=1.78, 1.36, respectively). CONCLUSIONS Change in economic status of households in which the cancer patient was the head of household was associated with a greater likelihood that the household would incur catastrophic health costs. It is imperative that the Korean government connect health and labor policies in order to develop economic programs to assist households with cancer patients.
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Affiliation(s)
- Jae-Woo Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea E-mail :
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Hanly P, Céilleachair AÓ, Skally M, O'Leary E, Staines A, Kapur K, Fitzpatrick P, Sharp L. Time costs associated with informal care for colorectal cancer: an investigation of the impact of alternative valuation methods. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:193-203. [PMID: 23549793 DOI: 10.1007/s40258-013-0013-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND A societal perspective in economic evaluation necessitates that all resources associated with a disease or intervention should be valued; however, informal care time costs are rarely considered. OBJECTIVE We estimated time allocated to care by informal carers of colorectal cancer survivors; and investigated the impact of applying alternative valuation methods to this time. METHODS Colorectal cancer cases (ICD10 C18-C20) diagnosed 6-30 months previously and identified from the National Cancer Registry Ireland were invited to provide details of informal carers. Carers completed a postal questionnaire. Time estimates per week associated with hospital-related and domestic-related care activities were collected for two phases: diagnosis and initial treatment (initial 3 months) and ongoing care (previous 30 days). Seven valuation scenarios, based on variants of the opportunity cost approach (OCA), and the proxy good approach (PGA), were considered. The base-case was OCA with all carer time valued at the average national wage. RESULTS We received 154 completed questionnaires (response rate = 68 %). Average weekly time allocated to caring was 42.5 h in the diagnosis and initial treatment phase and 16.9 h in the ongoing care phase. Under the base-case, average weekly time costs were <euro>295 (95 % CI 255-344) for hospital-related activities and <euro>630 (95 % CI 543-739) for domestic-related activities in the diagnosis and initial treatment phase and <euro>359 (95 % CI 293-434) in the ongoing care phase. PGA estimates were 23 % below the base-case. Only one alternative scenario (occupation and gender-specific wages for carers in paid work and replacement wages for non-working carers) surpassed base-case costs, and the difference was modest. CONCLUSIONS Overall, significant time is associated with informal caring in colorectal cancer. Different time valuation methods can produce quite different cost estimates. A standardised methodology for estimating informal care costs would facilitate better integration of these into economic evaluations.
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Affiliation(s)
- Paul Hanly
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
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Hanly P, Céilleachair AÓ, Skally M, O'Leary E, Kapur K, Fitzpatrick P, Staines A, Sharp L. How much does it cost to care for survivors of colorectal cancer? Caregiver's time, travel and out-of-pocket costs. Support Care Cancer 2013; 21:2583-92. [PMID: 23649879 PMCID: PMC6763575 DOI: 10.1007/s00520-013-1834-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/21/2013] [Indexed: 11/25/2022]
Abstract
Purpose Cancer treatment is increasingly delivered in an outpatient setting. This may entail a considerable economic burden for family members and friends who support patients/survivors. We estimated financial and time costs associated with informal care for colorectal cancer. Methods Two hundred twenty-eight carers of colorectal cancer survivors diagnosed on October 2007–September 2009 were sent a questionnaire. Informal care costs included hospital- and domestic-based foregone caregiver time, travel expenses and out-of-pocket (OOP) costs during two phases: diagnosis and treatment and ongoing care (previous 30 days). Multiple regression was used to determine cost predictors. Results One hundred fifty-four completed questionnaires were received (response rate = 68 %). In the diagnosis and treatment phase, weekly informal care costs per person were: hospital-based costs, incurred by 99 % of carers, mean = €393 (interquartile range (IQR), €131–€541); domestic-based time costs, incurred by 85 %, mean = €609 (IQR, €170–€976); and domestic-based OOP costs, incurred by 68 %, mean = €69 (IQR, €0–€110). Ongoing costs included domestic-based time costs incurred by 66 % (mean = €66; IQR, €0–€594) and domestic-based OOP costs incurred by 52 % (mean = €52; IQR, €0–€64). The approximate average first year informal care cost was €29,842, of which 85 % was time costs, 13 % OOP costs and 2 % travel costs. Significant cost predictors included carer age, disease stage, and survivor age. Conclusion Informal caregiving associated with colorectal cancer entails considerable time and OOP costs. This burden is largely unrecognised by policymakers, service providers and society in general. These types of studies may facilitate health decision-makers in better assessing the consequences of changes in cancer care organisation and delivery. Electronic supplementary material The online version of this article (doi:10.1007/s00520-013-1834-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul Hanly
- National Cancer Registry Ireland, Cork Airport Business Park, Kinsale Road, Cork, Ireland.
