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Bonner SN, Edwards MA. The Impact of Racial Disparities and the Social Determinants of Health on Esophageal and Gastric Cancer Outcomes. Surg Oncol Clin N Am 2024; 33:595-604. [PMID: 38789201 DOI: 10.1016/j.soc.2023.12.015] [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] [Indexed: 05/26/2024]
Abstract
Reducing long-standing inequities in gastric and esophageal cancers is a priority of patients, providers, and policy makers. Many social determinants of health influence risk factors for disease development, incidence, treatment, and outcomes of gastric and esophageal cancers.
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Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, 1500 East Medical Center Drive, 2100 Taubman Center, Ann Arbor, MI 48109, USA
| | - Melanie A Edwards
- Trinity Health IHA Medical Group, Cardiovascular & Thoracic Surgery Ann Arbor, 5325 Elliott Drive, Suite 102, Ypsilanti, MI 48197, USA.
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2
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Hallgren E, Moore R, Ayers BL, Purvis RS, Bryant-Smith G, DelNero P, McElfish PA. "It was kind of a nightmare, it really was:" financial toxicity among rural women cancer survivors. J Cancer Surviv 2024; 18:1006-1015. [PMID: 36870038 DOI: 10.1007/s11764-023-01344-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/27/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The purpose of this study was to examine how rural women cancer survivors experience and manage financial toxicity. METHODS A qualitative descriptive design was used to explore experiences of financial toxicity among rural women who received cancer treatment. We conducted qualitative interviews with 36 socioeconomically diverse rural women cancer survivors. RESULTS Participants were categorized into three groups: (1) survivors who struggled to afford basic living expenses but did not take on medical debt; (2) survivors who took on medical debt but were able to meet their basic needs; and (3) survivors who reported no financial toxicity. The groups differed by financial and job security and insurance type. We describe each group and, for the first two groups, the strategies they used to manage financial toxicity. CONCLUSIONS Financial toxicity related to cancer treatment is experienced differently by rural women cancer survivors depending on financial and job security and insurance type. Financial assistance and navigation programs should be tailored to support rural patients experiencing different forms of financial toxicity. IMPLICATIONS FOR CANCER SURVIVORS Rural cancer survivors with financial security and private insurance may benefit from policies aimed at limiting patient cost-sharing and financial navigation to help patients understand and maximize their insurance benefits. Rural cancer survivors who are financially and/or job insecure and have public insurance may benefit from financial navigation services tailored to rural patients that can assist with living expenses and social needs.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA.
| | - Ramey Moore
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Britni L Ayers
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Rachel S Purvis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Gwendolyn Bryant-Smith
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St. - Slot 556, Little Rock, AR, 72205, USA
| | - Peter DelNero
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48th St, Springdale, AR, 72762, USA
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Xu B, So WK, Choi KC, Huang Y, Liu M, Qiu L, Tan J, Tao H, Yan K, Yang F. Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study. Asia Pac J Oncol Nurs 2024; 11:100443. [PMID: 38665637 PMCID: PMC11039943 DOI: 10.1016/j.apjon.2024.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024] Open
Abstract
Objective We assessed financial toxicity (FT) among Chinese patients with cancer and investigated associated risk factors guided by a multilevel conceptual framework. Methods Applying multistage stratified sampling, we selected six tertiary and six secondary hospitals across three economically diverse provinces in China. From February to October 2022, 1208 patients with cancer participated. FT was measured using the COmprehensive Score for financial Toxicity (COST), with 28 potential risk factors identified at multilevel. Multiple regression analysis was used for risk factor identification. Results FT prevalence was 82.6% (95% confidence interval [CI]: 80.5%, 84.8%), with high FT (COST score ≤ 18.5) observed in 40.9% of participants (95% CI: 38.1%, 43.7%). Significant risk factors included younger age at cancer diagnosis, unmarried status, low annual household income, negative impact of cancer on participants' or family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side effects, high perceived stress, poor emotional/informational support, lack of social medical insurance or having urban and rural resident basic medical insurance, lack of commercial medical insurance, tertiary hospital treatment, and inadequate cost discussions with healthcare providers (all P < 0.05). Conclusions Cancer-related FT is prevalent in China, contributing to disparities in cancer care access and health-related outcomes. The risk factors associated with cancer-related FT encompasses multilevel, including patient/family, provider/practice, and payer/policy levels. There is an urgent need for collective efforts by patients, healthcare providers, policymakers, and insurers to safeguard the financial security and well-being of individuals affected by cancer, promoting health equities in the realm of cancer care.
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Affiliation(s)
- Binbin Xu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie K.W. So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Huang
- The Nursing Department of the Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, China
| | - Mei Liu
- The Infection Control Department of Xuzhou Cancer Hospital, Xuzhou, China
| | - Lanxiang Qiu
- The Nursing Department of the Third Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jianghong Tan
- The Nursing Department of Zhuzhou Central Hospital, Zhuzhou, China
| | - Hua Tao
- The Oncology Department of the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Keli Yan
- The Internal Medicine Nursing Office, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yang
- The Nursing Department of Nanjing Pukou People's Hospital, Nanjing, China
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Carrera PM, Curigliano G, Santini D, Sharp L, Chan RJ, Pisu M, Perrone F, Karjalainen S, Numico G, Cherny N, Winkler E, Amador ML, Fitch M, Lawler M, Meunier F, Khera N, Pentheroudakis G, Trapani D, Ripamonti CI. ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer. ESMO Open 2024; 9:102992. [PMID: 38626634 PMCID: PMC11033153 DOI: 10.1016/j.esmoop.2024.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022. METHODS A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting. RESULTS AND DISCUSSION A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.
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Affiliation(s)
- P M Carrera
- German Cancer Research Center, Heidelberg, Germany; Healtempact: Health/Economic Insights-Impact, Hengelo, The Netherlands.
| | - G Curigliano
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
| | - D Santini
- Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Rome, Italy
| | - L Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - R J Chan
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - M Pisu
- University of Alabama in Birmingham, Birmingham, USA
| | - F Perrone
- National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy
| | | | - G Numico
- Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - N Cherny
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Winkler
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Medical Faculty, Department of Medical Oncology, Heidelberg, Germany
| | - M L Amador
- Spanish Association Against Cancer (AECC), Madrid, Spain
| | - M Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - M Lawler
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - F Meunier
- European Initiative on Ending Discrimination against Cancer Survivors and Belgian Royal Academy of Medicine (ARMB), Brussels, Belgium
| | | | | | - D Trapani
- European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan
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Augustovski F, Tsou F, González L, Martín C, Vigo S, Gabay C, Alcaraz A, Argento F. Impact of Lung Cancer on Health-Related Quality of Life, Financial Toxicity, and Household Economics in Patients From the Public and the Private Healthcare Sector in Argentina. Value Health Reg Issues 2024; 41:94-99. [PMID: 38290167 DOI: 10.1016/j.vhri.2023.12.001] [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: 06/27/2023] [Revised: 10/23/2023] [Accepted: 12/06/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Non-small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. METHODS We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment - General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. RESULTS We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable. CONCLUSIONS Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.
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Affiliation(s)
- Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; University of Buenos Aires School of Medicine, Buenos Aires, Argentina; Center for Research in Epidemiology and Public Health (CIESP), National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
| | | | - Lucas González
- Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | | | - Silvina Vigo
- Hospital Interzonal de Agudos y Crónicos San Juan de Dios de La Plata, Buenos Aires, Argentina; Hospital Interzonal General de Agudos Profesor Dr. Rodolfo Rossi, Buenos Aires, Argentina
| | - Carolina Gabay
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Fernando Argento
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Hong YR, Wang R, Case S, Jo A, Turner K, Ross KM. Association of food insecurity with overall and disease-specific mortality among cancer survivors in the US. Support Care Cancer 2024; 32:309. [PMID: 38664265 DOI: 10.1007/s00520-024-08495-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To investigate the association of food insecurity with overall and disease-specific mortality among US cancer survivors. METHODS Data from the National Health and Nutrition Examination Survey (NHANES 1999-2018) were used to examine the impact of food insecurity on mortality risks among cancer survivors in the US. Study participants aged ≥ 20 years who had a history of cancer and completed the Adult Food Security Survey Module were included. Mortality data [all-cause, cancer, and cardiovascular (CVD) specific] through December 31, 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazard regression, hazard ratios of mortality based on food security status were estimated. RESULTS Among 5032 cancer survivors (mean age 62.5 years; 58.0% women; 86.2% non-Hispanic White), 596 (8.8%) reported food insecurity. Overall, 1913 deaths occurred (609 cancer deaths and 420 CVD deaths) during the median follow-up of 6.8 years. After adjusting for age, food insecurity was associated with a higher risk of overall (HR = 1.93; 95% CI = 1.56-2.39), CVD-specific (HR = 1.95; 95% CI = 1.24-3.05), and cancer-specific (HR = 1.70; 95% CI = 1.20-2.42) mortality (P < 0.001). However, after adjusting for socioeconomic characteristics and health-related factors (physical activity, diet quality measured by healthy eating index), the association between food insecurity and overall mortality was no longer statistically significant. CONCLUSIONS Food insecurity was associated with a greater risk of overall mortality among cancer survivors. Further studies are needed to confirm these findings and evaluate whether the observed association represents a causal phenomenon and, if so, whether the effect is modifiable with food assistance programs.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Stuart Case
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Ara Jo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Kathryn M Ross
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Brink E, Pilegaard MS, Bonnesen TG, Nielsen CV, Pedersen P. Employment status in cancer patients the first five years after diagnosis-a register-based study. J Cancer Surviv 2024:10.1007/s11764-024-01576-5. [PMID: 38587762 DOI: 10.1007/s11764-024-01576-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Work is important for identity formation, social status, and economic independency. Although some evidence within the field of work and cancer survivorship exists, no study has so far investigated employment status across all cancer diagnoses. Thus, the aim of the present study was to investigate the impact of all cancer diagnoses on employment status. METHODS Danish cancer patients aged 20-60 years, diagnosed between 2000 and 2015, were identified through Danish registers and matched 1:5 with cancer-free controls. Logistic and linear regression was performed separately in 11 cancer types to assess and compare work status and work participation between cancer patients and cancer-free controls one, three, and five years after diagnosis. RESULTS A total of 111,770 cancer patients and 507,003 cancer-free controls were included. All cancer types had lower chances of working one year after diagnosis (ORs between 0.05 and 0.76), with lung, colorectal, upper gastrointestinal, and blood cancer patients having the lowest chances. After three years, 10 of 11 cancer types had lower chances (ORs between 0.39 and 0.84). After five years, there were minimal differences between cancer patients and controls among most cancer types (ORs between 0.75 and 1.36). CONCLUSION Most cancer patients had lower chances of working compared with the general population until five years after diagnosis. However, patients with certain cancer types experienced lower chances of working all years, despite improvement over time. IMPLICATIONS FOR CANCER SURVIVORS The knowledge will help increase awareness on challenges regarding work-life after cancer. Furthermore, the distinguishing between diagnoses can inform to more targeted vocational rehabilitation.
