1
|
Sadigh G, Duan F, An N, Gareen ID, Sicks J, Suga JM, Kehn H, Mehan PT, Bajaj R, Hanson DS, Dalia SM, Acoba JD, Yasar DG, Taylor MA, Park E, Wagner LI, Kircher SM, Carlos RC. Financial Hardship Among Patients With Early-Stage Colorectal Cancer. JAMA Netw Open 2024; 7:e2431967. [PMID: 39287948 DOI: 10.1001/jamanetworkopen.2024.31967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
Importance The degree of cancer patients' financial hardship is dynamic and can change over time. Objective To assess longitudinal changes in financial hardship among patients with early-stage colorectal cancer. Design, Setting, and Participants In this prospective longitudinal cohort study, English-speaking adult patients with a new diagnosis of stage I to III colorectal cancer being treated with curative intent at National Cancer Institute (NCI) Community Oncology Research Program (NCORP) practices between May 2018 and July 2020 and who had not started chemotherapy and/or radiation were included. Data analysis was conducted from March to December 2023. Main Outcomes and Measures Patients completed surveys at baseline as well as at 3, 6, 12, and 24 months after enrollment. Cost-related care nonadherence and material hardship, as adopted by Medical Expenditure Panel Survey, were measured. Factors associated with financial hardship were assessed using longitudinal multivariable logistic regression models with time interaction. Results A total of 451 patients completed baseline questions, with 217 (48.1%) completing the 24-month follow-up. Mean (SD) age was 61.0 (12.0) years (210 [46.6%] female; 33 [7.3%] Black, 380 [84.3%] White, and 33 [7.3%] American Indian or Alaska Native, Asian, multiracial, or Native Hawaiian or Other Pacific Islander individuals or those who did not report race or who had unknown race). Among 217 patients with data at baseline and 24 months, 19 (8.8%) reported cost-related care nonadherence at baseline vs 20 (9.2%) at 24 months (P = .84), and 125 (57.6%) reported material hardship at baseline vs 76 (35.0%) at 24 months (P < .001). In multivariable analysis, lower financial worry (odds ratio [OR], 0.90; 95% CI, 0.87-0.93), higher education (OR, 0.34; 95% CI, 0.15-0.77), and older age (OR, 0.94; 95% CI, 0.91-0.98) were associated with lower nonadherence. Receipt of chemotherapy was associated with higher material hardship (OR, 2.68; 95% CI, 1.15-6.29), while lower financial worry was associated with lower material hardship (OR, 0.83; 95% CI, 0.80-0.96). Over 24 months, female sex was associated with lower nonadherence (OR, 0.90; 95% CI, 0.85-0.96), while higher education was associated with higher nonadherence (OR, 1.09; 95% CI, 1.03-1.17). Being employed was associated with lower material hardship (OR, 0.85; 95% CI, 0.78-0.93), while receipt of care at safety-net hospitals was associated with higher hardship (OR, 1.09; 95% CI, 1.01-1.17). Conclusions and Relevance In patients with early-stage colorectal cancer, material hardship was more common than cost-related cancer care nonadherence and decreased over time, while nonadherence remained unchanged. Early and longitudinal financial screening and referral to intervention are recommended to mitigate financial hardship.
Collapse
Affiliation(s)
| | - Fenghai Duan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Na An
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana D Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - JoRean Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Jennifer M Suga
- Kaiser Permanente NCI Community Oncology Research Program and NCORP, Vallejo, California
| | - Heather Kehn
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park
| | | | - Rajesh Bajaj
- Carolina Health Care and NCORP, Florence, South Carolina
| | | | | | | | | | | | - Elyse Park
- Massachusetts General Hospital Cancer Center, Boston
| | - Lynne I Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Sheetal M Kircher
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Ruth C Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor
| |
Collapse
|
2
|
Huang H, Yang Z, Dong Y, Wang YQ, Wang AP. Cancer cost-related subjective financial distress among breast cancer: a scoping review. Support Care Cancer 2024; 32:484. [PMID: 38958768 DOI: 10.1007/s00520-024-08698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This article provided a comprehensive scoping review, synthesizing existing literature on the financial distress faced by breast cancer patients. It examined the factors contributing to financial distress, the impact on patients, coping mechanisms employed, and potential alleviation methods. The goal was to organize existing evidence and highlight possible directions for future research. METHODS We followed the scoping review framework proposed by the Joanna Briggs Institute (JBI) to synthesize and report evidence. We searched electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, for relevant literature. We included English articles that met the following criteria: (a) the research topic was financial distress or financial toxicity, (b) the research subjects were adult breast cancer patients, and (c) the article type was quantitative, qualitative, or mixed-methods research. We then extracted and integrated relevant information for reporting. RESULTS After removing duplicates, 5459 articles were retrieved, and 43 articles were included based on the inclusion and exclusion criteria. The articles addressed four main themes related to financial distress: factors associated with financial distress, impact on breast cancer patients, coping mechanisms, and potential methods for alleviation. The impact of financial distress on patients was observed in six dimensions: financial expenses, financial resources, social-psychological reactions, support seeking, coping care, and coping lifestyle. While some studies reported potential methods for alleviation, few discussed the feasibility of these solutions. CONCLUSIONS Breast cancer patients experience significant financial distress with multidimensional impacts. Comprehensive consideration of possible confounding factors is essential when measuring financial distress. Future research should focus on exploring and validating methods to alleviate or resolve this issue.
Collapse
Affiliation(s)
- Hao Huang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Zhen Yang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Yu Dong
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Yu Qi Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Ai Ping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
| |
Collapse
|
3
|
Waters AR, Petermann VM, Planey AM, Manning M, Spencer JC, Spees LP, Rosenstein DL, Gellin M, Padilla N, Reeder-Hayes KE, Wheeler SB. Financial burden among metastatic breast cancer patients: a qualitative inquiry of costs, financial assistance, health insurance, and financial coping behaviors. Cancer Causes Control 2024; 35:955-961. [PMID: 38388859 PMCID: PMC11129926 DOI: 10.1007/s10552-024-01854-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Metastatic breast cancer (MBC) patients often face substantial financial burden due to prolonged and expensive therapy. However, in-depth experiences of financial burden among MBC patients are not well understood. METHODS Qualitative interviews were conducted to describe the experiences of financial burden for MBC patients, focusing on the drivers of financial burden, their experience using their health insurance, accessing financial assistance, and any resulting cost-coping behaviors. Interviews were transcribed and qualitatively analyzed using a descriptive phenomenological approach to thematic analysis. RESULTS A total of n = 11 MBC patients or caregiver representatives participated in the study. MBC patients were on average 50.2 years of age (range: 28-65) and 72.7% non-Hispanic White. MBC patients were diagnosed as metastatic an average of 3.1 years (range: 1-9) before participating in the study. Qualitative analysis resulted in four themes including (1) causes of financial burden, (2) financial assistance mechanisms, (3) health insurance and financial burden, and (4) cost-coping behaviors. Both medical and non-medical costs drove financial burden among participants. All participants reported challenges navigating their health insurance and applying for financial assistance. Regardless of gaining access to assistance, financial burden persisted for nearly all patients and resulted in cost-coping behaviors. CONCLUSION Our findings suggest that current systems for health insurance and financial assistance are complex and difficult to meet patient needs. Even when MBC patients accessed assistance, excess financial burden persisted necessitating use of financial coping-behaviors such as altering medication use, maintaining employment, and taking on debt.