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Lathia N, Isogai PK, Walker SE, De Angelis C, Cheung MC, Hoch JS, Mittmann N. Eliciting patients' preferences for outpatient treatment of febrile neutropenia: a discrete choice experiment. Support Care Cancer 2012; 21:245-51. [PMID: 22684150 DOI: 10.1007/s00520-012-1517-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 05/28/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have demonstrated that patients at low risk for febrile neutropenia (FN) complications can be treated safely and effectively at home. Information on patient preferences for outpatient treatment of this condition will help to optimize health care delivery to these patients. The purpose of this study was to elicit non-Hodgkin lymphoma patients' preferences on attributes related to outpatient treatment of FN. METHODS We used a self-administered discrete choice experiment questionnaire based on the attributes of out-of-pocket costs, unpaid caregiver time required daily, and probability of return to the hospital. Ten paired scenarios in which levels of the attributes were varied were presented to study patients. For each pair, patients indicated the scenario they preferred. Adjusted odds ratios (ORs) of accepting a scenario that described outpatient care for FN were estimated. RESULTS Eighty-eight patients completed the questionnaire. Adjusted ORs [95 % confidence intervals] of accepting outpatient care for FN were 0.84 [0.75, 0.95] for each $10 increase in out-of-pocket cost; 0.82 [0.68, 0.99] for each 1 h increase in daily unpaid caregiver time; and 0.53 [0.50, 0.57] for each 5 % increase in probability of return to the hospital. CONCLUSIONS Probability of return to the hospital was the most important attribute to patients when considering home-based care for FN. Patients considered out-of-pocket costs and unpaid caregiver time to be less important than probability of return to the hospital. This study identifies factors that could be incorporated into outpatient delivery systems for FN care to ensure adequate patient uptake and satisfaction with such programs.
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Affiliation(s)
- Nina Lathia
- Department of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada.
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Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev 2012; 20:2006-14. [PMID: 21980008 DOI: 10.1158/1055-9965.epi-11-0650] [Citation(s) in RCA: 333] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The economic burden of cancer in the United States is substantial and expected to increase significantly in the future because of expected growth and aging of the population and improvements in survival as well as trends in treatment patterns and costs of care following cancer diagnosis. In this article, we describe measures of the economic burden of cancer and present current estimates and projections of the national burden of cancer in the United States. We discuss ongoing efforts to characterize the economic burden of cancer in the United States and identify key areas for future work including developing and enhancing research resources, improving estimates and projections of economic burden, evaluating targeted therapies, and assessing the financial burden for patients and their families. This work will inform efforts by health care policy makers, health care systems, providers, and employers to improve the cancer survivorship experience in the United States.
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Affiliation(s)
- K Robin Yabroff
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
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Hendricks AM, Loggers ET, Talcott JA. Costs of home versus inpatient treatment for fever and neutropenia: analysis of a multicenter randomized trial. J Clin Oncol 2011; 29:3984-9. [PMID: 21931037 DOI: 10.1200/jco.2011.35.1247] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE For patients with cancer who have febrile neutropenia, relative costs of home versus hospital treatment, including unreimbursed costs borne by patients and families, are poorly characterized. We estimated costs from a randomized trial of patients with low-risk febrile neutropenia for whom outpatient care was feasible, comparing inpatient treatment with discharge to home care after inpatient observation. METHODS We collected direct medical and self-reported indirect costs for 57 inpatient and 35 outpatient treatment episodes of patients enrolled in a randomized trial from 1996 through 2000. Charges from hospital bills were converted to costs using Medicare cost-to-charge ratios. Patients kept daily logs of out-of-pocket payments and time spent by informal caregivers providing care. Dollar amounts were standardized to June 2008. RESULTS Mean total charges for the hospital arm were 49% higher than for the home treatment arm ($16,341 v $10,977; P < .01). Mean estimated total costs for the hospital arm were 30% higher ($10,143 v $7,830; P < .01). Inspection of sparse available data suggests that payments made were similar by treatment arm. Inpatients and their caregivers spent more out of pocket than their outpatient counterparts (mean, $201 v $74; P < .01). Informal caregivers for both treatment arms reported similar time caring and lost from work. CONCLUSION Home intravenous antibiotic treatment was less costly than continued inpatient care for carefully selected patients with cancer having febrile neutropenia without significantly increased indirect costs or caregiver burden.