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Affiliation(s)
- E Brink
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- DEFACTUM, Central Denmark Region, Aarhus, Denmark.
| | - M S Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - T G Bonnesen
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - C V Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Goedstrup Hospital, Herning, Denmark
| | - P Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Schlander M, van Harten W, Retèl VP, Pham PD, Vancoppenolle JM, Ubels J, López OS, Quirland C, Maza F, Aas E, Crusius B, Escobedo A, Franzen N, Fuentes-Cid J, Hernandez D, Hernandez-Villafuerte K, Kirac I, Paty A, Philip T, Smeland S, Sullivan R, Vanni E, Varga S, Vermeulin T, Eckford RD. The socioeconomic impact of cancer on patients and their relatives: Organisation of European Cancer Institutes task force consensus recommendations on conceptual framework, taxonomy, and research directions. Lancet Oncol 2024; 25:e152-e163. [PMID: 38547899 DOI: 10.1016/s1470-2045(23)00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024]
Abstract
Loss of income and out-of-pocket expenditures are important causes of financial hardship in many patients with cancer, even in high-income countries. The far-reaching consequences extend beyond the patients themselves to their relatives, including caregivers and dependents. European research to date has been limited and is hampered by the absence of a coherent theoretical framework and by heterogeneous methods and terminology. To address these shortages, a task force initiated by the Organisation of European Cancer Institutes (OECI) produced 25 recommendations, including a comprehensive definition of socioeconomic impact from the perspective of patients and their relatives, a conceptual framework, and a consistent taxonomy linked to the framework. The OECI task force consensus statement highlights directions for future research with a view towards policy relevance. Beyond descriptive studies into the dimension of the problem, individual severity and predictors of vulnerability should be explored. It is anticipated that the consensus recommendations will facilitate and enhance future research efforts into the socioeconomic impact of cancer and cancer care, providing a crucial reference point for the development and validation of patient-reported outcome instruments aimed at measuring its broader effects.
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Affiliation(s)
- Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany; Alfred Weber Institute (AWI), University of Heidelberg, Mannheim, Germany; Institute for Innovation & Valuation (InnoVal(HC)), Wiesbaden, Germany.
| | - Wim van Harten
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands; Rijnstate Hospital, Arnhem, Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Phu Duy Pham
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julie M Vancoppenolle
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, Netherlands
| | - Jasper Ubels
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany; Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Olaya Seoane López
- The Support Team, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Camila Quirland
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felipe Maza
- Health Technology Assessment Unit, Arturo López Perez Foundation, Santiago, Chile
| | - Eline Aas
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Agustín Escobedo
- Oncology Care Management, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nora Franzen
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Diego Hernandez
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Iva Kirac
- Genetic Counseling Unit, University Hospital for Tumors, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Artus Paty
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Thierry Philip
- Organisation of European Cancer Institutes (OECI), Brussels, Belgium; Institut Curie, Paris, France
| | - Sigbjørn Smeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Cancer Medicine, Oslo University Hospital Comprehensive Cancer Centre, Oslo, Norway
| | | | - Elena Vanni
- Business Controlling, Humanitas Clinical and Research Center, Milan, Italy; Biomedical Sciences, Humanitas Clinical and Research Center, Milan, Italy
| | - Sinisa Varga
- Institute for Gastroenterological Tumours, Zagreb, Croatia
| | - Thomas Vermeulin
- Department of Medical Information, Centre Henri Becquerel, Rouen, France
| | - Rachel D Eckford
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Wechsler S, Ma M, El-Jawahri A, Laws KE, Naticchioni H, Flannery K, Coleman A, Lyons K. Employment-related Education and Support for Cancer Survivors: a Content Analysis of Employment Resources Offered on National Cancer Institute-Designated Cancer Center Websites. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:139-146. [PMID: 38051463 DOI: 10.1007/s13187-023-02386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
High rates of employment changes and associated concerns among cancer survivors following diagnosis and treatment suggest a need to examine what employment-related educational resources and support are currently being offered to cancer survivors and what gaps exist in those resources. In 2023, we conducted a content analysis of employment resources described on the websites of the NCI-Designated Cancer Centers that provide clinical care (N = 64) through a systematic review procedure using predetermined search terms and a standardized process to examine the availability and accessibility of such resources. Descriptive analyses were conducted to characterize the employment resources identified. In total, 175 employment resources were identified across 49 cancer center websites; 102 (58%) provided patient-facing education/information, 58 (33%) offered a consultation, 14 (8%) offered support groups/classes, and 1 (1%) was classified as "Other." Most (76%) resources were provided internally by the cancer center, and often, more than one discipline was involved, most commonly social work and medicine. These findings are encouraging as they suggest that most (77%) NCI-Designated Cancer Centers recognize employment support as a component of survivorship care. The multidisciplinary nature of the resources identified is supported by moderate evidence that multidisciplinary interventions appear to have the greatest potential to foster a return to work for cancer survivors and align with suggestions made by recent expert groups and guidelines regarding employment support for cancer survivors. Ongoing work is needed to assess the utilization, impact, and equity of available employment resources to optimize work outcomes among cancer survivors.
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Affiliation(s)
- Stephen Wechsler
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA.
| | - Michele Ma
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
| | - Areej El-Jawahri
- Division of Hematology Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Kristen Elizabeth Laws
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
| | - Haley Naticchioni
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
| | - Kaitlin Flannery
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
| | - Alison Coleman
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
| | - Kathleen Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, USA
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Vasquez-Trespalacios EM, Rivera Rivera JN, McIntyre M, Santiago-Datil W, Wenham RM, Vadaparampil ST, Buras AL, Conley CC. High Financial Hardship among Patients with Advanced Ovarian Cancer. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:120-132. [PMID: 38635421 DOI: 10.1080/15524256.2024.2342285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
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Affiliation(s)
| | | | - McKenzie McIntyre
- Department of Health Outcomes & Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Robert M Wenham
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Andrea L Buras
- Department of Gynecologic Oncology, Lacks Cancer Center, Grand Rapids, MI, USA
| | - Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA
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11
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Jewett PI, Purani H, Vogel RI, Parsons HM, Borrero M, Blaes A. Comparisons of financial hardship in cancer care by family structure and among those with and without minor children using nationally representative data. Cancer Med 2024; 13:e7088. [PMID: 38520136 PMCID: PMC10960158 DOI: 10.1002/cam4.7088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION While demographic risk factors of cancer-related financial hardships have been studied, having minor children or being single have rarely been assessed in the context of healthcare-related financial hardships. METHODS Using data from the 2015 to 2018 National Health Interview Survey, we assessed financial hardship (material and psychological hardship; behavioral coping due to costs: delaying/foregoing care, reducing prescription costs, or skipping specialists or follow-up care) among adults aged 18-59 years with cancer (N = 2844) by minor child parenting status and family structure. In a secondary analysis, we compared this group with individuals without cancer. Using logistic regression models, we compared those with and without children aged <18 years, further distinguishing between those who were single versus one of two or more adults in the family. RESULTS Compared to individuals from families with two or more adults/without children, single adults with children more often reported cancer-related financial hardships, for example material hardship (45.9% vs. 38.8%), and reducing prescription costs, (50.7% vs. 34.4%, adjusted OR 1.57, 95% CI 1.07-2.28). Single adults without minor children and those from families with two or more adults/with minor children also reported greater financial hardships on some dimensions. Associations were similar among those without cancer, but the overall magnitude of financial hardships was lower compared to those with cancer. CONCLUSIONS Our findings suggest that having minor children, and being a single adult are risk factors for cancer-related financial hardship. Financial vulnerability associated with family structure should be taken into consideration in healthcare, and especially cancer care.
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Affiliation(s)
- Patricia I Jewett
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Himal Purani
- Department of Neurology, University of California Davis, Davis, California, USA
| | - Rachel I Vogel
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Helen M Parsons
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria Borrero
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anne Blaes
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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12
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Li L, Zhang D, Li Y, Jain M, Lin X, Hu R, Liu J, Thapa J, Mu L, Chen Z, Liu B, Pagán JA. Medical financial hardship between young adult cancer survivors and matched individuals without cancer in the United States. JNCI Cancer Spectr 2024; 8:pkae007. [PMID: 38366027 PMCID: PMC10903972 DOI: 10.1093/jncics/pkae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Young adult cancer survivors face medical financial hardships that may lead to delaying or forgoing medical care. This study describes the medical financial difficulties young adult cancer survivors in the United States experience in the post-Patient Protection and Affordable Care Act period. METHOD We identified 1009 cancer survivors aged 18 to 39 years from the National Health Interview Survey (2015-2022) and matched 963 (95%) cancer survivors to 2733 control individuals using nearest-neighbor matching. We used conditional logistic regression to examine the association between cancer history and medical financial hardship and to assess whether this association varied by age, sex, race and ethnicity, and region of residence. RESULTS Compared with those who did not have a history of cancer, young adult cancer survivors were more likely to report material financial hardship (22.8% vs 15.2%; odds ratio = 1.65, 95% confidence interval = 1.50 to 1.81) and behavior-related financial hardship (34.3% vs 24.4%; odds ratio = 1.62, 95% confidence interval = 1.49 to 1.76) but not psychological financial hardship (52.6% vs 50.9%; odds ratio = 1.07, 95% confidence interval = 0.99 to 1.16). Young adult cancer survivors who were Hispanic or lived in the Midwest and South were more likely to report psychological financial hardship than their counterparts. CONCLUSIONS We found that young adult cancer survivors were more likely to experience material and behavior-related financial hardship than young adults without a history of cancer. We also identified specific subgroups of young adult cancer survivors that may benefit from targeted policies and interventions to alleviate medical financial hardship.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mayuri Jain
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xingyu Lin
- Department of Statistical and Actuarial Sciences, University of Western Ontario, London, ON, Canada
| | - Rebecca Hu
- Department of Molecular and Cellular Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janani Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Lan Mu
- Department of Geography, University of Georgia, Athens, GA, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
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13
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Bradley CJ, Kitchen S, Owsley KM. Much work to do about measuring work. J Natl Cancer Inst 2024; 116:194-199. [PMID: 38070483 PMCID: PMC10852620 DOI: 10.1093/jnci/djad258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 02/10/2024] Open
Abstract
Work ability is a critical economic and well-being indicator in cancer care. Yet, work ability is understudied in clinical trials and observational research and is often undocumented in medical records. Despite agreement on the importance of work from well-being, health insurance, and financial perspectives, standardized approaches for collecting, measuring, and analyzing work outcomes are lacking in the health-care setting. The necessary components for closing the gap in patient and caregiver employment research in health-care settings involve a common set of measures, including those that replace or translate generic measures of mental and physical functioning into work outcomes in observational and clinical trial research, standardized approaches to data collection and documentation, and the use of longitudinal data to understand the consequences of reduced work ability over time. We present a conceptual framework for the inclusion of work ability in outcomes research. We cover constructs for employment and work ability measurement that can be adopted in research, recorded as patient-level data, and used to guide treatment decisions. The inclusion of return to work and hours worked, productivity, and ability to perform in a similar job can support conversations that guide treatment decisions and minimize economic consequences. Our hope is that by considering impact on work ability, improved treatments will be developed, health inequities reduced, and resources directed toward aiding patients and their caregivers in balancing work and health demands.
