Financial toxicity among head and neck cancer patients and their caregivers: A cross-sectional pilot study

Financial Toxicity in Dementia Caregiving: Sociodemographic Predictors in a U.S. Nationally Representative Survey

BACKGROUND AND OBJECTIVES

"Financial toxicity" describes the negative effects of medical expenses on financial security and health-related quality of life. Beyond dementia, financial toxicity is used to address the financial and health consequences of illness. Here, we utilize the COmprehensive Score for financial Toxicity (COST) to examine the experience of financial toxicity in dementia caregiving.

RESEARCH DESIGN AND METHODS

We conducted a nationally representative survey of 317 dementia caregivers. Financial toxicity was defined as COST<26 and categorized as mild (COST ≥14 and <26), moderate (COST >0 and <14), or severe (COST = 0). Nested multivariable regression examined potential predictors of financial toxicity. Mediation analyses were performed to assess whether the influence of basic caregiver demographic predictors was mediated by care recipient clinical characteristics, caregiver socioeconomic demographics, or relational characteristics.

RESULTS

52.7% of dementia caregivers in the United States experience financial toxicity. Of those, 73.1% endure mild, 25.7% moderate, and 1.2% severe toxicity. 69.5% of Black, 54.1% of Hispanic, and 42.3% of White caregivers report financial toxicity, with prevalence significantly higher in Black caregivers compared to White caregivers (p = .017). Older caregiver age was associated with less financial toxicity (p = .024). Caregiver employment status mediated this effect, with retirement associated with less financial toxicity (p < .001) and unemployment associated with greater financial toxicity (p < .001).

DISCUSSION AND IMPLICATIONS

Most dementia caregivers in the United States experience financial toxicity, with Black caregivers bearing the highest risk. Older caregiver age protects against financial toxicity, reflecting the relationship between age and employment status.

Uncovering Care Challenges for Head and Neck Cancer Patients and Caregivers in the United States: A Scoping Review

Individuals undergoing treatment for head and neck cancer (HNC) face numerous challenges, including financial and food insecurity, which affect both the patients and their caregivers. This scoping review explores and consolidates the current literature addressing the care challenges experienced by HNC patients and their caregivers. Eligible studies were identified through a search of MEDLINE and Embase databases. The scoping review was conducted in accordance with Arksey and O'Malley's five-stage methodology and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Data extraction and analysis were performed using a thematic approach. The inclusion criteria encompassed full-text articles published in English that examined challenges faced by both adult HNC patients and caregivers as primary outcomes in the United States. Eligible studies underwent assessment using the Covidence data screening and extraction tool. Information encompassing general study details, article characteristics, and scoping review-relevant details were extracted through Research Electronic Data Capture (REDCap). Out of the 822 articles initially identified, 40 met the inclusion criteria. The majority of these comprised descriptive surveys (n = 23; 54%), retrospective chart reviews (n = 7; 18%), cross-sectional studies (n = 6; 15%), and prospective cohort studies (n = 13). Within the included studies, the majority of the studies (n = 36) concentrated on quantifying and describing the financial toxicity and out-of-pocket costs experienced by patients with HNC. Two articles concentrated on challenges associated with providing nutritional care to patients with HNC. Additionally, four studies explored the quality of life and the burden experienced by caregivers of patients undergoing treatment for HNC. Despite the existing body of literature addressing the financial challenges faced by patients with HNC, a noticeable gap exists in the literature concerning challenges related to providing nutritional care and the obstacles faced by caregivers in delivering care to this population. This scoping review offers a comprehensive overview of these challenges and the literature's current focus on addressing them. The findings emphasize the necessity for further research to gain a deeper understanding of the experiences of both patients and caregivers, evaluate the impact of interventions, and bridge knowledge gaps. Ultimately, such endeavors will contribute to enhancing the quality of care and support for individuals affected by HNC.

Pre-Surgical Education and Discharge Planning for Head and Neck Cancer: A Qualitative Study of Patient and Caregiver Perspectives

IntroductionResearch on pre-surgical education and discharge planning for head and neck cancer (HNC) remains limited. To address this gap, this qualitative study aims to assess patient and caregiver perspectives on pre-surgical education and discharge planning in HNC surgery.Methods and MaterialsSemi-structured interviews were conducted with 13 individuals who received HNC surgery and 10 of their caregivers after hospital discharge. Participants were recruited from an NCI-designated Comprehensive Cancer Center and a community oncology setting.ResultsFive key recommendations for HNC surgical care emerged from the data: (1) improve communication about anticipated side effects; (2) provide targeted education through multiple modalities; (3) connect patients and caregivers with individuals who have gone through HNC surgery; (4) improve patient-provider communication for individuals with speech, vision, and hearing impairment; and (5) present the best and worst case scenarios to prepare individuals for post-surgical recovery. ConclusionParticipants identified gaps in pre-surgical education and discharge planning and provided recommendations to improve HNC surgical care.

Screening for Financial Toxicity Among Patients With Cancer: A Systematic Review

OBJECTIVE

Despite the pervasiveness and adverse impacts of financial toxicity (FT) in cancer care, there are no definitive measures for FT screening that have been widely integrated into clinical practice. The aim of this review is to evaluate current methods of assessing FT among patients with cancer and confirm factors associated with higher risk of FT.

METHODS

A systematic review was performed according to PRISMA guidelines. We included peer-reviewed studies that cross-sectionally, longitudinally, or prospectively measured the self-reported financial impact of patients undergoing cancer care in the United States.

RESULTS

Out of 1,085 identified studies, 51 met final inclusion criteria. Outcomes evaluated included FT measures or tools, time and setting of screening, FT prevalence, and sociodemographic or clinical patient-level associated factors. Our findings demonstrate that there is wide variability in FT screening practices including in the timing (diagnosis versus treatment versus survivorship), setting (clinic-based, online, telephone or mail), tools used (21 unique tools, 7 previously validated), and interpretations of screening results (varying FT score cutoffs defining high versus low FT). Younger age, lower income, lower education, non-White race, employment status change, advanced cancer stage, and systemic or radiation therapy were among factors associated with worse FT across the studies.

DISCUSSION

FT screening remains heterogenous within the United States. With the ever-escalating cost of cancer care, and the strong association between FT and poor patient outcomes, universal and routine FT screening is imperative in cancer care. Further research and multifaceted interventions identifying best practices for FT screening are needed.

Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study

PURPOSE

Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers.

METHODS

This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants (N = 33) were survivors of HNC who completed a full course of chemoradiation (n = 20) and HNC healthcare providers (n = 13). Participants completed electronic surveys and semi-structured interviews.

RESULTS

Survivors were M = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction.

CONCLUSION

Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.