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Affiliation(s)
- Ann M Hendricks
- Health Care Financing & Economics, Veterans Administration Boston Healthcare System, Boston, MA 02130, USA.
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Amir Z, Wilson K, Hennings J, Young A. The meaning of cancer: implications for family finances and consequent impact on lifestyle, activities, roles and relationships. Psychooncology 2011; 21:1167-74. [PMID: 21769990 DOI: 10.1002/pon.2021] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 04/11/2011] [Accepted: 05/26/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study explores the impact that cancer-related financial hardship/worries can have on family life. METHODS Forty patients (19 male and 21 female) and 17 carers participated in a qualitative study, which drew on certain elements of grounded theory methods. Participants were 18 years or older and were accessed through a regional cancer centre, an acute National Health Service trust, a support group and the Macmillan Benefits Helpline. Interviews were transcribed verbatim and analysed thematically with the aid of nvivo 7 (QSR International, Cambridge, MA, USA). RESULTS Many participants said that prior to experiencing cancer, they had never thought about its effects on finances. The early part of the cancer journey was characterised by a need to be positive about the future, limited discussion about money within families and a lack of action in relation to finances. Many participants, especially those of working age, described cancer-related financial worries and difficulties that had impacted on family lifestyle, roles and relationships. Consequences included house repossession, bankruptcy, loss of independence and relationship breakdown. CONCLUSIONS Health and social care professionals have a role in prompting people affected by cancer to take stock of their finances early in the cancer trajectory, in order to avert knock-on effects. An approach that combines hope with proactivity is needed. More work into the long-term effects of financial difficulties/worries and specific financial issues that affect people from Black and minority ethnic backgrounds is needed.
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Affiliation(s)
- Ziv Amir
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
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Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: a narrative review. Eur J Oncol Nurs 2010; 15:302-10. [PMID: 21093369 DOI: 10.1016/j.ejon.2010.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 10/14/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To review out-of-pocket costs related to cancer that are borne by patients and their families. METHODS A literature search using key terms relating to out-of-pocket costs incurred by cancer patients and their families was undertaken to generate a comprehensive narrative synthesis of the information available. RESULTS Four themes were identified: measuring costs; sources of costs; the impact of costs and reducing costs. The wide variety of measures for ascertaining hidden costs makes comparison of findings difficult; some articles cover a very narrow range of costs. Qualitative research is useful for elucidating a wide range of costs. Costs pertaining to hospital visits, nutrition and clothing are widely mentioned. Low additional expenditure may indicate that needs/wants are going unmet. Financial capacity to cope and subjective perception of impact are important. Low income, younger age, chemotherapy and living rurally are associated with greater impact. Extra expense can exert long-term effects on family finances. Primary care follow-up, telemedicine and treatments that entail fewer visits may serve to reduce patient costs. CONCLUSIONS The key question is how to organise/deliver cancer care in order to reduce additional expenses to patients and families. Future research could identify critical time-points and demographic groups susceptible to significant additional costs, in order to target support at those most in need.
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Affiliation(s)
- Joanna Brooks
- Centre for Applied Psychological Research, University of Huddersfield, Queensgate, UK.
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Measurement challenges of informal caregiving: a novel measurement method applied to a cohort of palliative care patients. Soc Sci Med 2010; 71:1890-5. [PMID: 20884103 DOI: 10.1016/j.socscimed.2010.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 07/05/2010] [Accepted: 08/04/2010] [Indexed: 11/24/2022]
Abstract
Informal caregiving is a complex concept, and inconsistencies are found in the literature regarding how to measure it. The differences in tasks included in the definition of caregiving, as well as the different methods used to measure caregiving time may explain the huge variations in results found in the literature. The current paper aimed to lay out the challenges of how to calculate the time spent by informal caregivers on providing care and assistance to an ill person at home. It also proposes a method for measuring informal caregiving time, which attempts to distinguish between "normal" activities and "caregiving" activities. The proposed measurement method is then applied to a cohort of informal caregivers of palliative care patients. The illustration study revealed that this method brought advantages comparatively to other methods, and that persisting challenges remain in measuring informal caregiving time. We conclude that, the estimate of time spent caregiving for palliative care patients may be useful in guiding support programs for the families taking care of a loved one at home during the palliative phase of care.