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Affiliation(s)
- Cathy J Bradley
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, Aurora, CO, USA
| | - Sara Kitchen
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Kelsey M Owsley
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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14
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Anampa-Guzmán A, Contreras-Chavez P, Lustberg MB, Nekhlyudov L. Online description of services provided in adult survivorship programs across U.S. accredited cancer centers. J Cancer Surviv 2024; 18:79-83. [PMID: 36933086 DOI: 10.1007/s11764-023-01361-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE The American College of Surgeons Standard 4.8 requires an institution to implement a survivorship program to become a Commission on Cancer (CoC)-accredited cancer center. The online information offered by these cancer centers can help educate patients and their caregivers about available services. We assessed the content of survivorship program websites of CoC-accredited cancer centers in the United States. METHODS Of the 1245 CoC-accredited centers for adults, we sampled 325 institutions (26%) based proportionately on the 2019 new cancer cases by state. Website pages of the institutions' survivorship programs were assessed for information and services offered using the COC Standard 4.8. We included programs for adult survivors of adult- and childhood-onset cancers. RESULTS 54.5% of the cancer centers did not have a survivorship program website. Of the 189 included programs, most were aimed at adult survivors in general, rather than those with specific cancer types. On average, five essential CoC-recommended services were described, most commonly nutrition, care plans, and psychology services. The least mentioned services were genetic counseling, fertility, and smoking cessation. Most programs described services offered to patients who had completed treatment, while 7.4% of described services for those with metastatic disease. CONCLUSION More than half of CoC-accredited programs did have information about cancer survivorship programs on their websites and when included, had variable and limited description of services. IMPLICATIONS FOR CANCER SURVIVORS Our study provides an overview of online cancer survivorship services and offers a methodology that may be used by cancer centers to review, expand, and improve the information described on their websites.
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Affiliation(s)
- Andrea Anampa-Guzmán
- San Fernando Medical SchoolFaculty of Medicine, Universidad Nacional Mayor de San Marcos. Lima, Lima, Peru.
- Department of Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm St, Buffalo, NY, 14203, USA.
| | | | | | - Larissa Nekhlyudov
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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15
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Azzani M, Atroosh WM, Anbazhagan D, Kumarasamy V, Abdalla MMI. Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis. Front Public Health 2024; 11:1266533. [PMID: 38229668 PMCID: PMC10789858 DOI: 10.3389/fpubh.2023.1266533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/17/2023] [Indexed: 01/18/2024] Open
Abstract
Background There is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment. Methods PubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT. Results Out of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0-70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9. Conclusion This study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Centre of Occupational Safety, Health and Wellbeing, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
| | - Wahib Mohammed Atroosh
- Department of Parasitology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Microbiology and Parasitology, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Deepa Anbazhagan
- Department of Microbiology, International Medical School (IMS), Management & Science University (MSU), Shah Alam, Selangor, Malaysia
| | - Vinoth Kumarasamy
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Kuala Lumpur, Malaysia
| | - Mona Mohamed Ibrahim Abdalla
- Physiology Department, Human Biology Division, School of Medicine, International Medical University (IMU), Kuala Lumpur, Malaysia
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Chen X, Chaimongkol N, Hengudomsub P. Effects of a Phone-Based Support Program for Women With Breast Cancer Undergoing Chemotherapy: A Pilot Study. SAGE Open Nurs 2024; 10:23779608241231176. [PMID: 38415216 PMCID: PMC10898293 DOI: 10.1177/23779608241231176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/21/2023] [Accepted: 01/20/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction The increasing number of women with breast cancer undergoing chemotherapy may result in long-lasting, adverse physical side effects and reduced quality of life. Objective This study aimed to develop and assess the feasibility and preliminary effects of the Phone-Based Support Program for women with breast cancer undergoing chemotherapy. The primary outcome was self-care self-efficacy; secondary outcomes were symptom distress and quality of life. Methods This pilot study was conducted at a tertiary hospital in Jiangsu province, China, from February to March 2023. The Phone-Based Support Program was delivered to 20 participants through the smartphone application WeChat, consisting of learning, discussion, ask-the-expert, and personal stories components. Outcome measures were assessed at three time points: preintervention, postintervention, and follow-up. Results The Phone-Based Support Program was feasible and could improve self-care self-efficacy, decrease symptom distress, and promote quality of life. The program was well-accepted, and participants engaged actively in the online discussion and sought expert advice. Conclusions The Phone-Based Support Program showed feasibility and effectiveness in improving self-care self-efficacy, reducing symptom distress, and enhancing quality of life.
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Affiliation(s)
- Xi Chen
- Faculty of Nursing, Burapha University, Chon Buri, Thailand
- Yancheng NO.1 People's Hospital in Jiangsu, Jiangsu, China
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17
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Roskoski R. Cost in the United States of FDA-approved small molecule protein kinase inhibitors used in the treatment of neoplastic and non-neoplastic diseases. Pharmacol Res 2024; 199:107036. [PMID: 38096958 DOI: 10.1016/j.phrs.2023.107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
Because genetic alterations including mutations, overexpression, translocations, and dysregulation of protein kinases are involved in the pathogenesis of many illnesses, this enzyme family is the target of many drug discovery programs worldwide. The FDA has approved 80 small molecule protein kinase inhibitors with 77 drugs orally bioavailable. The data indicate that 69 of these medicinals are approved for the management of neoplasms including solid tumors such as breast and lung cancer as well as non-solid tumors such as leukemia. Moreover, the remaining 11 drugs target non-neoplastic diseases including psoriasis, rheumatoid arthritis, and ulcerative colitis. The cost of drugs was obtained from www.pharmacychecker.com using the FDA label to determine the dosage and number of tablets required per day. This methodology excludes any private or governmental insurance coverage, which would cover the entire cost or more likely a fraction of the stated price. The average monthly cost for the treatment of neoplastic diseases was $17,900 with a price of $44,000 for futibatinib (used to treat cholangiocarcinomas with FGFR2 fusions) and minimum of $5100 for binimetinib (melanoma). The average monthly cost for the treatment of non-neoplastic diseases was $6800 with a maximum of $17,000 for belumosudil (graft vs. host disease) and a minimum of $200 for netarsudil eye drops (glaucoma). There is a negative correlation of the cost of the drugs and the incidence of the targeted disease. Many of these agents are or were designated as orphan drugs meaning that there are fewer than 200,000 potential patients in the United States.
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Affiliation(s)
- Robert Roskoski
- Blue Ridge Institute for Medical Research, 221 Haywood Knolls Drive, Hendersonville, NC 28791, United States.
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18
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Pangestu S, Harjanti EP, Pertiwi IH, Rencz F, Nurdiyanto FA. Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis. Value Health Reg Issues 2023; 41:25-31. [PMID: 38154366 DOI: 10.1016/j.vhri.2023.11.007] [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: 07/12/2023] [Revised: 09/28/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia. METHODS Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis. RESULTS We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members. CONCLUSIONS This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.
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Affiliation(s)
- Stevanus Pangestu
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | | | - Ika Hana Pertiwi
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - F A Nurdiyanto
- Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia
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Wu Y, Liu X, Maculaitis MC, Li B, Berk A, Massa A, Weiss MC, McRoy L. Financial Toxicity among Patients with Breast Cancer during the COVID-19 Pandemic in the United States. Cancers (Basel) 2023; 16:62. [PMID: 38201491 PMCID: PMC10778054 DOI: 10.3390/cancers16010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
This study reported the prevalence of financial distress (financial toxicity (FT)) and COVID-19-related economic stress in patients with breast cancer (BC). Patients with BC were recruited from the Ciitizen platform, Breastcancer.org, and patient advocacy groups between 30 March and 6 July 2021. FT was assessed with the COmprehensive Score for financial Toxicity (COST) instrument. COVID-19-related economic stress was assessed with the COVID-19 Stress Scale. Among the 669 patients, the mean age was 51.6 years; 9.4% reported a COVID-19 diagnosis. The prevalence rates of mild and moderate/severe FT were 36.8% and 22.4%, respectively. FT was more prevalent in patients with metastatic versus early BC (p < 0.001). The factors associated with FT included income ≤ USD 49,999 (adjusted odds ratio (adj OR) 6.271, p < 0.0001) and USD 50,000-USD 149,999 (adj OR 2.722, p < 0.0001); aged <50 years (adj OR 3.061, p = 0.0012) and 50-64 years (adj OR 3.444, p = 0.0002); living alone (adj OR 1.603, p = 0.0476); and greater depression severity (adj OR 1.155, p < 0.0001). Black patients (adj OR 2.165, p = 0.0133), patients with income ≤ USD 49,999 (adj OR 1.921, p = 0.0432), or greater depression severity (adj OR 1.090, p < 0.0001) were more likely to experience COVID-19-related economic stress. FT was common in patients with BC, particularly metastatic disease, during COVID-19. Multiple factors, especially lower income and greater depression severity were associated with financial difficulties during COVID-19.
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Affiliation(s)
- Yan Wu
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ 07103, USA;
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | - Xianchen Liu
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | | | - Benjamin Li
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
| | - Alexandra Berk
- Invitae Corporation, San Francisco, CA 94103, USA; (A.B.); (A.M.)
| | - Angelina Massa
- Invitae Corporation, San Francisco, CA 94103, USA; (A.B.); (A.M.)
| | | | - Lynn McRoy
- Pfizer Inc., New York, NY 10001, USA; (B.L.); (L.M.)