Collapse
Affiliation(s)
- Austin R Waters
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Victoria M Petermann
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Arrianna Marie Planey
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle Manning
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lisa P Spees
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald L Rosenstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mindy Gellin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neda Padilla
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Ghazal LV, Doran J, Bryant M, Zebrack B, Liang MI. Evaluation of a Conference on Cancer-Related Financial and Legal Issues: A Potential Resource to Counter Financial Toxicity. Curr Oncol 2024; 31:2817-2835. [PMID: 38785495 PMCID: PMC11119701 DOI: 10.3390/curroncol31050214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
This study describes the conception, development, and growth of the Triage Cancer Conference hosted by Triage Cancer, a national nonprofit organization providing free legal and financial education to the cancer community. We conducted a retrospective analysis of post-conference participant surveys. Descriptive statistics were calculated for participant demographics, and acceptability, feasibility, and appropriateness were evaluated. From 2016-2021, 1239 participants attended the conference and completed post-conference surveys. Participants included social workers (33%), nurses (30%), and cancer patients/survivors (21%), with representation from over 48 states. Among those who reported race, 16% were Black, and 7% were Hispanic. For acceptability, more than 90% of participants felt that the conference content, instructors, and format were suitable and useful. For feasibility, more than 90% of participants felt that the material was useful, with 93-96% reporting that they were likely to share the information and 98% reporting that they would attend another triage cancer event. Appropriateness was also high, with >80-90% reporting that the sessions met the pre-defined objectives. Triage Cancer fills an important gap in mitigating financial toxicity, and formal evaluation of these programs allows us to build evidence of the role and impact of these existing resources. Future research should focus on adding validated patient-reported outcomes, longer-term follow-up, and ensuring inclusion and evaluation of outcome metrics among vulnerable populations.
Collapse
Affiliation(s)
- Lauren V. Ghazal
- School of Nursing, University of Rochester, Rochester, NY 14642, USA
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Joanna Doran
- Triage Cancer, Chicago, IL 60646, USA; (J.D.); (M.B.)
| | - Monica Bryant
- Triage Cancer, Chicago, IL 60646, USA; (J.D.); (M.B.)
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Margaret I. Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
| |
Collapse
|
5
|
Ehsan AN, Wu CA, Minasian A, Bass M, Sana H, Patel A, Pace L, Mekary RA, Ranganathan K. Evaluation of Financial Interventions in Breast Cancer Care Worldwide: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5683. [PMID: 38784829 PMCID: PMC11115981 DOI: 10.1097/gox.0000000000005683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/30/2024] [Indexed: 05/25/2024]
Abstract
Background Out-of-pocket costs are burdensome for breast cancer patients. Cost-reducing interventions, though implemented, have unclear comparative efficacy. This study aimed to critically evaluate characteristics of successful versus unsuccessful interventions designed to decrease out-of-pocket costs for breast cancer patients. Methods A systematic review was conducted in accordance with the PRISMA checklist. Embase, PubMed, Global Index Medicus, and Global Health were queried from inception to February 2021. Articles describing a financial intervention targeting costs for breast cancer screening, diagnosis, or treatment and addressing clinical or patient-level financial outcomes were included. Methodological quality was evaluated using the QualSyst tool. Interventions were organized in accordance with timing of implementation, with narrative description of intervention type, success, and outcomes. Results Of the 11,086 articles retrieved, 21 were included in this review. Of these, 14 consisted of interventions during screening, and seven during diagnosis or treatment. Free/subsidized screening mammography was the most common screening intervention; 91% of these programs documented successful outcomes. Patient navigation and gift voucher programs demonstrated mixed success. The most successful intervention implemented during diagnosis/treatment was reducing medication costs. Low-cost programs and direct patient financial assistance were also successful. Limitations included lack of standardization in outcome metrics across studies. Conclusions Financial interventions reducing prices through free screening mammography and decreasing medication costs were most successful. Less successful interventions were not contextually tailored, including gift card incentivization and low-cost treatment modalities. These findings can facilitate implementation of broader, more generalizable programs to reduce costs and improve outcomes during evaluation and management of breast cancer.
Collapse
Affiliation(s)
- Anam N. Ehsan
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
- Brigham and Women’s Hospital, Boston, Mass
| | | | | | - Michelle Bass
- Countway Library of Medicine, Harvard Medical School, Boston, Mass
| | - Hamaiyal Sana
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
| | | | - Lydia Pace
- Brigham and Women’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
| | - Rania A. Mekary
- Brigham and Women’s Hospital, Boston, Mass
- School of Pharmacy, MCPHS University, Boston, Mass
| | - Kavitha Ranganathan
- From the Program in Global Surgery and Social Change, Harvard Medical School, Boston, Mass
- Brigham and Women’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
| |
Collapse
|
6
|
Ragavan MV, Swartz S, Clark M, Chino F. Pharmacy Assistance Programs for Oral Anticancer Drugs: A Narrative Review. JCO Oncol Pract 2024; 20:472-482. [PMID: 38241597 DOI: 10.1200/op.23.00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/20/2023] [Accepted: 11/28/2023] [Indexed: 01/21/2024] Open
Abstract
Oral anticancer medications (OAMs) are high priced with a significant cost-sharing burden to patients, which can lead to catastrophic financial, psychosocial, and clinical repercussions. Cost-conscious prescribing and inclusion of low-cost alternatives can help mitigate this burden, but cost transparency at the point of prescribing remains a major barrier to doing so. Pharmacy assistance programs, including co-payment cards and patient assistance programs administered by manufacturers and foundation-based grants, remain an essential resource for patients facing prohibitive co-payments for OAMs. However, access to these programs is fraught with complexities, including lack of trained financial navigators, limited transparency on eligibility criteria, onerous documentation burdens, and limits in available funding. Despite these drawbacks and the potential for such programs to incentivize manufacturers to keep list prices high, assistance programs have been demonstrated to improve financial well-being for patients with cancer. The increasing development of integrated specialty pharmacies with dedicated, trained pharmacy staff can help improve and standardize access to such programs, but these services are disproportionately available to patients seen at tertiary care centers. Multistakeholder interventions are needed to mitigate the burden of cost sharing for OAMs, including increased clinician knowledge of financial resources and novel assistance mechanisms, investment of institutions in trained financial navigation services and centralized platforms to identify assistance programs, and policies to cap out-of-pocket spending and improve transparency of rates charged by pharmacy benefit managers to a health plan.