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Van Houtven CH, Ramsey SD, Hornbrook MC, Atienza AA, van Ryn M. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist 2010; 15:883-93. [PMID: 20667966 DOI: 10.1634/theoncologist.2010-0005] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Informal care provides many benefits to cancer patients, but can be costly to caregivers. This study quantified the economic burden for informal caregivers of lung cancer (LC) and colorectal cancer (CRC) patients, examining differences by cancer type, phase of disease, stage at diagnosis, patient age, and relationship. METHODS A cross-sectional survey of caregivers of LC and CRC patients participating in the Share Thoughts on Care survey was conducted. Economic burden was calculated using the opportunity cost of caregiver time, the value of work hours lost, and out-of-pocket expenditures. Factors associated with economic burden to caregivers were modeled using fixed-effects generalized least squares estimation. RESULTS Informal caregivers (1,629) completed mailed surveys. Of these, 663, 822, and 144 were surveyed during the patient's initial phase (first year after diagnosis, not within 6 months of death), continuing phase (after 1 year, not within 6 months of death), and terminal phase (within 6 months of death) of disease, respectively. The accumulated economic burdens for caregivers were $7,028, $19,701, and $14,234 for those evaluated during the patient's initial phase, continuing phase, and terminal phase of disease, respectively. Economic burden was higher for caregivers of LC patients than CRC patients (p = .044) and for caregivers of patients diagnosed at stage 4 versus stage 1 (p = .001). Spouses faced higher economic burden than other relatives (p = .000) or friends (p = .000). CONCLUSIONS Economic burden for informal caregivers of LC and CRC patients is substantial and should be included in estimates of the societal cost of cancer care.
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Guerriere DN, Zagorski B, Fassbender K, Masucci L, Librach L, Coyte PC. Cost variations in ambulatory and home-based palliative care. Palliat Med 2010; 24:523-32. [PMID: 20348270 DOI: 10.1177/0269216310364877] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Restructuring health care in Canada has emphasized the provision of ambulatory and home-based palliative care. Acquiring economic evidence is critical given this trend and its tremendous demands on family caregivers. The purposes of this study were: 1) to comprehensively assess the societal costs of home-based palliative care; and 2) to examine the socio-demographic and clinical factors that account for variations in costs over the course of the palliative trajectory. One hundred and thirty-six family caregivers were interviewed every two weeks from time of palliative referral until death. Information regarding appointments, travel and out-of-pocket expenses, time devoted to caregiving, as well as demographic and clinical characteristics were measured. The mean monthly cost of care per patient was $24,549 (2008 CDN$). Family caregivers' time costs comprised most costs (70%). Multivariable linear regression indicated that costs were greater for patients who: had lower physical functioning (p < 0.001); lived with someone (p = 0.007); and when the patients approached death (p = 0.021). Information highlighting the variation in costs across individuals may aid policy makers and mangers in deciding how to allocate resources. Greater clarity regarding costs over the course of the palliative trajectory may improve access to care.
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Affiliation(s)
- Denise N Guerriere
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Lauzier S, Maunsell E, Drolet M, Coyle D, Hébert-Croteau N. Validity of information obtained from a method for estimating cancer costs from the perspective of patients and caregivers. Qual Life Res 2010; 19:177-89. [DOI: 10.1007/s11136-009-9575-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2009] [Indexed: 10/19/2022]
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Gupta R. Systems Perspective: Understanding Care Giving of the Elderly in India. Health Care Women Int 2009; 30:1040-54. [DOI: 10.1080/07399330903199334] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Syse A, Tretli S, Kravdal O. The impact of cancer on spouses' labor earnings: a population-based study. Cancer 2009; 115:4350-61. [PMID: 19731350 DOI: 10.1002/cncr.24582] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer affects patients' incomes, but to the authors' knowledge few studies to date have examined how the income of the patients' spouses may be influenced. In this population-based study from Norway, the effects of cancer on both partners' earnings are analyzed. METHODS The difference between labor earnings the year before the cancer diagnosis and that 2, 5, or 8 years later was compared with the difference in earnings over a corresponding period for similar persons without cancer, applying linear regression models to national registry data. Approximately 1.1 million married persons ages 35 to 59 years were included, among them 17,250 persons diagnosed with cancer during 1991 through 1999. RESULTS Two and 5 years after a cancer diagnosis, married men experienced lower earnings than they would have absent the illness. Cancer in wives, however, did not affect men's earnings. Women's earnings were adversely influenced to the same extent by their own as by their spouses' cancer. Brain, lung, and colorectal cancer in male spouses produced the most adverse effects on women's earnings. All effects were most pronounced for women no longer married. CONCLUSIONS Women's earnings are lower after both their own and their spouses' cancer illness, and divorced and widowed women experience the most pronounced reduction after spousal cancer. Men's earnings are lower only if they are diagnosed themselves. This may reflect traditional sex roles, with men as main breadwinners and women as caregivers. For family households, cancer in men may result in greater financial difficulties than cancer among women, although the effect will depend on breadwinner roles before diagnosis.