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20
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Forbat L. Multiple myeloma in people of working age in Czechia, Germany, and Poland: findings from a qualitative interview study. J Cancer Surviv 2023:10.1007/s11764-023-01510-1. [PMID: 38114713 DOI: 10.1007/s11764-023-01510-1] [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: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The study sought to understand the experiences of working age adults with myeloma and their partner/family members, living in Czechia, Germany, and Poland. METHODS Qualitative interviews were conducted with 36 working age adults living with myeloma, and three family members. Data were collected from May to October 2022. Thematic analysis was applied to the data. RESULTS Healthcare and state support within each country are described. The degree of work engagement was informed by patients' symptom burden, treatment needs, state financial aid, and family/financial obligations. Many did not conceptualise their status as involving 'return to work' as they had continued to be engaged with their jobs throughout. For some, remote working enabled them to manage treatments/side-effects and their job, while avoiding infection. In some cases, patients did not tell their employer or colleagues about their illness, for fear of discrimination. CONCLUSION While experiences varied between countries, common across accounts was a struggle to balance ongoing treatments with employment, at a time when participants were expected to finance their own households and maintain their income and roles. Implications for Cancer Survivors To improve quality of life, clinical discussions around treatment decision-making should take into account patients' attitudes/approach to work, type of work engaged in, and other activities considered important to them. European Union and national cancer plans should set out optimum standards for employers, to ensure an equitable benchmark for how employees are supported. Such approaches would improve legal protections and better enforcement of employer policies to accommodate patients' limitations in the workplace.
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21
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Le GH, Hermansen Å, Dahl E. Return to work after cancer-the impact of working conditions: A Norwegian Register-based Study. J Cancer Surviv 2023:10.1007/s11764-023-01503-0. [PMID: 38114712 DOI: 10.1007/s11764-023-01503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The purpose of this study is to compare a cohort of cancer survivors with a cohort of cancer-free employees (1) with respect to employment prospects over a 15-year period and (2) with respect to the differential impact of working conditions on employment over this time period. METHODS The cancer cohort is retrieved from the Cancer Registry of Norway, while data on the non-cancer cohort are retrieved from register data managed by Statistics Norway. Job exposure matrices were used to remedy the lack of working-conditions information in the register data. We use nearest-neighbor matching to match the non-cancer cohort (the control group) to the cancer-survivor cohort (the treatment group). Cox regression analysis was applied to examine the relationships between working conditions, employment, and cancer. The results are reported separately for mechanical-job exposures and psychosocial exposures, as well as by gender. RESULTS Cancer survivors are more likely to experience reduced employment as compared to individuals without a history of cancer. Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer. This does not apply to female cancer survivors. Regarding the impact of psychosocial exposures on employment, we find no differences over time between cancer survivors and the non-cancer population. CONCLUSIONS Male cancer survivors in physically demanding occupations have an increased risk of reduced employment after being diagnosed with cancer, whereas this is not the case for female cancer survivors. Psychosocial exposures do not impact the relative risk of reduced employment over time. IMPLICATIONS FOR CANCER SURVIVORS We suggest that return to work after cancer should be considered a process rather than only the re-entry step of resuming work. Thus, it is important to provide long-term support for cancer survivors. We recommend providing more attention to working conditions, particularly in occupations that involve a high level of mechanical-job exposures.
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Affiliation(s)
- Giang Huong Le
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway.
| | - Åsmund Hermansen
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, OsloMet - Oslo Metropolitan University, Faculty of Social Sciences, Oslo, Norway
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22
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Nicoli I, Lockwood G, Fitch L, Longo CJ, Fitch MI. Impact of Income on Physical Concerns, Help Seeking, and Unmet Needs of Adult Cancer Survivors. Physiother Can 2023; 75:339-347. [PMID: 38037576 PMCID: PMC10686300 DOI: 10.3138/ptc-2021-0084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/29/2021] [Accepted: 12/22/2021] [Indexed: 12/02/2023]
Abstract
Purpose Cancer treatment can have consequences for individuals which may have profound impact on daily living. Accessing assistance can be problematic. This study explores associations between income and concerns, help-seeking, and unmet needs related to physical changes following cancer treatment. Method A national survey was conducted with cancer survivors about experiences with follow-up care one to three years after treatment. We report a trend analysis describing associations between income and cancer survivors' concerns, help-seeking, and unmet needs related to physical changes after treatment. Results In total 5,283 cancer survivors between 18 and 64 years responded, of which 4,264 (80.7%) indicated annual household income. The majority of respondents were survivors of breast (34.4%), colorectal (15.0%), and prostate (14.0%) cancers. Over 90% wrote about experiencing physical changes following cancer treatment. Survivors with low annual household incomes of less than $25,000 (CAN) reported the highest levels of concern about multiple physical changes and were more likely to seek help to address them. Conclusions Cancer survivors can experience various physical challenges and unmet needs following cancer treatment and difficulty obtaining relevant help across all income levels. Those with low income are more severely affected. Financial assessment and tailored follow-up are recommended.
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Affiliation(s)
- Irene Nicoli
- From the:
From the: Health Care Independent Consultant, Toronto, Ontario, Canada
| | - Gina Lockwood
- Biostatistician Independent Consultant, Toronto, Ontario, Canada
| | - Lauren Fitch
- Davidson Physiotherapy, Riverview, New Brunswick, Canada
| | - Christopher J. Longo
- Associate Health Policy and Management, De Groote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Fardell JE, Tan SY(C, Kerin-Ayres K, Dhillon HM, Vardy JL. Symptom Clusters in Survivorship and Their Impact on Ability to Work among Cancer Survivors. Cancers (Basel) 2023; 15:5119. [PMID: 37958295 PMCID: PMC10647426 DOI: 10.3390/cancers15215119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Cancer survivors often experience a range of symptoms after treatment which can impact their quality of life. Symptoms may cluster or co-occur. We aimed to investigate how symptoms and symptom clusters impact the ability to work among cancer survivors. METHODS We used symptom severity data and ability to work data routinely collected from cancer survivors attending a survivorship clinic after primary treatment with curative intent. We defined symptom clusters using single linkage and a threshold on the rescaled distances of <10. We then conducted a logistic regression to examine how symptoms and symptom clusters were related to the ability to work. RESULTS We analysed data from 561 cancer survivors, mean age 58 years and 1.5 years post diagnosis, with mixed diagnoses including breast (40.5%), colorectal (32.3%), and haematological cancers (15.3%). Limitations to work ability were reported by 34.9% of participants. Survivors experiencing pain, emotional, and cognitive symptom clusters were 14-17% more likely to report limitations in their ability to work. Older survivors and those with a higher stage disease were more likely to report limitations in their ability to work. CONCLUSION A better understanding and management of symptom severity and symptom clusters may help the sizable proportion of cancer survivors experiencing symptoms to participate in work after treatment.
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Affiliation(s)
- Joanna E. Fardell
- UNSW Medicine & Health, School of Clinical Medicine, UNSW Sydney, Sydney 1466, Australia;
- Western Sydney Youth Cancer Service, Westmead Hospital, Sydney 2145, Australia
| | - Sim Yee (Cindy) Tan
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney 2139, Australia;
| | - Kim Kerin-Ayres
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney 2139, Australia;
| | - Haryana M. Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney 2006, Australia;
| | - Janette L. Vardy
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia;
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney 2139, Australia;
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24
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Su M, Liu S, Liu L, Wang F, Lao J, Sun X. Heterogeneity of financial toxicity and associated risk factors for older cancer survivors in China. iScience 2023; 26:107768. [PMID: 37731611 PMCID: PMC10507189 DOI: 10.1016/j.isci.2023.107768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Abstract
In China, older cancer survivors may show heterogeneity in financial toxicity (FT). We aimed to identify FT profiles among older Chinese cancer survivors and examine the association between FT profiles and individual characteristics. We used a latent profile analysis to categorize participants and a multinomial logistic regression to examine the associations. We identified three distinct FT profiles: high, moderate, and low. Participants aged 65-69 years, with a monthly household income ≥ 5,000 CNY and a high school education or above were more likely to be classified into the moderate than high FT profile, a monthly household income ≥ 5,000 CNY increased the likelihood of being in the low FT profile and living alone negatively affected the odds of being in the low FT profile. The findings identified heterogeneity in FT among this population, may help identify high-risk groups, and may enable early intervention.
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Affiliation(s)
- Mingzhu Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
| | - Siqi Liu
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Li Liu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Fang Wang
- Center of Health System and Policy, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100020, China
| | - Jiahui Lao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan Shandong, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, Shandong 250012, China
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25
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Liu WH, Fox J, Yates P. Work-related experiences of prostate cancer survivors in Australia: a qualitative study. BMC Public Health 2023; 23:1806. [PMID: 37716940 PMCID: PMC10505317 DOI: 10.1186/s12889-023-16706-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most diagnosed cancer in Australian men, and the number of survivors is growing with advances in diagnosis and treatment. Work participation following PCa diagnosis and treatment becomes a significant aspect of quality of life and survivorship. Using a qualitative phenomenological approach, we explored the work-related experiences of PCa survivors in Australia. METHODS Semi-structured telephone interviews were conducted with 16 men (6 salaried employees, 10 self-employed; 8 diagnosed ≥ 5 years) purposively sampled from a community setting. Interviews were inductively analysed. RESULTS Five main themes emerged: motivations to work; treatment decisions and work; the effects of PCa and its treatment on ability to participate in work; being an employee versus being self-employed; and personal agency. PCa and its treatment side-effects were detrimental to men's work capacity and ability, and could persist over an extended period. Most men expressed a strong desire to retain work or return to work. Discussions with healthcare professionals about work-related consequences were largely missing when treatment decisions were made. Self-employed men faced greater challenges than their salaried counterparts due to high financial burden and limited social and business support. Family, workplace and wider community support, and self-care, enhanced men's work participation experiences. CONCLUSIONS PCa and its treatment substantially and persistently impacted men's working lives, and their experiences were diverse and multifaceted. Self-employed and long-term PCa survivors face greater challenges and are at high risk of poor work outcomes. A systematic approach and involvement of stakeholders at all levels is required to support ongoing work participation.
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Affiliation(s)
- Wei-Hong Liu
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
| | - Jennifer Fox
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Patsy Yates
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Nicoll I, Lockwood G, Fitch MI. Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care. Curr Oncol 2023; 30:8134-8148. [PMID: 37754505 PMCID: PMC10528685 DOI: 10.3390/curroncol30090590] [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: 07/25/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors' perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors' physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship.