Collapse
Affiliation(s)
- Meera V Ragavan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Scott Swartz
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Mackenzie Clark
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
7
|
Ragavan MV, Swartz S, Clark M, Lo M, Gupta A, Chino F, Lin TK. Access to Financial Assistance Programs and Their Impact on Overall Spending on Oral Anticancer Medications at an Integrated Specialty Pharmacy. JCO Oncol Pract 2024; 20:291-299. [PMID: 38175987 DOI: 10.1200/op.23.00446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 11/15/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE Financial assistance (FA) programs are increasingly used to help patients afford oral anticancer medications (OAMs), but access to such programs and their impact on out-of-pocket (OOP) spending has not been well explored. This study aimed to (1) characterize the impact of receipt of FA on both OOP spending and likelihood of catastrophic spending on OAMs and (2) evaluate racial/ethnic disparities in access to FA programs. METHODS Patients with a cancer diagnosis prescribed an OAM anytime between January 1, 2021, and December 31, 2021 were included in this retrospective, single-center study at an integrated specialty pharmacy affiliated with a tertiary academic cancer center. Fixed-effect regression models were used to characterize the impact of receipt of FA on overall spending and likelihood of catastrophic spending on OAMs, as well as explore the association of race/ethnicity with receipt of FA. RESULTS Across 1,186 patients prescribed an OAM, 37% received FA. Receipt of FA was associated with lower annual spending on OAMs (β = -$1,236 US dollars [USD; 95% CI, -$1,841 to -$658], P < .001) but not reduced risk of catastrophic spending (odds ratio [OR], 0.442 [95% CI, 0.755 to 3.199], P = .23). Non-White patients (OR, 0.60 [95% CI, 0.43 to 0.85], P = .004) and patients who spoke English as a second language (OR, 0.46 [95% CI, 0.23 to 0.90], P = .02) were less likely to receive FA compared with White and English-speaking patients, respectively. CONCLUSION FA programs can mitigate high OOP spending but not for patients who spend at catastrophic levels. There are racial/ethnic and language disparities in access to such programs. Future studies should evaluate access to FA programs across diverse delivery settings.
Collapse
Affiliation(s)
- Meera V Ragavan
- University of California, San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA
| | - Scott Swartz
- University of California, San Francisco, School of Medicine, San Francisco, CA
| | - Mackenzie Clark
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Mimi Lo
- University of California, San Francisco, School of Pharmacy, San Francisco, CA
| | - Arjun Gupta
- University of Minnesota, Department of Internal Medicine, Minneapolis, MN
| | - Fumiko Chino
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY
| | - Tracy Kuo Lin
- University of California, San Francisco, Institute for Health and Aging, School of Nursing, San Francisco, CA
| |
Collapse
|
8
|
Lee K, Jun HS. Health-related quality of life of premenopausal young breast cancer survivors undergoing endocrine therapy. Eur J Oncol Nurs 2024; 68:102496. [PMID: 38194899 DOI: 10.1016/j.ejon.2023.102496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/19/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The incidence of breast cancer in premenopausal women in South Korea is higher compared to the West. This study aimed to identify factors associated with the health-related quality of life (HRQoL) among survivors with premenopausal young breast cancer undergoing endocrine therapy by examining the effects of menopausal symptoms, social support, and resilience on HRQoL. METHODS Cross-sectional study was used to select survivors with breast cancer undergoing endocrine therapy. The study instruments used included a basic information questionnaire, Menopause Rating Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Health-Related Quality of Life Instrument with 8 items. Researchers utilized independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression to analyze the data. The data were collected from August to September 2021, and the questionnaire was administered via a link posted on a bulletin board of an online breast cancer survivors community. Finally, 133 questionnaires were included in the final analysis. RESULTS Among 150 participants, 133 completed the questionnaires. HRQoL was higher in the groups with a monthly income of ≥5 million KRW (β = 0.231, p = .011), fewer menopausal symptoms (β = -0.399, p < .001), and higher social support (β = 0.170, p = .038), and lower in the group receiving endocrine therapy and OFS (β = -0.192, p = .010). The explanatory power for HRQoL of premenopausal young breast cancer survivors undergoing endocrine therapy was 38.3% (F = 10.634, p < .001). CONCLUSION Breast cancer survivors should be supported to participate in economic activity, utilize rehabilitation and intervention programs to alleviate menopausal symptoms, and benefit from a social support network formed by the hospital, community, and government.
Collapse
Affiliation(s)
- Kyungmi Lee
- College of Nursing, Baekseok University, Cheonan, Republic of Korea
| | - Hye Suk Jun
- Department of Nursing, Hallym University, Kangdong Sacred Heart Hospital, Seoul, South Korea.
| |
Collapse
|
9
|
Nazari E, Naderi H, Tabadkani M, ArefNezhad R, Farzin AH, Dashtiahangar M, Khazaei M, Ferns GA, Mehrabian A, Tabesh H, Avan A. Breast cancer prediction using different machine learning methods applying multi factors. J Cancer Res Clin Oncol 2023; 149:17133-17146. [PMID: 37773467 DOI: 10.1007/s00432-023-05388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE Breast cancer (BC) is a multifactorial disease and is one of the most common cancers globally. This study aimed to compare different machine learning (ML) techniques to develop a comprehensive breast cancer risk prediction model based on features of various factors. METHODS The population sample contained 810 records (115 cancer patients and 695 healthy individuals). 45 attributes out of 85 were selected based on the opinion of experts. These selected attributes are in genetic, biochemical, biomarker, gender, demographic and pathological factors. 13 Machine learning models were trained with proposed attributes and coefficient of attributes and internal relationships were calculated. RESULT Compared to other methods random forest (RF) has higher performance (accuracy 99.26%, precision 99%, and area under the curve (AUC) 99%). The results of assessing the impact and correlation of variables using the RF method based on PCA indicated that pathology, biomarker, biochemistry, gene, and demographic factors with a coefficient of 0.35, 0.23, 0.15, 0.14, and 0.13 respectively, affected the risk of BC (r2 = 0.54). CONCLUSION Breast cancer has several risk factors. Medical experts use these risk factors for early diagnosis. Therefore, identifying related risk factors and their effect can increase the accuracy of diagnosis. Considering the broad features for predicting breast cancer leads to the development of a comprehensive prediction model. In this study, using RF technique a breast cancer prediction model with 99.3% accuracy was developed based on multifactorial features.
Collapse
Affiliation(s)
- Elham Nazari
- Faculty of Medicine, Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Naderi
- Faculty of Medicine, Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Tabadkani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza ArefNezhad
- Halal Research Center of IRI, FDA, Tehran, Iran
- Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Majid Khazaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton & Sussex Medical School, Falmer, Brighton, BN1 9PH, Sussex, UK
| | - Amin Mehrabian
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Hamed Tabesh
- Faculty of Medicine, Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
- College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq.
| |
Collapse
|
10
|
Thom B, Arora N, Benedict C, Aviki EM, Chino F, Friedman DN, Watson SE, Zeitler MS. Using Real-World Data to Explore the Impact of One-Time Financial Grants Among Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2023; 12:912-917. [PMID: 37852000 PMCID: PMC10739788 DOI: 10.1089/jayao.2022.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Young adult (YA) cancer survivors experience worse financial outcomes than older survivors. This analysis used data from Expect Miracles Foundation to explore the impact of one-time financial grants on financial well-being and access to health care. Among 300 respondents, the average grant was $1526 (standard deviation = $587; range $300-$3000). Respondents reported improved ability to pay expenses (t = 4.45, p < 0.001), increased financial decision-making power (t = 2.79, p = 0.06), decreased medical debt impact (t = 2.1, p = 0.04), improved transportation access (t = 2.38, p = 0.02), and fewer challenges in accessing care (t = 3.0, p = 0.005) 6 months after receiving a financial grant. Financial assistance offers YAs an opportunity to meet medical and nonmedical expenses.