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Affiliation(s)
- Astri Syse
- Cancer Registry of Norway, Oslo, Norway.
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Yabroff KR, Kim Y. Time costs associated with informal caregiving for cancer survivors. Cancer 2009; 115:4362-73. [DOI: 10.1002/cncr.24588] [Citation(s) in RCA: 215] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Quattrin R, Artico C, Farneti F, Panariti M, Palese A, Brusaferro S. Study on the impact of caregivers in an Italian high specialization hospital: presence, costs and nurse’s perception. Scand J Caring Sci 2009; 23:328-33. [DOI: 10.1111/j.1471-6712.2008.00626.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Park SM, Kim YJ, Kim S, Choi JS, Lim HY, Choi YS, Hong YS, Kim SY, Heo DS, Kang KM, Jeong HS, Lee CG, Moon DH, Choi JY, Kong IS, Yun YH. Impact of caregivers' unmet needs for supportive care on quality of terminal cancer care delivered and caregiver's workforce performance. Support Care Cancer 2009; 18:699-706. [PMID: 19484480 DOI: 10.1007/s00520-009-0668-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Accepted: 05/19/2009] [Indexed: 11/26/2022]
Abstract
GOALS OF WORK Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood. PATIENTS AND METHODS We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL). RESULTS Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care. CONCLUSIONS Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged.
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Affiliation(s)
- Sang Min Park
- National Cancer Control Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, South Korea
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Garcés J, Carretero S, Ródenas F, Sanjosé V. Variables related to the informal caregivers’ burden of dependent senior citizens in Spain. Arch Gerontol Geriatr 2009; 48:372-9. [DOI: 10.1016/j.archger.2008.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/10/2008] [Accepted: 03/12/2008] [Indexed: 11/16/2022]
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Papastavrou E, Charalambous A, Tsangari H. Exploring the other side of cancer care: the informal caregiver. Eur J Oncol Nurs 2009; 13:128-36. [PMID: 19297245 DOI: 10.1016/j.ejon.2009.02.003] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 02/04/2009] [Accepted: 02/07/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify the caregiver outcomes among relatives caring for patients with cancer and to examine the patient and family caregiver variables that predicted for caregiver burden and depression. METHODS One hundred and thirty caregivers completed the Greek versions of the Burden Interview (BI), the Center of Epidemiology--Depression Scale (CES-D) and the Ways of Coping Questionnaire. Principal component analysis was performed to examine the underlying dimensions of caregiver outcome measures. One-way ANOVA and independent sample t-tests were used to test for differences in burden and depression in relation to demographic variables of interest. One-way ANOVA was used for examining differences in coping strategies. FINDINGS One-way ANOVA showed that there are significant differences among the various educational levels (p<0.001) and the income (p<0.005) of the caregiver in terms of overall burden. 66.4% of caregivers had a depression above the usual cutoff point for depression. An independent samples t-test for possible gender differences, showed that there is a significant difference between males and females (p=0.29). In regression analysis it was found that only caregiver's income and patient's age are statistically significant in predicting burden and depression. When considering high-burdened caregivers results showed that there are significant differences in the use of coping strategies (p<0.001). CONCLUSIONS Caregivers reported high levels of burden and depression. These outcomes of caregiving are related to several variables, but the caregiver's income and patient's age are predictive. Intervention strategies are needed to the vulnerable caregivers to help reduce burden and depression associated with caregiving.
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Affiliation(s)
- Evridiki Papastavrou
- School of Health Sciences, Department of Nursing, Cyprus University of Technology, 215 Dromos Lemesou, 2252 Latsia, Nicosia, Nicosia 2252, Cyprus.