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Affiliation(s)
- Irene Nicoll
- Health Care Consultant, Toronto, ON M4C 4V9, Canada;
| | - Gina Lockwood
- Biostatistician Consultant, Toronto, ON M4C 4V9, Canada;
| | - Margaret I. Fitch
- Faculty of Nursing, University of Toronto, 207 Chisholm Ave., Toronto, ON M4C 4V9, Canada
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Tak HJ, Horner RD, Lee MS, Shih YCT. Impact of functional disability on health-care use and medical costs among cancer survivors. JNCI Cancer Spectr 2023; 7:pkad059. [PMID: 37584678 PMCID: PMC10505255 DOI: 10.1093/jncics/pkad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies health-care use and costs. This study examined the association between functional disability among cancer survivors and their health-care utilization and medical costs. METHODS We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included use of 6 service types (inpatient, outpatient, office-based physician, office-based nonphysician, emergency department, and prescription) and medical costs of aggregate services and by each of 6 service types. The primary independent variable was a categorical variable for the total number of functional disabilities. We employed multivariable generalized linear models and 2-part models, adjusting for sociodemographics and health conditions and accounting for survey design. RESULTS Among cancer survivors (n = 9359; weighted n = 21 046 285), 38.8% reported at least 1 disability. Compared with individuals without a disability, cancer survivors with 4 or more disabilities experienced longer hospital stays (adjusted average marginal effect = 1.14 days, 95% confidence interval [CI] = 0.55 to 1.73), more visits to an office-based physician (average marginal effect = 1.43 visits, 95% CI = 0.51 to 2.35), and a greater number of prescriptions (average marginal effect = 12.1 prescriptions, 95% CI = 9.27 to 15.0). Their total (average marginal effect = $9537, 95% CI = $5713 to $13 361) and out-of-pocket (average marginal effect = $639, 95% CI = $79 to $1199) medical costs for aggregate services were statistically significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services. CONCLUSIONS Cancer survivors with a disability experienced greater health-care use and higher costs. Cancer survivorship planning for health care and financial stability should consider the patients' disability profile.
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Affiliation(s)
- Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ronnie D Horner
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, NE, USA
| | - Min Sok Lee
- Department of Economics, University of Chicago, Chicago, IL, USA
| | - Ya-Chen Tina Shih
- Jonsson Comprehensive Cancer Center and Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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28
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Galiti D, Linardou H, Agelaki S, Karampeazis A, Tsoukalas N, Psyrri A, Karamouzis M, Syrigos KN, Ardavanis A, Athanasiadis I, Arvanitou E, Sgourou S, Mala A, Vallilas C, Boukovinas I. Exploring the Use of a Digital Platform for Cancer Patients to Report Their Demographics, Disease and Therapy Characteristics, Age, and Educational Disparities: An Early-Stage Feasibility Study. Curr Oncol 2023; 30:7608-7619. [PMID: 37623032 PMCID: PMC10453047 DOI: 10.3390/curroncol30080551] [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: 04/01/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The increasing burden of cancer, the development of novel therapies, and the COVID-19 pandemic have made cancer care more complex. Digital innovation was then pushed toward developing platforms to facilitate access to cancer care. Age, education, and other disparities were, however, shown to limit the use of the digital health innovation. The aim of this early-stage feasibility study was to assess whether Greek cancer patients would register at CureCancer and self-report their demographics, disease and therapy characteristics, and socioeconomic issues. The study was organized by the Hellenic Society of Medical Oncology. METHODS Patients from nine cancer centers were invited to register on the CureCancer platform and complete an anonymous questionnaire on demographics, disease and therapy characteristics, and socioeconomic issues. Patients were also encouraged to upload, in a secure area for them, their medical files and share them with their physicians. They were then asked to comment on their experience of registration and how easy it was to upload their medical files. RESULTS Of the 159 patients enrolled, 144 (90.56%) registered, and 114 of those (79.16%) completed the questionnaire, suggesting that the study is feasible. Users' median age was 54.5 years, and 86.8% of them were university and high school graduates. Most patients (79.8%) reported their specific type of cancer diagnosis, and all reported their therapy characteristics. Breast and lung cancers were the most common. A total of 87 patients (76.3%) reported being on active cancer therapy, 46 (40.4%) had metastatic disease, and 51 (44.7%) received supportive care medications. Eighty-one (71.05%) patients received prior cancer therapies, and twenty-seven recalled prior supportive care medications. All patients reported visiting non-oncology Health Care Professionals during the study. Nineteen of 72 (26.39%) patients who worked prior to cancer diagnosis changed work status; 49 (42.98) patients had children under 24 years; and 16 (14%) patients lived alone. Nine (7.9%) patients were members of patient associations. Registration was "much/very much" easy for 98 (86.0%) patients, while 67 (58.8%) had difficulties uploading their files. Patients commented on the well-organized data access, improved communication, feeling safe, medication adherence, interventions from a distance, and saving time and money. Over 80% of patients "preferred the digital way". DISCUSSION A total of 114 patients succeeded in registering on the digital platform and reporting their demographics, disease and therapy characteristics, and socioeconomic issues. Age and educational disparities were disclosed and highlighted the need for educational programs to help older people and people of lower education use digital innovation. Health care policy measures would support patients' financial burden associated with work changes, living alone, and children under 24 years old at school or college. Policy actions would motivate patients to increase their participation in patient associations. According to the evidence DEFINED framework, the number of patients, and the focus on enrollment, engagement, and user experience, the study fulfills actionability level criterion 1.
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Affiliation(s)
- Dimitra Galiti
- Clinic of Oral Diagnosis and Radiology, School of Dentistry, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | | | - Sofia Agelaki
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | - Amanda Psyrri
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
| | | | | | | | | | | | | | - Anastasia Mala
- Hellenic Society of Medical Oncology, 11475 Athens, Greece
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Hallgren E, Narcisse MR, Andersen JA, Willis DE, Thompson T, Bryant-Smith G, McElfish PA. Medical Financial Hardship and Food Security among Cancer Survivors in the United States. Cancer Epidemiol Biomarkers Prev 2023; 32:1038-1047. [PMID: 37255367 PMCID: PMC10524473 DOI: 10.1158/1055-9965.epi-22-1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/21/2022] [Accepted: 05/05/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Some cancer survivors experience medical financial hardship, which may reduce their food security. The purpose of this study was to explore whether medical financial hardship is related to food security among cancer survivors. METHODS The study was based on cross-sectional data from the 2020 National Health Interview Survey. We used ordinal logistic regression to examine the relationship between material, psychological, and behavioral medical financial hardships and household food security (i.e., high, marginal, low, or very low) among individuals ages ≥18 years who reported a cancer diagnosis from a health professional (N = 4,130). RESULTS The majority of the sample reported high household food security (88.5%), with 4.8% reporting marginal, 3.6% reporting low, and 3.1% reporting very low household food security. In the adjusted model, the odds of being in a lower food security category were higher for cancer survivors who had problems paying or were unable to pay their medical bills compared with those who did not [OR, 1.73; 95% confidence interval (CI), 1.06-2.82, P = 0.027], who were very worried about paying their medical bills compared with those who were not at all worried (OR, 2.88; 95% CI, 1.64-5.07; P < 0.001), and who delayed medical care due to cost compared with those who did not (OR, 2.56; 95% CI, 1.29-5.09; P = 0.007). CONCLUSIONS Food insecurity is rare among cancer survivors. However, medical financial hardship is associated with an increased risk of lower household food security among cancer survivors. IMPACT A minority of cancer survivors experience medical financial hardship and food insecurity; social needs screenings should be conducted.
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Affiliation(s)
- Emily Hallgren
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Jennifer A. Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Don E. Willis
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
| | - Tess Thompson
- Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
| | - Gwendolyn Bryant-Smith
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St. – Slot 556, Little Rock, AR 72205, USA
| | - Pearl A. McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, 2708 S. 48 St., Springdale, AR 72762, USA
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Kim Y, Chae J, Shin S, Jo G, Shin J, Kim B, Kim DS, Lee JY. Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020. Infect Chemother 2023; 55:237-246. [PMID: 37407241 DOI: 10.3947/ic.2023.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. MATERIALS AND METHODS We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. RESULTS PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at -0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. CONCLUSION PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.
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Affiliation(s)
- Yujeong Kim
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Jungmi Chae
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Seohee Shin
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Gayoung Jo
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Jihye Shin
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
| | - Byungsoo Kim
- Drug Utilization Review (DUR) Operation Division, DUR Department, Health Insurance Review and Assessment Service (HIRA), Wonju, Korea
| | - Dong-Sook Kim
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
- Department of Health Administration, College of Nursing and Health, Kongju National University, Gongju, Korea.
| | - Jin Yong Lee
- Health Insurance Review and Assessment (HIRA) Research Institute, Wonju, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Sarkar S, Arakelyan S, Choa E, Poghosyan H. The role of financial security in loneliness or sadness among Medicare-enrolled cancer survivors during the COVID-19 pandemic. J Geriatr Oncol 2023; 14:101507. [PMID: 37216846 PMCID: PMC10123351 DOI: 10.1016/j.jgo.2023.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION This study aims to estimate the relative decreased rate of financial security and increased rate of loneliness or sadness during the COVID-19 pandemic and investigate the association between financial security and loneliness or sadness among Medicare beneficiaries with a cancer history. MATERIAL AND METHODS We examined population-based, cross-sectional data from the Medicare Current Beneficiary Survey COVID-19 Winter 2021 survey. The study cohort included 1,632 Medicare beneficiaries (aged ≥65 years) with self-reported cancer history. The outcome was feelings of loneliness or sadness, and the independent variable was financial security during the 2020-2021 winter surge of COVID-19. We conducted weighted descriptive statistics, a cross-tabulation analysis, and multivariable logistic regression analyses. RESULTS Overall, 18.8% of cancer survivors reported increased feelings of loneliness or sadness and 11.2% reported decreased financial security during the 2020-2021 winter surge of COVID-19. Cancer survivors who reported decreased financial security had 93% higher odds of increased feelings of loneliness or sadness compared to those who reported feeling more or about the same financial security (Adjusted odds ratio [AOR] = 1.93; 95% Confidence Interval [CI] 1.25-3.01; p <0.004). DISCUSSION Decreased financial security and increased feelings of loneliness or sadness were prevalent among cancer survivors. Additional screenings and interventions beyond what are currently available are needed to ease the socioeconomic vulnerabilities experienced by cancer survivors.
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Affiliation(s)
| | - Stella Arakelyan
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, Edinburgh University, Edinburgh, UK.
| | | | - Hermine Poghosyan
- Yale University School of Nursing, Orange, CT, USA; COPPER Center, Yale School of Medicine, New Haven, CT, USA.