Collapse
Affiliation(s)
- Bridgette Thom
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neha Arora
- Texas A&M School of Medicine, College Station, Texas, USA
| | - Catherine Benedict
- Stanford University School of Medicine, Stanford Cancer Institute, Palo Alto, California, USA
| | - Emeline M. Aviki
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Fumiko Chino
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danielle N. Friedman
- Thom, Aviki, Friedman, Chino: Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | |
Collapse
|
11
|
Çeli K Y, Çeli K SŞ, Sarıköse S, Arslan HN. Evaluation of financial toxicity and associated factors in female patients with breast cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:691. [PMID: 37953376 DOI: 10.1007/s00520-023-08172-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE These systematic review and meta-analysis were conducted to discuss the financial toxicity (FT) level among breast cancer (BC) patients and the associated demographic and economic factors. METHODS A systematic review and meta-analysis of single means were used by following the Joanna Briggs Institute guidelines and PRISMA guidance. Untransformed means (MRAW) were used to estimate the confidence interval for individual studies, while I2 and tau2 statistics were used to examine heterogeneity among pooled studies. Electronic databases were PubMed, CINAHL, Web of Science, Scopus, Cochrane Library, Ovid MEDLINE(R), Science Direct, and Turkish databases were used to find relevant studies published in the last 15 years (between 2008 and 2023). RESULTS A total of 50 studies were reviewed in the systematic review, and 11 were included in the overall and subgroup meta-analyses. The majority of reviewed studies were from the USA (38 studies), while there were four studies from China and eight studies from other countries having different types of health systems. The overall estimated FT level based on 11 pooled studies was 23.19, meaning mild level FT in the range of four categories (no FT score > 25, mild FT score 14-25, moderate FT score 1-13, and severe FT score equal to 0), with a 95% CI of 20.66-25.72. The results of subgroup meta-analyses showed that the estimated FT levels were higher among those patients who were single, with lower education levels, stage 3 patients, younger, lower income, unemployed, and living in other countries compared to those who were married, more educated, and stages 1 and 2 patients, more aged, more income, employed, and patients in the USA. CONCLUSION The cost-effectiveness of the treatment strategies of BC depends on the continuity of care. However, FT is one of the leading factors causing BC patients to use the required care irregularly, and it has a negative effect on adherence to treatment. So, removing the economic barriers by taking appropriate measures to decrease FT will increase the efficiency of already allocated resources to BC treatments and improve the health outcomes of BC patients.
Collapse
Affiliation(s)
- Yusuf Çeli K
- Faculty of Health Sciences, Department of Health Management, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Sevilay Şenol Çeli K
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey
| | - Seda Sarıköse
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey.
| | - Hande Nur Arslan
- Koç University School of Nursing, Koç University Health Sciences Campus, Istanbul, Turkey
| |
Collapse
|
12
|
Lin L, Chen Q, Lai F, Guo D, Wang J, Tian L. The interaction of financial toxicity and social support on social functioning in post-chemotherapy breast cancer patients: a cross-sectional study. Support Care Cancer 2023; 31:583. [PMID: 37728783 DOI: 10.1007/s00520-023-08048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To explore the correlation between financial toxicity, social support, and social functioning in post-chemotherapy breast cancer patients, as well as any possible interaction of financial toxicity and social support on social functioning. METHODS Post-chemotherapy breast cancer patients admitted to the thyroid and breast surgery departments of three first-class general hospitals in East China from December 2020 to January 2022 were recruited by convenience sampling for a cross-sectional survey. The survey instruments included the general information form, the comprehensive scores for financial toxicity based on the patient-reported outcome measures (COST-PROM), the social roles and activity participation subscale from the patient-reported outcomes measurement system-breast-chemotherapy (PROMS-B-C) (score range: 8-40), and the social support subscale from PROMS-B-C (score range: 16-80). RESULTS The results showed that low social functioning (low score) in post-chemotherapy breast cancer patients was positively correlated with high financial toxicity (low score) as well as poor economic resources (low score) and poor psychosocial responses (low score) (P<0.01) and negatively correlated with low economic expenditures (low score) (P<0.01); high social functioning (high score) was positively correlated with high social support (high score) (P<0.01). The interaction analysis results showed an additive interaction between financial toxicity and social support in social functioning. CONCLUSION There was an additive interaction of financial toxicity and social support in the social functioning of post-chemotherapy breast cancer patients. Those patients with high financial toxicity and low social support are the most likely to benefit from relevant intervention measures compared to other breast cancer populations.
Collapse
Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Qiuyun Chen
- Department of Nursing, Dushu Lake Hospital Affiliated to Soochow University, No. 9 Chongwen Road, Suzhou, 215006, People's Republic of China
| | - Fengxia Lai
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Daoxia Guo
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China
| | - Jie Wang
- Department of Nursing, Dushu Lake Hospital Affiliated to Soochow University, No. 9 Chongwen Road, Suzhou, 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China.
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Road, Suzhou, 215006, People's Republic of China.
| |
Collapse
|
13
|
Şengün İnan F, Yedigün T, Er İ. Exploring the Unmet Supportive Care Needs of Breast Cancer Survivors Experiencing Psychological Distress: Qualitative Study. Semin Oncol Nurs 2023; 39:151449. [PMID: 37246015 DOI: 10.1016/j.soncn.2023.151449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/03/2023] [Accepted: 04/19/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES This study aimed to explore the unmet supportive care needs of breast cancer survivors who experience psychological distress. DATA SOURCES A qualitative study design with inductive content analysis was used. Semistructured interviews were conducted with 18 Turkish breast cancer survivors who experienced psychological distress. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the study. CONCLUSION Three key themes emerged from data analysis: sources of psychological distress, unmet supportive care needs, and barriers to support. The survivors who experienced psychological distress defined a variety of unmet supportive care needs, in the areas of information support, psychological/emotional support, social support, and individualized health care support. They also described personal and health professional-related factors as barriers. IMPLICATIONS FOR NURSING PRACTICE Nurses should assess psychosocial well-being and supportive care needs of breast cancer survivors. Survivors should be supported to discuss their experiences of symptoms in the early survival phase, and they should be referred to an appropriate supportive care resource. A multidisciplinary survivorship services model is needed to offer posttreatment psychological support routinely in Turkey. Early, effective psychological care integrated into follow-up services for survivors can be protective against psychological morbidity.