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Kim Y, Wellisch DK, Spillers RL. Effects of psychological distress on quality of life of adult daughters and their mothers with cancer. Psychooncology 2009; 17:1129-36. [PMID: 18318454 DOI: 10.1002/pon.1328] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION As the population continues to age, adult daughters are more likely to be involved in caregiving. Given the fact that sharing emotional experiences is common in female relationships, (dis)similarity between mothers with cancer and their adult caregiving daughters is expected. However, the extent to which the (dis)similarity in psychological distress influences the quality of life of each person remains unknown. METHOD This study aims at addressing this concern, using a total of 98 mother-daughter dyads participating in the American Cancer Society's Study of Cancer Survivors-I and Quality of Life Survey for Caregivers. RESULTS Using the Actor Partner Interdependence Model, the results showed that although each person's psychological distress is the strongest predictor of their own quality of life, a mother's distress also plays a significant role in the daughter's quality of life. Specifically, when mothers experienced greater levels of psychological distress, the daughters reported better mental health but poorer physical health. CONCLUSIONS Our findings on the disproportionately strong association between psychological distress of mothers with cancer and their adult caregiving daughters' quality of life suggest that caregiving daughters may benefit from programs designed to assist them to cope better with their mothers' psychological distress when both are living with cancer.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, 250 Williams St., NW, Atlanta, GA 30303, USA.
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Tsu VD, Levin CE. Making the case for cervical cancer prevention: what about equity? REPRODUCTIVE HEALTH MATTERS 2008; 16:104-12. [DOI: 10.1016/s0968-8080(08)32411-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kim Y, Given BA. Quality of life of family caregivers of cancer survivors: across the trajectory of the illness. Cancer 2008; 112:2556-68. [PMID: 18428199 DOI: 10.1002/cncr.23449] [Citation(s) in RCA: 303] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cancer affects not only the quality of life (QOL) of individuals with the disease but also that of their family members and close friends. The impact on various aspects of the family caregivers' QOL is significant throughout the trajectory of the illness. The authors reviewed literature on the QOL of family caregivers at the acute and middle- to long-term survivorship phases as well as the bereavement phase. METHODS By using several databases, the authors searched the literature published in English from 1996 through July 2007. Keywords searched included cancer, carcinoma, family, family member, caregivers, and quality of life. Several criteria were used to guide the literature review: Articles had to be published in refereed journals and had to use rigorous methods, sample, and validated measures. RESULTS The findings suggested that the QOL of family caregivers of individuals with cancer varies along the illness trajectory. This highlights were importance of assessing the ongoing adjustment of the caregivers over time. However, there were few theory-driven studies, and significant gaps remain in the current understanding of the effects of family caregiving beyond the time of diagnosis and treatment. CONCLUSIONS Accumulating evidence has supported the concept that cancer affects not only the patients/survivors but also their family members. However, theoretically and methodologically rigorous research on various aspects of the family's QOL, including not only the psychological but also the physical, spiritual, and behavioral adjustment to cancer in the family, remains sparse. Family-based interventions across the trajectory of the illness also are needed.
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Affiliation(s)
- Youngmee Kim
- Behavioral Research Center, American Cancer Society, Atlanta, Georgia 30303-1002, USA.
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Guerriere DN, Wong AYM, Croxford R, Leong VW, McKeever P, Coyte PC. Costs and determinants of privately financed home-based health care in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:126-136. [PMID: 18290978 DOI: 10.1111/j.1365-2524.2007.00732.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.
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Affiliation(s)
- Denise N Guerriere
- Department of Health Policy, Management and Evaluation, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
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Gordon L, Scuffham P, Hayes S, Newman B. Exploring the economic impact of breast cancers during the 18 months following diagnosis. Psychooncology 2008; 16:1130-9. [PMID: 17345557 DOI: 10.1002/pon.1182] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The economic impact on individuals with breast cancer is not well understood. We sought to identify and describe the direct and indirect economic losses to breast cancer survivors in Australia. A longitudinal, population-based study of 287 women was used to explore economic outcomes (costs and lost income) for women with breast cancer 0-18 months post-diagnosis. Survey methods collected data on out-of-pocket costs, care-giving support, paid and unpaid work reductions, and perceptions from participants on these financial impacts. Bootstrapping was used to estimate 95% confidence intervals around means. Data were sub-grouped by cost type, age category and disease severity. Lost income, health service expenditures and lost unpaid work were the greatest sources of economic burden. Women with positive lymph nodes reported significantly higher costs than those with negative lymph nodes (US$6674 versus US$3533, p<0.001), and younger women (< or =50 years) with positive lymph nodes experienced costs 80% greater than older women (US$8880 versus US$4937, p<0.001). Economic costs related to breast cancer may continue to affect women 18 months post-diagnosis. Economic research adds an important dimension for understanding the impact of breast cancer, and findings may be used to help improve supportive care services for women and families confronted by this disease.