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Fiala MA, Silberstein AE, Schroeder MA, Stockerl-Goldstein KE, Vij R. The Dynamics of Financial Toxicity in Multiple Myeloma. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:266-272. [PMID: 36754693 DOI: 10.1016/j.clml.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION/BACKGROUND People with multiple myeloma are at risk for financial toxicity due to the high cost of treatment and prolonged treatment duration. However, little data exist regarding financial toxicity among people with myeloma. PATIENTS AND METHODS In this study, a cohort of 135 patients were recruited from an ongoing observational trial to complete the Comprehensive Score for financial Toxicity (COST). Participants were sent follow-up surveys at 3, 6, and 12 months. RESULTS The median age was 68 years; the majority were non-Hispanic whites (88%), male (63%), held a college degree (61%), and had left the workforce (70%). The median time from myeloma diagnosis was 28 months. The median COST score was 27; 48% of participants had a score below 27 and considered to have financial toxicity. The only characteristic associated with financial toxicity was a college degree. After controlling for other covariates, those with a college education were 69% less likely to have financial toxicity. Of the 108 participants who completed a follow-up survey, 34% reported changes in their financial toxicity status at a subsequent time point. Transitioning from not having financial toxicity to having financial toxicity was more common than the reverse. CONCLUSION Because financial toxicity is a dynamic process, which patients are experiencing it at any given time is difficult to predict. Focusing the research agenda on improved detection and intervention may be warranted.
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Affiliation(s)
- Mark A Fiala
- Washington University School of Medicine, St. Louis, MO.
| | | | | | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, MO
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Millar MM, Herget KA, Ofori-Atta B, Codden RR, Edwards SL, Carter ME, Belnap B, Kirchhoff AC, Sweeney C. Cancer survivorship experiences in Utah: an evaluation assessing indicators of survivors' quality of life, health behaviors, and access to health services. Cancer Causes Control 2023; 34:337-347. [PMID: 36723708 PMCID: PMC10367944 DOI: 10.1007/s10552-023-01671-5] [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: 06/27/2022] [Accepted: 01/14/2023] [Indexed: 02/02/2023]
Abstract
PURPOSE The 2016-2020 Utah Comprehensive Cancer Prevention and Control Plan prioritized strategies to address cancer survivorship experiences. In this paper we present estimates for nine indicators evaluating these priorities, trends over time, and assess disparities in survivorship experiences across demographic subgroups. METHODS We surveyed a representative sample of Utah cancer survivors diagnosed between 2012 and 2019 with any reportable cancer diagnosis. We calculated weighted percentages and 95% confidence intervals (CI) for each indicator. We assessed change over time using a test for trend across survey years in a logistic regression model and used Rao-Scott F-adjusted chi-square tests to test the association between demographic characteristics and each survivorship indicator. RESULTS Most of the 1,793 respondents (93.5%) reported their pain was under control, 85.7% rated their overall health as good, very good, or excellent, but 46.5% experienced physical, mental, or emotional limitations. Only 1.7% of survivors aged 75 or older were current smokers, compared to 5.8% of 65-74-year-olds and 7.9% of survivors aged 55-74 (p < 0.006). No regular physical activity was reported by 20.6% and varied by survivor age and education level. The proportion who received a survivorship care plan increased from 34.6% in 2018 to 43.0% in 2021 (p = 0.025). However, survivors under age 55 were significantly less likely to receive a care plan than older survivors. CONCLUSION This representative survey of cancer survivors fills a gap in understanding of the cancer survivorship experience in Utah. Results can be used to evaluate and plan additional interventions to improve survivorship quality of life.
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Affiliation(s)
- Morgan M Millar
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA.
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | | | | | - Rachel R Codden
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Sandra L Edwards
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
| | | | - Brad Belnap
- Utah Department of Health and Human Services, Utah Cancer Control Program, Salt Lake City, UT, USA
| | - Anne C Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Carol Sweeney
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Di Giuseppe G, Pagalan L, Jetha A, Pechlivanoglou P, Pole JD. Financial toxicity among adolescent and young adult cancer survivors: A systematic review of educational attainment, employment, and income. Crit Rev Oncol Hematol 2023; 183:103914. [PMID: 36706969 DOI: 10.1016/j.critrevonc.2023.103914] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/17/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To identify, evaluate and summarize the evidence on educational attainment, employment status and income of AYAs surviving cancer. METHODS A search of six databases for articles published between 01/01/2010 and 03/31/2022 was performed. Articles with an AYA survivorship population, quantitative design and a cancer-free comparator group were included. Data extraction was conducted, and quality appraisal was completed using ROBINS-I. Results were summarized using a narrative synthesis. RESULTS A total of 2801 articles were identified, of which 12 were included. Among the limited evidence, educational attainment did not differ from cancer-free peers. Survivors were more likely to be unemployed, have lower incomes and require social security for income supplementation. Evidence suggested that females, diagnosis of brain cancer and the presence of late-effects were among the risk factors for severe outcomes. CONCLUSIONS Limited socioeconomic evidence exists for AYAs surviving cancer. Long-lasting financial toxicities occur and highlights a need for further investigation.
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Affiliation(s)
- Giancarlo Di Giuseppe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Lief Pagalan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Arif Jetha
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute for Work & Health, Toronto, Ontario, Canada
| | | | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Health Sciences Research, University of Queensland, Brisbane, Australia
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Liang MI, Harrison R, Aviki EM, Esselen KM, Nitecki R, Meyer L. Financial toxicity: A practical review for gynecologic oncology teams to understand and address patient-level financial burdens. Gynecol Oncol 2023; 170:317-327. [PMID: 36758422 DOI: 10.1016/j.ygyno.2023.01.035] [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: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
Financial toxicity describes the adverse impact patients experience from the monetary and time costs of cancer care. The financial burden patients experience comes from substantially increased out-of-pocket spending that often occurs concurrent with reduced income due to sick leave from work. Financial toxicity is common affecting approximately half of patients with a gynecological cancer depending on the validated instrument used for measurement. Financial toxicity is experienced by patients in three domains: economic hardship affecting patients' material conditions (i.e., medical debt), psychological response (i.e., distress), and health-related coping behaviors that patients adopt (i.e., foregoing care due to costs). Higher financial toxicity among cancer patients has been associated with decreased quality of life, impaired adherence to recommended care, and worse overall survival. In this review, we describe the current literature on financial toxicity, including how it can be assessed with validated tools, the downstream impact on patients, risk factors, and employment concerns of survivors. Whenever possible, we highlight data from research featuring patients with gynecologic cancer specifically. We also review studies with interventions aimed to mitigate financial toxicity and offer the reader real world examples of interventions currently being used. Lastly, we provide an overview of health policy developments relevant to financial toxicity and advocate for innovation in the development and implementation of strategies to decrease the financial toxicity patients experience following a diagnosis of gynecologic cancer.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ross Harrison
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Emeline M Aviki
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Larissa Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Farina E, Rosso M, Dansero L, Ippoliti R, Numico G, Macciotta A, Bena A, Ricceri F. Short-term effect of colorectal cancer on income: analysis of an Italian cohort. J Epidemiol Community Health 2023; 77:196-201. [PMID: 36707238 DOI: 10.1136/jech-2022-220088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The ability to return to work after a cancer diagnosis is a key aspect of cancer survivorship and quality of life. Studies have reported a significant risk of income loss for cancer survivors; however, there is limited evidence of the Italian context. METHODS The Work Histories Italian Panel (WHIP)-Salute database was used to select a cohort of incident cases of colorectal cancer (CRC) among workers in the private sector, based on hospital discharges. A propensity score matching was used to find a balanced control group for several confounders. Ordinary least square and logistic regressions were used to estimate the effect of a CRC diagnosis on annual income and the probability of switching from a full-time contract to a part-time one considering 3 years after the diagnosis. RESULTS Overall, we identified 925 CRC incident cases from 2006 until 2012. Our results confirm a statistically significant reduction in survivors' income compared with controls. This reduction was greater in the first year and then tend to decrease, with an average income loss over 3 years of about €12 000. Stratified analyses by sex and position confirmed the overall trend while indicating a strong effect modification. Regarding the switching from full-time to part-time employment, the results were never significant. CONCLUSION Income loss does not seem to be related to an increase in part-time contracts, but rather to survivors' reduced work capacity following the invasive treatments. Further research is needed to investigate the complex dynamics behind this association.
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Affiliation(s)
- Elena Farina
- Department of Epidemiology, ASL TO3, Grugliasco, Piemonte, Italy
| | - Marco Rosso
- Department of Economics, University of Bologna, Bologna, Italy
| | - Lucia Dansero
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, Università degli Studi di Torino, Orbassano, Piemonte, Italy
| | - Roberto Ippoliti
- Faculty of Business Administration and Economics, University of Bielefeld, Bielefeld, Germany
| | - Gianmauro Numico
- Department of Medical Oncology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Alessandra Macciotta
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, Università degli Studi di Torino, Orbassano, Piemonte, Italy
| | - Antonella Bena
- Documentation Centre for Health Promotion, ASL TO3, Grugliasco, Piemonte, Italy
| | - Fulvio Ricceri
- Centre for Biostatistics, Epidemiology, and Public Health (C-BEPH), Department of Clinical and Biological Sciences, Università degli Studi di Torino, Orbassano, Piemonte, Italy
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Camgoz Akdag H, Menekse A. Breast cancer treatment planning using a novel spherical fuzzy CRITIC-REGIME. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2023. [DOI: 10.3233/jifs-222648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Breast cancer is the leading cause of cancer-related deaths, and choosing a suitable treatment plan for this disease has proved difficult for oncologists owing to the variety of criteria and alternatives that must be considered during the decision-making process. Since prospective treatment options influence patients’ health-related quality of life in a variety of ways, a methodology that can completely and objectively evaluate alternative treatments has become an essential issue. This paper proposes a novel multi-criteria decision-making (MCDM) methodology by integrating the CRiteria Importance Through Intercriteria Correlation (CRITIC) and the REGIME techniques and handles the problem of breast cancer treatment selection problem. CRITIC enables the determination of objective criterion weights based on the decision matrix, while REGIME ranks the options without the need for lengthy computations or normalization procedures. The suggested methodology is demonstrated in a spherical fuzzy atmosphere, which allows decision experts to independently express their degrees of membership, non-membership, and hesitancy in a broad three-dimensional spherical space. In the numerical example provided, three oncologists evaluate four breast cancer treatment alternatives, namely, surgery, radiotherapy, chemotherapy, and hormone therapy, with respect to five criteria, which are disease or tumor type, stage of disease, patient type, side effects, and financial status of the patient. The tumor type is determined to be the most important assessment criterion, and surgery is selected as the best course of action. The stability and validity of the proposed methodology are verified through sensitivity and comparative studies. The discussions, limitations, and future research avenues are also given within the study.