Collapse
Affiliation(s)
- Figen Şengün İnan
- Assistant Professor, Faculty of Nursing, Psychiatric Nursing Department, Gazi University, Çankaya, Ankara, Turkey
| | | | - İlhami Er
- Radiation Oncologist, İzmir Katip Celebi University Atatürk Education and Research Hospital, İzmir, Turkey
| |
Collapse
|
14
|
Miaskowski C, Mastick J, Paul S, Wallhagen M, Abrams G, Levine JD. Associations among hearing loss, multiple co-occurring symptoms, and quality of life outcomes in cancer survivors. J Cancer Surviv 2023; 17:59-68. [PMID: 36454519 PMCID: PMC9714406 DOI: 10.1007/s11764-022-01301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Evaluate for differences in demographic and clinical characteristics, occurrence of common symptoms, symptom severity scores, and quality of life (QOL) outcomes in survivors with (n = 155) and without (n = 118) audiometrically confirmed hearing loss. METHODS Survivors, who were recruited from throughout the San Francisco Bay area, completed the self-report questionnaires to obtain the information of demographic and clinical characteristics; the occurrence and severity of depression, anxiety, fatigue, decrements in energy, sleep disturbance, pain, and cognitive impairment; and the general and cancer-specific QOL outcomes. Parametric and non-parametric tests were used to evaluate for differences between the two survivor groups. RESULTS Survivors with audiometrically confirmed hearing loss were older, more likely to be male, were more likely to be unemployed, report a lower annual household income, and had a higher comorbidity burden. Except for the severity of worst pain, no between-group differences were found in the occurrence rates for or severity of any of the symptoms. Survivors with hearing loss reported worse physical function and general health scores. CONCLUSIONS While no between-group differences in symptom occurrence rates and severity scores were found, across the total sample, a relatively high percentage of survivors who were over 6 years from their cancer diagnosis reported clinically meaningful levels of depression (25%), anxiety (50%), fatigue (40%), decrements in energy (70%), sleep disturbance (58%), cognitive impairment (57%), and pain (60%). IMPLICATIONS FOR CANCER SURVIVORS Clinicians need to perform routine assessments of hearing loss, as well as common co-occurring symptoms and initiate individualized symptom management interventions.
Collapse
Affiliation(s)
- Christine Miaskowski
- School of Medicine, University of California, San Francisco, CA, USA.
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
| | - Judy Mastick
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Margaret Wallhagen
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Gary Abrams
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| |
Collapse
|
15
|
Kim SJ, Shin H. [The Experience of Gynecologic Cancer in Young Women: A Qualitative Study]. J Korean Acad Nurs 2023; 53:115-128. [PMID: 36898689 DOI: 10.4040/jkan.22119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/13/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer. METHODS Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories. RESULTS Grounded theory analysis revealed nine categories and a core category of 'the journey to find my life after losing the life as a typical woman.' The categories that emerged as the conditions are 'Unwelcomed guest, cancer,' 'Completely devastated life as an ordinary woman,' 'Uncertain future,' 'Losing my physical characteristics as a woman,' and 'Life tied with treatments.' The actions/interactions were'Decrease of interpersonal relationships,' 'A lonely battle to overcome alone,' and 'The power to overcome hardships.' The consequence was 'Live my own life.' CONCLUSION This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study's results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.
Collapse
Affiliation(s)
- Sung-Jin Kim
- Department of Hemato-Oncology, Samsung Medical Center, Seoul, Korea.,College of Nursing, Korea University, Seoul, Korea
| | | |
Collapse
|
16
|
Financial hardship in breast cancer survivors: a prospective analysis of change in financial concerns over time. Support Care Cancer 2023; 31:62. [DOI: 10.1007/s00520-022-07493-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/12/2022] [Indexed: 12/23/2022]
|
17
|
Financial Toxicity of Breast Cancer Care: The Patient Perspective Through Surveys and Interviews. J Surg Res 2023; 281:122-129. [PMID: 36155269 DOI: 10.1016/j.jss.2022.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although the economic burden of cancer care is an emerging concern in the United States, the potential financial toxicity of breast cancer care at the patient level remains poorly understood. This study aims to characterize the scope of the contributors to financial distress on breast cancer patients and the resources utilized to address them. METHODS Adult female patients diagnosed with invasive breast cancer or ductal carcinoma in situ between 2014 and 2019 at a single institution were retrospectively evaluated. Those who enrolled in copay assistance or indicated financial concerns on an intake distress screen were provided a web-based survey assessing financial changes, resources used, and financial engagement with providers. Semi-structured interviews further explored sources of financial distress and were analyzed by two researchers using grounded theory methodology. RESULTS Sixty-eight patients completed the online survey, 15 of the 68 also participated in semi-structured phone interviews. On the online survey 74% of participants endorsed a financial distress score ≥5 on a scale of 0-10. Seventy-four percent changed their budget, 72% used their savings, and 60% cut down on spending. However, only 40% used resources such as financial counseling or financial assistance. Interviews revealed three major contributors to financial distress: (1) unexpected medical and nonmedical expenses, (2) lost revenue from missed work, and (3) altered budgeting. CONCLUSIONS Many breast cancer patients experience significant financial distress without access to the resources they need. This study highlights the need for financial transparency, supportive financial services counseling at the time of diagnosis, throughout treatment and beyond.
Collapse
|
18
|
Adams A, Kluender R, Mahoney N, Wang J, Wong F, Yin W. The Impact of Financial Assistance Programs on Health Care Utilization: Evidence from Kaiser Permanente. AMERICAN ECONOMIC REVIEW. INSIGHTS 2022; 4:389-407. [PMID: 36338144 PMCID: PMC9634821 DOI: 10.1257/aeri.20210515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Most hospitals have financial assistance programs for low-income patients. We use administrative data from Kaiser Permanente to study the effects of financial assistance on healthcare utilization. Using a regression discontinuity design based on an income threshold for program eligibility, we find that financial assistance increases the likelihood of an inpatient, ambulatory and emergency department encounter by 3.6 pp (59%), 13.4 pp (20%), and 6.7 pp (53%), respectively, though effects dissipate three quarters after program receipt. Financial assistance also increases the detection and management of treatment-sensitive conditions (e.g., drugs treating diabetes), suggesting financial assistance may increase receipt of high-value care.
Collapse
Affiliation(s)
| | | | | | | | | | - Wesley Yin
- University of California, Los Angeles and NBER
| |
Collapse
|
19
|
Sayani A, Dilney J, Kuhnke JL, McNeil T. "My Cancer Is Worth Only Fifteen Weeks"? A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in Canada. Int J Health Policy Manag 2022; 11:1814-1822. [PMID: 34634872 PMCID: PMC9808211 DOI: 10.34172/ijhpm.2021.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Cancer patients experience financial hardship due to rising expenses related to cancer treatment and declining income levels associated with reduced employability. Employment Insurance Sick Benefits (EI-SB) is a social income support program which provides temporary income replacement to Canadians when they fall ill. Although EI-SB is designed to maintain continuity of income during an illness, little is known about the perspectives of cancer patients who receive EI-SB. This knowledge can inform the development of public policies which are responsive to the needs and priorities of cancer patients. METHODS We conducted a theory-informed thematic analysis of data collected from twenty semi-structured interviews with participants who were receiving care in a cancer centre in Cape Breton, Nova Scotia and had received EI-SB. A coding framework was developed using Taplin and colleagues' intermediate outcomes of patient care across the cancer care continuum. Interpretation of findings was guided by the synergies of oppression theoretical lens. RESULTS Three overarching themes describe the experiences of cancer patients receiving social income support: Economic exclusion, in which the structure of the labour market and social welfare system determine access to workplace benefits and continuity of reasonable income; financial toxicity, a vicious cycle of financial burden and increasing financial distress; and constrained choices, where cancer influences employability and lowered income influences the need to be employed. CONCLUSION Cancer patients need income support programs that are tailored to match their healthcare priorities. In addition, policies which strengthen working conditions and facilitate a reintegration to work when possible will be important in addressing the structural drivers of income insecurity experienced by cancer patients.