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Affiliation(s)
- Louisa Gordon
- Viertel Centre for Research in Cancer Control, Queensland Cancer Fund, Spring Hill, Brisbane, Australia.
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Francoeur RB. The influence of age on perceptions of anticipated financial inadequacy by palliative radiation outpatients. PATIENT EDUCATION AND COUNSELING 2007; 69:84-92. [PMID: 17766078 PMCID: PMC2243225 DOI: 10.1016/j.pec.2007.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 07/16/2007] [Accepted: 07/22/2007] [Indexed: 05/17/2023]
Abstract
OBJECTIVE A consistent body of knowledge suggests that with advancing age, adults tend to report lower financial strain from their current economic condition. But are more negative perceptions shifted onto their expectations about their future economic condition? This study of seriously ill outpatients investigates whether advancing age is related to more negative expectations of future health-related financial strain, in which illness progression would necessitate greater health care consumption. METHODS Ordinal probit multivariate regression was conducted on survey findings from 268 outpatients initiating palliative radiation for recurrent cancer. Half were retirees age>/=65. Age comparisons are reported when there was no recent work transition. RESULTS As age advances (from 40 to 84), outpatients incurring low objective financial stress were more likely to reveal that their health insurance and finances would be less adequate to meet future health needs. CONCLUSION Previously, these outpatients were reported to minimize perceptions of current financial strain as age advances. Therefore, older outpatients may cope with current circumstances by displacing perceptions of financial inadequacy onto plausible future situations of cancer progression demanding greater healthcare consumption. PRACTICE IMPLICATIONS Financial strain may be hidden in older outpatients initiating palliative radiation. These outpatients appear at risk of foregoing appropriate healthcare. Targeted screening and advocacy are warranted.
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Affiliation(s)
- Richard B Francoeur
- Adelphi University School of Social Work, 1 South Avenue, Box 701, Garden City, NY 11530, United States.
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LONGO C, DEBER R, FITCH M, WILLIAMS A, D’SOUZA D. An examination of cancer patients’ monthly ‘out-of-pocket’ costs in Ontario, Canada. Eur J Cancer Care (Engl) 2007; 16:500-7. [DOI: 10.1111/j.1365-2354.2007.00783.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yabroff KR, McNeel TS, Waldron WR, Davis WW, Brown ML, Clauser S, Lawrence WF. Health limitations and quality of life associated with cancer and other chronic diseases by phase of care. Med Care 2007; 45:629-37. [PMID: 17571011 DOI: 10.1097/mlr.0b013e318045576a] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate health limitations and health-related quality of life (HRQL) associated with cancer and other chronic conditions in a nationally representative sample within a phase-of-care framework. STUDY DESIGN AND SETTING We used a nested case-control design to assess health limitations and HRQL in individuals reporting a breast, colorectal, prostate, or lung cancer diagnosis, or a diagnosis of arthritis, diabetes, heart disease, or hypertension compared with similar controls without these conditions. All subjects were selected from the 1986-1994 National Health Interview Surveys linked to mortality files in 1995, and classified into the initial, continuing, or last year of life phase of care. Health limitations and HRQL were compared for cases and controls for each condition with 2-sided statistical tests. RESULTS Across all conditions, individuals in the last year of life phase of care reported greater health limitations and lower HRQL, as measured by the Health Activities and Limitations Index (HALex), than did individuals in the initial and continuing phases of care. Compared with their matched controls, individuals with cancer or other chronic conditions were more likely to report health limitations and lower mean HALex values in the initial, continuing, and last year of life phases of care (P < 0.05). CONCLUSIONS We observed greater health limitations and lower HRQL associated with cancer and other chronic diseases compared with similar individuals without these conditions. The phase-of-care framework used in this study seems to be applicable to the assessment of HRQL for cancer and other chronic diseases.
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Affiliation(s)
- K Robin Yabroff
- Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, Bethesda, MD 20892, USA.
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