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Affiliation(s)
- Hatice Camgoz Akdag
- Department of Management Engineering, Istanbul Technical University, Istanbul, Turkey
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Chen Y, Chen Z, Jin H, Chen Y, Bai J, Fu G. Associations of financial toxicity with symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home: a prospective observational study. BMC Cancer 2023; 23:140. [PMID: 36765325 PMCID: PMC9912596 DOI: 10.1186/s12885-023-10580-4] [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: 05/18/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Cancer patients with financial toxicity experience psychological distress and often miss medical appointments and quit treatments early, which could be a barrier to the effective management of oral chemotherapy drugs at home. This study explores whether financial toxicity predicts symptoms and unplanned healthcare utilization among cancer patients taking oral chemotherapy at home, which will contribute to the safe management of oral chemotherapy. METHODS Data in this study was from a prospective observational study, which was conducted between October 2018 and December 2019. 151 patients completed the Comprehensive Score for Financial Toxicity at discharge and completed the MD Anderson Symptom Inventory and unplanned healthcare utilization questionnaires after finishing one cycle of oral chemotherapy at home. Regression analyses were conducted to explore the associations of financial toxicity with symptoms and unplanned healthcare utilization. RESULTS Among 151participants, 88.08% reported severe or moderate financial toxicity, 43.05% reported symptom interference, and 31.79% reported unplanned healthcare utilization while taking oral chemotherapy at home. Patients between the age of 45-60y (p = 0.042) have higher financial toxicity, while those living in urban areas (p = 0.016) have lower financial toxicity. Patients with worse financial toxicity suffered increased symptoms of fatigue, emotional distress, disturbed sleep, and lack of appetite. Consequently, their mood and personal relation with other significant suffered. However, no statistical differences in unplanned healthcare utilization were found among patients with different levels of financial toxicity. CONCLUSION Middle-aged adults and those living in suburban or rural areas experienced worse financial toxicity than other groups. Patients with worse financial toxicity experienced more severe psychological symptoms (e.g., fatigue, distress, disturbed sleep, and lack of appetite) and affective interference (e.g., mood and relations with others). Identifying at-risk patients is necessary to offer tailored support for psychological symptom management.
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Affiliation(s)
- Yongfeng Chen
- grid.410652.40000 0004 6003 7358Nursing Department, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhenxiang Chen
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Haiyun Jin
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yanrong Chen
- grid.410652.40000 0004 6003 7358The Department of Chemotherapy, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, 30322, Atlanta, GA, USA.
| | - Guifen Fu
- Nursing Department, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China. .,Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, 530021, Nanning, China.
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Liu M, Huang D, Liu Y. Financial toxicity of patients with lung cancer in China: Results from a National Survey Study. Cancer Med 2023; 12:4751-4760. [PMID: 36128854 PMCID: PMC9972021 DOI: 10.1002/cam4.5244] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To develop a comprehensive understanding of financial toxicity (FT) among patients with lung cancer in China and the major factors affecting FT. METHODS Drawing from a national cross-sectional survey, which used the validated comprehensive score for financial toxicity (COST) questionnaire, we estimated the prevalence and degree of FT. Patient coping actions were investigated. Pearson's chi tests and multinomial logistic regression were used to evaluate the predictors of FT in patients with lung cancer. RESULTS The median score of FT was 20 (scored on a range of 0-44, with lower scores indicating more severe toxicity). Altogether, 77% of the sample patients had FT (COST <26), 54.5% had mild FT (COST 14-25), and 22.5% had moderate and severe FT (COST 0-13). Living in the less-developed western region of China, being male, having a lower educational level, lower annual family income, and advanced stage or worse self-reported health status were significantly related to higher FT than their counterparts (p < 0.05). Patients with higher FT tended to have a lower level of medical compliance, a higher risk of incurring debts, and reduced living expenditures relative to those with lower FT. CONCLUSION Despite China's remarkable progress in the past two decades with regard to Universal Healthcare Coverage, FT still presents a serious challenge for patients with lung cancer. Keen attention must be paid to reducing the disproportionate high financial risks of patients with low socioeconomic status.
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Affiliation(s)
- Meicen Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dengmin Huang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Pangestu S, Rencz F. Comprehensive Score for Financial Toxicity and Health-Related Quality of Life in Patients With Cancer and Survivors: A Systematic Review and Meta-Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:300-316. [PMID: 36064514 DOI: 10.1016/j.jval.2022.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Financial toxicity is recognized as an important adverse effect of cancer treatment that may decrease patients' health-related quality of life (HRQOL). We aim to perform a systematic review and meta-analysis on studies investigating the association of HRQOL and financial toxicity measured with the Comprehensive Score for Financial Toxicity in patients with cancer and survivors. METHODS A systematic literature search was completed in PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo (last update April 2022). Methodological quality of included studies was assessed using the Appraisal Tool for Cross-Sectional Studies and the Critical Appraisal Skills Program Cohort Study Checklist. Where possible, study outcomes were pooled by random-effects meta-analysis. RESULTS Thirty-one studies were included with a combined sample of 13 481 patients and survivors with more than 25 cancer types from 9 countries. Nineteen different validated HRQOL instruments were used in these studies, with the Functional Assessment of Cancer Therapy - General (n = 9), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (n = 5), and EQ-5D (n = 5) being the most common. All but one included studies reported that higher financial toxicity was significantly associated with worse HRQOL. Ten HRQOL domains were correlated with financial toxicity, including physical health (r = 0.34-0.66), social health (r = 0.16-0.55), mental health (r = 0.21-0.54), and daily functioning (r = 0.23-0.52). The meta-analysis indicated a moderate correlation between financial toxicity and overall HRQOL as measured by the Functional Assessment of Cancer Therapy instruments (r = 0.49, 95% confidence interval 0.44-0.54). CONCLUSIONS This is the first systematic review and meta-analysis to summarize the literature on the association of financial toxicity and HRQOL in patients with cancer and survivors. Our findings substantiate financial toxicity as a relevant outcome of cancer care that is associated with a decline of HRQOL.
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Affiliation(s)
- Stevanus Pangestu
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Politi MC, Housten AJ, Forcino RC, Jansen J, Elwyn G. Discussing Cost and Value in Patient Decision Aids and Shared Decision Making: A Call to Action. MDM Policy Pract 2023; 8:23814683221148651. [PMID: 36643615 PMCID: PMC9834940 DOI: 10.1177/23814683221148651] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
Direct and indirect costs of care influence patients' health choices and the ability to implement those choices. Despite the significant impact of care costs on patients' health and daily lives, patient decision aid (PtDA) and shared decision-making (SDM) guidelines almost never mention a discussion of costs of treatment options as part of minimum standards or quality criteria. Given the growing study of the impact of costs in health decisions and the rising costs of care more broadly, in fall 2021 we organized a symposium at the Society for Medical Decision Making's annual meeting. The focus was on the role of cost information in PtDAs and SDM. Panelists gave an overview of work in this space at this virtual meeting, and attendees engaged in rich discussion with the panelists about the state of the problem as well as ideas and challenges in incorporating cost-related issues into routine care. This article summarizes and extends our discussion based on the literature in this area and calls for action. We recommend that PtDA and SDM guidelines routinely include a discussion of direct and indirect care costs and that researchers measure the frequency, quality, and response to this information.
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Affiliation(s)
- Mary C. Politi
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Ashley J. Housten
- Division of Public Health Sciences, Department
of Surgery, Washington University in St Louis, St Louis, MO, USA
| | - Rachel C. Forcino
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
| | - Jesse Jansen
- School for Public Health and Primary Care
CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and
Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon,
NH, USA
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Jiang JM, Eichler J, Bodner W, Fox J, Garg M, Kabarriti R, Mo A, Kalnicki S, Mehta K, Rivera A, Tang J, Yap J, Ohri N, Klein J. Predictors of Financial Toxicity in Patients Receiving Concurrent Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101141. [PMID: 36636262 PMCID: PMC9829707 DOI: 10.1016/j.adro.2022.101141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Financial toxicity (FT) is a significant concern for patients with cancer. We reviewed prospectively collected data to explore associations with FT among patients undergoing concurrent, definitive chemoradiation therapy (CRT) within a diverse, urban, academic radiation oncology department. Methods and Materials Patients received CRT in 1 of 3 prospective trials. FT was evaluated before CRT (baseline) and then weekly using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire Core-30 questionnaire. Patients were classified as experiencing FT if they answered ≥2 on a Likert scale question (1-4 points) asking if they experienced FT. Rate of change of FT was calculated using linear regression; worsening FT was defined as increase ≥1 point per month. χ2, t tests, and logistic regression were used to assess predictors of FT. Results Among 233 patients, patients attended an average of 9 outpatient and 4 radiology appointments over the 47 days between diagnosis and starting CRT. At baseline, 52% of patients reported experiencing FT. Advanced T stage (odds ratio, 2.47; P = .002) was associated with baseline FT in multivariate analysis. The mean rate of FT change was 0.23 Likert scale points per month. In total, 26% of patients demonstrated worsening FT during CRT. FT at baseline was not associated with worsening FT (P = .98). Hospitalization during treatment was associated with worsening FT (odds ratio, 2.30; P = .019) in multivariate analysis. Conclusions Most patients reported FT before CRT. These results suggest that FT should be assessed (and, potentially, addressed) before starting definitive treatment because it develops early in a patient's cancer journey. Reducing hospitalizations may mitigate worsening FT. Further research is warranted to design interventions to reduce FT and avoid hospitalizations.