Collapse
Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada
| | - Jessica Dilney
- Nova Scotia Health Authority, Cape Breton Regional Hospital, Sydney, NS, Canada
| | - Janet L. Kuhnke
- School of Professional Studies, Cape Breton University, Sydney, NS, Canada
| | - Tom McNeil
- Cape Breton Cancer Centre, Sydney, NS, Canada
| |
Collapse
|
20
|
Basurto-Hurtado JA, Cruz-Albarran IA, Toledano-Ayala M, Ibarra-Manzano MA, Morales-Hernandez LA, Perez-Ramirez CA. Diagnostic Strategies for Breast Cancer Detection: From Image Generation to Classification Strategies Using Artificial Intelligence Algorithms. Cancers (Basel) 2022; 14:3442. [PMID: 35884503 PMCID: PMC9322973 DOI: 10.3390/cancers14143442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/02/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Breast cancer is one the main death causes for women worldwide, as 16% of the diagnosed malignant lesions worldwide are its consequence. In this sense, it is of paramount importance to diagnose these lesions in the earliest stage possible, in order to have the highest chances of survival. While there are several works that present selected topics in this area, none of them present a complete panorama, that is, from the image generation to its interpretation. This work presents a comprehensive state-of-the-art review of the image generation and processing techniques to detect Breast Cancer, where potential candidates for the image generation and processing are presented and discussed. Novel methodologies should consider the adroit integration of artificial intelligence-concepts and the categorical data to generate modern alternatives that can have the accuracy, precision and reliability expected to mitigate the misclassifications.
Collapse
Affiliation(s)
- Jesus A. Basurto-Hurtado
- C.A. Mecatrónica, Facultad de Ingeniería, Campus San Juan del Río, Universidad Autónoma de Querétaro, Rio Moctezuma 249, San Cayetano, San Juan del Rio 76807, Mexico; (J.A.B.-H.); (I.A.C.-A.)
- Laboratorio de Dispositivos Médicos, Facultad de Ingeniería, Universidad Autónoma de Querétaro, Carretera a Chichimequillas S/N, Ejido Bolaños, Santiago de Querétaro 76140, Mexico
| | - Irving A. Cruz-Albarran
- C.A. Mecatrónica, Facultad de Ingeniería, Campus San Juan del Río, Universidad Autónoma de Querétaro, Rio Moctezuma 249, San Cayetano, San Juan del Rio 76807, Mexico; (J.A.B.-H.); (I.A.C.-A.)
- Laboratorio de Dispositivos Médicos, Facultad de Ingeniería, Universidad Autónoma de Querétaro, Carretera a Chichimequillas S/N, Ejido Bolaños, Santiago de Querétaro 76140, Mexico
| | - Manuel Toledano-Ayala
- División de Investigación y Posgrado de la Facultad de Ingeniería (DIPFI), Universidad Autónoma de Querétaro, Cerro de las Campanas S/N Las Campanas, Santiago de Querétaro 76010, Mexico;
| | - Mario Alberto Ibarra-Manzano
- Laboratorio de Procesamiento Digital de Señales, Departamento de Ingeniería Electrónica, Division de Ingenierias Campus Irapuato-Salamanca (DICIS), Universidad de Guanajuato, Carretera Salamanca-Valle de Santiago KM. 3.5 + 1.8 Km., Salamanca 36885, Mexico;
| | - Luis A. Morales-Hernandez
- C.A. Mecatrónica, Facultad de Ingeniería, Campus San Juan del Río, Universidad Autónoma de Querétaro, Rio Moctezuma 249, San Cayetano, San Juan del Rio 76807, Mexico; (J.A.B.-H.); (I.A.C.-A.)
| | - Carlos A. Perez-Ramirez
- Laboratorio de Dispositivos Médicos, Facultad de Ingeniería, Universidad Autónoma de Querétaro, Carretera a Chichimequillas S/N, Ejido Bolaños, Santiago de Querétaro 76140, Mexico
| |
Collapse
|
21
|
Hazard-Jenkins HW. Breast Cancer Survivorship—Mitigating Treatment Effects on Quality of Life and Improving Survival. Obstet Gynecol Clin North Am 2022; 49:209-218. [DOI: 10.1016/j.ogc.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Rabbi F, Dabbagh SR, Angin P, Yetisen AK, Tasoglu S. Deep Learning-Enabled Technologies for Bioimage Analysis. MICROMACHINES 2022; 13:mi13020260. [PMID: 35208385 PMCID: PMC8880650 DOI: 10.3390/mi13020260] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 02/05/2023]
Abstract
Deep learning (DL) is a subfield of machine learning (ML), which has recently demonstrated its potency to significantly improve the quantification and classification workflows in biomedical and clinical applications. Among the end applications profoundly benefitting from DL, cellular morphology quantification is one of the pioneers. Here, we first briefly explain fundamental concepts in DL and then we review some of the emerging DL-enabled applications in cell morphology quantification in the fields of embryology, point-of-care ovulation testing, as a predictive tool for fetal heart pregnancy, cancer diagnostics via classification of cancer histology images, autosomal polycystic kidney disease, and chronic kidney diseases.
Collapse
Affiliation(s)
- Fazle Rabbi
- Department of Mechanical Engineering, Koç University, Sariyer, Istanbul 34450, Turkey; (F.R.); (S.R.D.)
| | - Sajjad Rahmani Dabbagh
- Department of Mechanical Engineering, Koç University, Sariyer, Istanbul 34450, Turkey; (F.R.); (S.R.D.)
- Koç University Arçelik Research Center for Creative Industries (KUAR), Koç University, Sariyer, Istanbul 34450, Turkey
- Koc University Is Bank Artificial Intelligence Lab (KUIS AILab), Koç University, Sariyer, Istanbul 34450, Turkey
| | - Pelin Angin
- Department of Computer Engineering, Middle East Technical University, Ankara 06800, Turkey;
| | - Ali Kemal Yetisen
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK;
| | - Savas Tasoglu
- Department of Mechanical Engineering, Koç University, Sariyer, Istanbul 34450, Turkey; (F.R.); (S.R.D.)
- Koç University Arçelik Research Center for Creative Industries (KUAR), Koç University, Sariyer, Istanbul 34450, Turkey
- Koc University Is Bank Artificial Intelligence Lab (KUIS AILab), Koç University, Sariyer, Istanbul 34450, Turkey
- Institute of Biomedical Engineering, Boğaziçi University, Çengelköy, Istanbul 34684, Turkey
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- Correspondence:
| |
Collapse
|
23
|
Mi X, Hu M, Dong M, Yang Z, Zhan X, Chang X, Lu J, Chen X. Folic Acid Decorated Zeolitic Imidazolate Framework (ZIF-8) Loaded with Baicalin as a Nano-Drug Delivery System for Breast Cancer Therapy. Int J Nanomedicine 2022; 16:8337-8352. [PMID: 34992370 PMCID: PMC8714011 DOI: 10.2147/ijn.s340764] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 01/01/2023] Open
Abstract
Background Baicalin (BAN) has attracted widespread attention due to its low-toxicity and efficient antitumor activity, but its poor water solubility and low bioavailability severely limit its clinical application. Development of a targeted drug delivery system is a good strategy to improve the antitumor activity of baicalin. Methods We prepared a BAN nano-drug delivery system PEG-FA@ZIF-8@BAN with a zeolite imidazole framework-8 (ZIF-8) as a carrier, which can achieve the response of folate receptor (FR). We characterized this system in terms of morphology, particle size, zeta-potential, infrared (IR), ultraviolet (UV), x-ray diffraction (XRD), and Brunel-Emmett-Teller (BET), and examined the in vitro cytotoxicity and cellular uptake properties of PEG-FA@ZIF-8@BAN using MCF-7 cells. Lastly, we established a 4T1 tumor-bearing mouse model and evaluated its in vivo anti-mammary cancer activity. Results The PEG-FA@ZIF-8@BAN nano-delivery system had good dispersion with a BAN loading efficiency of 41.45 ± 1.43%, hydrated particle size of 176 ± 8.1 nm, Zeta-potential of −23.83 ± 1.1 mV, and slow and massive drug release in an acidic environment (pH 5.0), whereas release was 11.03% in a neutral environment (pH 7.4). In vitro studies showed that PEG-FA@ZIF-8@BAN could significantly enhance the killing effect of BAN on MCF-7 cells, and the folic acid-mediated targeting could lead to better uptake of nanoparticles by tumor cells and thus better killing of cancer cells. In vivo studies also showed that PEG-FA@ZIF-8@BAN significantly increased the inhibition of the proliferation of solid breast cancer tumors (p < 0.01 or p < 0.001). Conclusion The PEG-FA@ZIF-8@BAN nano-drug delivery system significantly enhanced the anti-breast cancer effect of baicalin both in vivo and in vitro, providing a more promising drug delivery system for the clinical applications and tumor management.
Collapse
Affiliation(s)
- Xiao Mi
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Meigeng Hu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Mingran Dong
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Zhihong Yang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Xia Zhan
- Key Laboratory of Cleaner Production and Integrated Resource Utilization of China National Light Industry, Beijing Technology and Business University, Beijing, 100048, People's Republic of China
| | - Xinyue Chang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Juan Lu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| | - Xi Chen
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100094, People's Republic of China
| |
Collapse
|
24
|
Benedict C, Fisher S, Schapira L, Chao S, Sackeyfio S, Sullivan T, Pollom E, Berek JS, Kurian AW, Palesh O. Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors. Psychooncology 2022; 31:9-20. [PMID: 34224603 PMCID: PMC9809212 DOI: 10.1002/pon.5763] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/29/2021] [Accepted: 06/15/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Financial toxicity includes distress and burden from cancer-related costs. Women are more likely to experience worse cancer-related financial outcomes than men. This study evaluated breast and gynecologic cancer patients' subjective experiences of financial toxicity and associations with distress and quality of life (QOL). METHODS A cross-sectional survey study included measures of financial toxicity (Comprehensive Score for Financial Toxicity [COST] Version 2), distress (Patient Health Questionnaire), and QOL (Functional Assessment of Cancer Therapy). Chi-square, t-tests, and ANOVAs examined bivariate relationships. Two regression models tested associations between financial toxicity and distress and QOL, controlling for covariates. Financial toxicity subgroups were compared based on a validated grading system. RESULTS Participants (N = 273; 74% breast cancer) averaged 54.65 years (SD = 12.08), were 3.42 years (SD = 4.20) post-diagnosis, and 33% reported cancer-related change in employment status. Financial toxicity was "mild" overall (COST M = 26.11, SD = 11.14); 32% worried about cancer-related financial problems (quite a bit/very much; item-level analysis). Worse financial toxicity related to younger age (p < 0.001), identifying as a non-Asian minority (p = 0.03) or Hispanic (p = 0.01), being single (p < 0.001), lower education (p = 0.004), lower income (p < 0.001), late-stage disease (p = 0.001), recurrent disease (p = 0.004), and active treatment (p < 0.001). In separate multivariable models, greater financial toxicity related to greater distress (β = -0.45 p < 0.001) and worse QOL (β = 0.58, p < 0.001). Financial toxicity subgroups reported clinically significant differences in distress and QOL (p's < 0.05). CONCLUSIONS Cancer-related financial burden is associated with pervasive negative effects and may impact subgroups differently. Future research should explore financial experiences across subgroups, aiming to better identify those at risk and build targeted interventions.
Collapse
Affiliation(s)
- Catherine Benedict
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Sophie Fisher
- Stanford University School of Medicine, Palo Alto, CA
| | - Lidia Schapira
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Sabrina Chao
- Stanford University School of Medicine, Palo Alto, CA
| | | | - Tara Sullivan
- Stanford University School of Medicine, Palo Alto, CA
| | - Erqi Pollom
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Jonathan S. Berek
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Allison W. Kurian
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| | - Oxana Palesh
- Stanford University School of Medicine, Palo Alto, CA,Stanford Cancer Institute, Stanford, CA
| |
Collapse
|
25
|
Understanding the Relationship between Breast Reconstruction Subtype and Risk of Financial Toxicity: A Single-Institution Pilot Study. Plast Reconstr Surg 2021; 148:1e-11e. [PMID: 34181599 DOI: 10.1097/prs.0000000000008015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The impact of breast reconstruction on financial toxicity remains poorly understood despite growing awareness. The authors sought to illustrate the relationship between breast reconstruction subtypes and the risk of financial toxicity. METHODS The authors conducted a single-institution cross-sectional survey of all female breast cancer patients undergoing any form of breast reconstruction between January of 2018 and June of 2019. Financial toxicity was measured by means of the validated Comprehensive Score for Financial Toxicity instrument. Demographics, clinical course, and coping strategies were abstracted from a purpose-built survey and electronic medical records. Multivariable linear regression was performed to identify associations with financial toxicity. RESULTS The authors' analytical sample was 350 patients. One hundred eighty-four (52.6 percent) underwent oncoplastic reconstruction, 126 (36 percent) underwent implant-based reconstruction, and 40 (11.4 percent) underwent autologous reconstruction. Oncoplastic reconstruction recipients were older, had a higher body mass index, and were more likely to have supplemental insurance and receive adjuvant hormonal therapy. No significant differences in the risk of financial toxicity were uncovered across breast reconstruction subtypes (p = 0.53). Protective factors against financial toxicity were use of supplemental insurance (p = 0.0003) and escalating annual household income greater than $40,000 (p < 0.0001). Receipt of radiation therapy was positively associated with worsening financial toxicity (-2.69; 95 CI percent, -5.22 to -0.15). Financial coping strategies were prevalent across breast reconstruction subtypes. CONCLUSIONS Breast reconstruction subtype does not differentially impact the risk of financial toxicity. Increasing income and supplemental insurance were found to be protective, whereas receipt of radiation therapy was positively associated with financial toxicity. Prospective, multicenter studies are needed to identify the main drivers of out-of-pocket costs and financial toxicity in breast cancer care.
Collapse
|
26
|
Eldaly AS. Cancer screening: the collateral damage of the pandemic in Egypt. J Egypt Public Health Assoc 2021; 96:14. [PMID: 34076748 PMCID: PMC8170625 DOI: 10.1186/s42506-021-00073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Abdullah S Eldaly
- Department of Plastic and Reconstructive Surgery, Tanta University Hospitals, Tanta, Egypt.
| |
Collapse
|
27
|
Financial hardship among cancer survivors in Southern New Jersey. Support Care Cancer 2021; 29:6613-6623. [PMID: 33945015 DOI: 10.1007/s00520-021-06232-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify predictors of financial hardship, operationalized as foregoing health care, making financial sacrifices, and being concerned about having inadequate financial and insurance information. METHODS Cancer survivors (n = 346) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to September 2019. Multivariable logistic regression analyses were performed. RESULTS Cancer survivors with household incomes less than $50,000 annually were more likely than those earning $50,0000-$90,000 to report foregoing health care (15.8 percentage points, p < 0.05). Compared to retirees, survivors who were currently unemployed, disabled, or were homemakers were more likely to forego doctor's visits (11.4 percentage points, p < 0.05), more likely to report borrowing money (16.1 percentage points, p < 0.01), and more likely to report wanting health insurance information (25.7 percentage points, p < 0.01). Employed survivors were more likely than retirees to forego health care (16.8 percentage points, p < 0.05) and make financial sacrifices (20.0 percentage points, p < 0.01). Survivors who never went to college were 9.8 percentage points (p < 0.05) more likely to borrow money compared to college graduates. Black survivors were more likely to want information about dealing with financial and insurance issues (p < 0.01); men were more likely to forego health care (p < 0.05). CONCLUSION Findings highlight the role of employment status and suggest that education, income, race, and gender also shape cancer survivors' experience of financial hardship. There is a need to refine and extend financial navigation programs. For employed survivors, strengthening family leave policies would be desirable.
Collapse
|
28
|
Dabbagh SR, Sarabi MR, Rahbarghazi R, Sokullu E, Yetisen AK, Tasoglu S. 3D-printed microneedles in biomedical applications. iScience 2021; 24:102012. [PMID: 33506186 PMCID: PMC7814162 DOI: 10.1016/j.isci.2020.102012] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Conventional needle technologies can be advanced with emerging nano- and micro-fabrication methods to fabricate microneedles. Nano-/micro-fabricated microneedles seek to mitigate penetration pain and tissue damage, as well as providing accurately controlled robust channels for administrating bioagents and collecting body fluids. Here, design and 3D printing strategies of microneedles are discussed with emerging applications in biomedical devices and healthcare technologies. 3D printing offers customization, cost-efficiency, a rapid turnaround time between design iterations, and enhanced accessibility. Increasing the printing resolution, the accuracy of the features, and the accessibility of low-cost raw printing materials have empowered 3D printing to be utilized for the fabrication of microneedle platforms. The development of 3D-printed microneedles has enabled the evolution of pain-free controlled release drug delivery systems, devices for extracting fluids from the cutaneous tissue, biosignal acquisition, and point-of-care diagnostic devices in personalized medicine.
Collapse
Affiliation(s)
- Sajjad Rahmani Dabbagh
- Department of Mechanical Engineering, Koç University, Sariyer, Istanbul 34450, Turkey
- Koç University Arçelik Research Center for Creative Industries (KUAR), Koç University, Sariyer, Istanbul 34450, Turkey
| | | | - Reza Rahbarghazi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran
- Department of Applied Cell Sciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz 5166653431, Iran
| | - Emel Sokullu
- Koc University School of Medicine, Koç University, Sariyer, Istanbul 34450, Turkey
| | - Ali K. Yetisen
- Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK
| | - Savas Tasoglu
- Department of Mechanical Engineering, Koç University, Sariyer, Istanbul 34450, Turkey
- Koç University Arçelik Research Center for Creative Industries (KUAR), Koç University, Sariyer, Istanbul 34450, Turkey
- Koc University Research Center for Translational Medicine, Koç University, Sariyer, Istanbul 34450, Turkey
- Boğaziçi Institute of Biomedical Engineering, Boğaziçi University, Çengelköy, Istanbul 34684, Turkey
| |
Collapse
|
29
|
Williams CP, Gallagher KD, Deehr K, Aswani MS, Azuero A, Daniel CL, Ford EW, Ingram SA, Balch AJ, Rocque GB. Quantifying treatment preferences and their association with financial toxicity in women with breast cancer. Cancer 2020; 127:449-457. [PMID: 33108023 DOI: 10.1002/cncr.33287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND The objective of the current study was to understand treatment preferences and their association with financial toxicity in Patient Advocate Foundation clients with breast cancer. METHODS This choice-based conjoint analysis used data from a nationwide sample of women with breast cancer who received assistance from the Patient Advocate Foundation. Choice sets created from 13 attributes of 3 levels each elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference archetypes. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity. Adjusted generalized linear models estimated COST score differences by preference archetype. RESULTS Of 220 respondents (for a response rate of 10%), the median age was 58 years (interquartile range, 49-66 years); 28% of respondents were Black, indigenous, or people of color; and approximately 60% had household incomes <$40,000. The majority of respondents were diagnosed with early-stage cancer (91%), 38% had recurrent disease, and 61% were receiving treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living. Two distinct treatment preference archetypes emerged. The "cost-prioritizing group" (75% of respondents) was most concerned about affordability, impact on activities of daily living, and burdening care partners. The "functional independence-prioritizing group" (25% of respondents) was most concerned about their ability to work, physical side effects, and interference with life events. COST scores were found to be similar between the archetypes in adjusted models (cost-prioritizing group COST score, 12 [95% confidence interval, 9-14]; and functional independence-prioritizing COST score, 11 [95% confidence interval, 9-13]). CONCLUSIONS Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision making could optimize patients' treatment experiences.
Collapse
Affiliation(s)
- Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Katie Deehr
- Patient Advocate Foundation, Hampton, Virginia
| | - Monica S Aswani
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andres Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Casey L Daniel
- University of South Alabama Mitchell Cancer Institute, Mobile, Alabama
| | - Eric W Ford
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Gabrielle B Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
30
|
Bauer AG, Jefferson M, Nahhas GJ, Savage S, Drake R, Lilly M, Ambrose L, Caulder S, Mahvi D, Hughes Halbert C. Financial toxicity and strain among men receiving prostate cancer care in an equal access healthcare system. Cancer Med 2020; 9:8765-8771. [PMID: 33070458 PMCID: PMC7724486 DOI: 10.1002/cam4.3484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To examine financial toxicity and strain among men in an equal access healthcare system based on social determinants and clinical characteristics. Methods Observational study among men receiving prostate cancer care (n = 49) at a Veterans Health Administration (VHA) facility. Financial hardship included overall financial strain and financial toxicity due to healthcare costs. Financial strain was measured with one item asking how much money they have leftover at the end of the month. Financial toxicity was measured with the Comprehensive Score for Financial Toxicity (COST) scale. Results Comprehensive Score for Financial Toxicity scores among participants indicated moderate levels of financial toxicity (M = 24.4, SD = 9.9). For financial strain, 36% of participants reported that they did not have enough money left over at the end of the month. There were no racial or clinically related differences in financial toxicity, but race and income level had significant associations with financial strain. Conclusion Financial toxicity and strain should be measured among patients in an equal access healthcare system. Findings suggest that social determinants may be important to assess, to identify patients who may be most likely to experience financial hardship in the context of obtaining cancer care and implement efforts to mitigate the burden for those patients.
Collapse
Affiliation(s)
- Alexandria G Bauer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Melanie Jefferson
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen Savage
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Urology, Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Richard Drake
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Lilly
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Linda Ambrose
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - Susan Caulder
- Ralph H. Johnson Veteran Affairs Medical Center, Charleston, SC, USA
| | - David Mahvi
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|