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Massa ST, Chidambaram S, Luong P, Graboyes EM, Mazul AL. Quantifying Total and Out-of-Pocket Costs Associated With Head and Neck Cancer Survivorship. JAMA Otolaryngol Head Neck Surg 2022; 148:1111-1119. [PMID: 36264567 PMCID: PMC9585466 DOI: 10.1001/jamaoto.2022.3269] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/28/2022] [Indexed: 01/10/2023]
Abstract
Importance Oncologic treatment is costly to the health care system and to individuals, but patients with head and neck cancer (HNC) also have long-term care needs after treatment. Survivors of HNC require specific consideration given their rapidly growing numbers. This subpopulation of cancer survivors often experiences long-term treatment-associated morbidity. Objective To describe the total and out-of-pocket (OOP) costs associated with HNC survivorship and the risk factors for financial toxicity among this population. Design, Setting, and Participants This was a retrospective review and economic evaluation of a cohort of US adults with a diagnosis of HNC from 2006 to 2018. The study used data the from IBM MarketScan Commercial Claims Database. Data were analyzed from November 2020 to June 2022. Exposures Treatment for HNC. Main Outcomes and Measures Total and OOP medical costs were assessed monthly and reported relative to the date of HNC diagnosis. The primary outcome was the difference between a patient's mean monthly survivorship costs (13-60 months after diagnosis) and mean monthly baseline costs (7-12 months before diagnosis). Univariate and multivariable linear regression models were created for total and OOP costs to generate coefficient estimates with 95% CIs. Results The study cohort of this economic evaluation included 19 098 patients with HNC (median [range] age, 56 [18-64] years; 14 144 [74.1%] men and 4954 [25.9%] women; race and ethnicity were not considered). Throughout the survivorship period, median total and OOP costs were $372 per month and $31 per month higher than baseline costs, respectively, with variation in expenses by demographic information, health plan type, and oncologic variables. In the multivariable model, greater total and OOP excess survivorship costs were associated with female sex ($343/mo; 95% CI, $126 to $560 and $9/mo; 95% CI, $4 to $14). Highest and lowest total excess survivorship costs associated with cancer site were seen for hypopharyngeal ($1908/mo; 95% CI, $1102 to $2714) and oropharyngeal cancers (-$703/mo; 95% CI, -$967 to -$439) vs oral cavity cancers. Compared with surgery or radiation therapy alone, multimodal treatment was generally associated with excess OOP survivorship costs. Conclusions and Relevance The findings of this retrospective economic evaluation review suggest that the costs of HNC survivorship remain persistently elevated above baseline costs for at least 5 years after diagnosis. High survivorship costs were associated with female sex, hypopharyngeal tumors, and treatment with multimodal therapy. Practitioners should seek to minimize costs for these patients at higher-risk of financial toxicity after treatment and work to provide directed supportive services.
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Affiliation(s)
- Sean T. Massa
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Smrithi Chidambaram
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Peter Luong
- Department of Otolaryngology−Head and Neck Surgery, St Louis University School of Medicine, St Louis, Missouri
| | - Evan M. Graboyes
- Department of Otolaryngology−Head and Neck Surgery, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Angela L. Mazul
- Department of Otolaryngology−Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Nezu K, Yamashita S, Kakimoto K, Uemura M, Kishida T, Kawai K, Nakamura T, Goto T, Osawa T, Nishimura K, Nonomura N, Negoro H, Shiraishi T, Ukimura O, Ogawa O, Shinohara N, Suzukamo Y, Ito A, Arai Y. Association of financial toxicity with quality of life in testicular cancer survivors. Int J Urol 2022; 29:1526-1534. [PMID: 36102302 DOI: 10.1111/iju.15039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study. METHODS We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. RESULTS With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). CONCLUSIONS TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.
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Affiliation(s)
- Kunihisa Nezu
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinichi Yamashita
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenichi Kakimoto
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Koji Kawai
- Department of Urology, University of Tsukuba, Tsukuba, Japan
| | - Terukazu Nakamura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Department of Urology, Saiseikai Imperial Gift Foundation Inc. Saiseikai Suita Hospital, Suita, Japan
| | - Takayuki Goto
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Takahiro Osawa
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Takumi Shiraishi
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ukimura
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Ogawa
- Department of Urology, Graduate School of Medicine and Faculty of Medicine Kyoto University, Kyoto, Japan
| | - Nobuo Shinohara
- Department of Urology, Graduate School of Medicine Hokkaido University, Sapporo, Japan
| | - Yoshimi Suzukamo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoichi Arai
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Urology, Miyagi Cancer Center, Natori, Japan
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45
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Islam JY, Turner K, Saeb H, Powell M, Dean LT, Camacho-Rivera M. Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey. Front Public Health 2022; 10:946721. [PMID: 36483249 PMCID: PMC9723235 DOI: 10.3389/fpubh.2022.946721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years). Results Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44). Conclusion Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,*Correspondence: Jessica Y. Islam
| | - Kea Turner
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Huda Saeb
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Margaux Powell
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States,Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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46
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Jiang H, Lyu J, Mou W, Jiang L, Zeng Y, Liu Y, Hu A, Jiang Q. Prevalence and risk factors of self-reported financial toxicity in cancer survivors: A systematic review and meta-analyses. J Psychosoc Oncol 2022:1-18. [DOI: 10.1080/07347332.2022.2142877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hua Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jianxia Lyu
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenxuan Mou
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Luxi Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Zeng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Ying Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Aiping Hu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinghua Jiang
- Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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47
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Patel MR, Zhang G, Heisler M, Song PX, Piette JD, Shi X, Choe HM, Smith A, Resnicow K. Measurement and Validation of the Comprehensive Score for Financial Toxicity (COST) in a Population With Diabetes. Diabetes Care 2022; 45:2535-2543. [PMID: 36048837 PMCID: PMC9679256 DOI: 10.2337/dc22-0494] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/16/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is a validated instrument measuring financial distress among people with cancer. The reliability and construct validity of the 11-item COST-FACIT were examined in adults with diabetes and high A1C. RESEARCH DESIGN AND METHODS We examined the factor structure (exploratory factor analysis), internal consistency reliability (Cronbach α), floor/ceiling effects, known-groups validity, and predictive validity among a sample of 600 adults with diabetes and high A1C. RESULTS COST-FACIT demonstrated a two-factor structure with high internal consistency: general financial situation (7-items, α = 0.86) and impact of illness on financial situation (4-items, α = 0.73). The measure demonstrated a ceiling effect for 2% of participants and floor effects for 7%. Worse financial toxicity scores were observed among adults who were women, were below the poverty line, had government-sponsored health insurance, were middle-aged, were not in the workforce, and had less educational attainment (P < 0.01). Worse financial toxicity was observed for those engaging in cost coping behaviors, such as taking less or skipping medicines, delaying care, borrowing money, "maxing out" the limit on credit cards, and not paying bills (P < 0.01). In regression models for the full measure and its two factors, worse financial toxicity was correlated with higher A1C (P < 0.01), higher levels of diabetes distress (P < 0.01), more chronic conditions (P < 0.01), and more depressive symptoms (P < 0.01). CONCLUSIONS Findings support both the reliability and validity of the COST-FACIT tool among adults with diabetes and high A1C levels. More research is needed to support the use of the COST-FACIT tool as a clinically relevant patient-centered instrument for diabetes care.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Guanghao Zhang
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Michele Heisler
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Peter X.K. Song
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - John D. Piette
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
- U.S. Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI
| | - Hae Mi Choe
- College of Pharmacy, University of Michigan, Ann Arbor, MI
- University of Michigan Medical Group, Ann Arbor, MI
| | - Alyssa Smith
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
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48
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Wang K, Ma C, Li FM, Truong A, Shariff-Marco S, Chu JN, Oh DL, Allen L, Kuo MC, Wong C, Bui H, Chen J, Gomez SL, Nguyen TT, Tsoh JY. Patient-reported supportive care needs among Asian American cancer patients. Support Care Cancer 2022; 30:9163-9170. [PMID: 36040670 PMCID: PMC9424805 DOI: 10.1007/s00520-022-07338-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/15/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Cancer is the leading cause of death for Asian Americans. However, few studies have documented supportive care needs from the perspective of Asian American cancer patients. This study describes the needs reported by Asian American patients with colorectal, liver, or lung cancer over a 6-month period during their treatment. METHODS Participants were recruited through the Greater Bay Area Cancer Registry and from cancer care providers in San Francisco. Participants self-identified as Asian or Asian American; were age 21 or older; spoke English, Chinese, or Vietnamese; and had stage I-III colon, rectum, liver, or lung cancer. Participants were matched with a language concordant patient navigator who provided support during a 6-month period. Needs were assessed by surveys at baseline, 3, and 6 months. RESULTS Among 24 participants, 58% were 65 years or older, 42% did not complete high school, and 75% had limited English proficiency (LEP). At baseline, the most prevalent needs were cancer information (79%), nutrition and physical activity (67%), language assistance (54%), and daily living (50%). At the 3- and 6-month follow-up surveys, there was a higher reported need for mental health resources and healthcare access among participants. CONCLUSION In this pilot study of Asian American cancer patients who predominantly had LEP, participants reported many needs, with cancer information and language assistance as the most prominent. The findings highlight the importance of culturally and linguistically appropriate patient navigators in addressing supportive care needs among cancer patients with LEP. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03867916.
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Affiliation(s)
- Katarina Wang
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Carmen Ma
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
| | - Feng Ming Li
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
| | - Angeline Truong
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
| | - Salma Shariff-Marco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Janet N Chu
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Debora L Oh
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Laura Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Mei-Chin Kuo
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Ching Wong
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Hoan Bui
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Junlin Chen
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Tung T Nguyen
- Asian American Research Center On Health, University of California, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Division of General Internal Medicine, University of California, San Francisco, CA, USA
| | - Janice Y Tsoh
- Asian American Research Center On Health, University of California, San Francisco, CA, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
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49
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Jiang H, Mou W, Lyu J, Jiang L, Liu Y, Zeng Y, Hu A, Zheng W, Jiang Q, Yang S. Assessment of self-reported financial toxicity among patients with nasopharyngeal carcinoma undergoing radiotherapy: A cross-sectional study in western China. Front Oncol 2022; 12:1011052. [PMID: 36387157 PMCID: PMC9650537 DOI: 10.3389/fonc.2022.1011052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/10/2022] [Indexed: 09/12/2023] Open
Abstract
OBJECTIVE Using the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among nasopharyngeal cancer (NPC) patients in western China and investigate the association between FT and psychological distress. METHODS We conducted a cross-sectional study of survivors with NPC in a tertiary oncology hospital in China. FT was assessed using the COST (Chinese version), a validated instrument widely used both at home and abroad. The NCCN Distress Thermometer (DT) was used to measure psychological distress. A multivariate logistic regression model was built to determine factors associated with FT, and the Pearson correlation was used to assess the correlation between COST and DT scores. RESULTS Of 210 patients included in this study, the mean FT score was 16.3 (median: 22.5, SD: 9.7), and the prevalence of FT was 66.2% (mild FT: 37.1%, moderate FT: 50.5%, severe FT: 2.4%). Suggested by the logistic regression model, 5 variables were associated with increased FT: unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. The Pearson correlation showed a significantly moderate correlation between financial toxicity and psychological distress (r= -0.587, P < 0.001). CONCLUSION Patients with nasopharyngeal carcinoma (NPC) in western China demonstrated higher self-reported financial toxicity (FT) associated with factors including unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. These predictors will help clinicians identify potential patients with FT in advance and conduct effective psychological interventions.
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Affiliation(s)
- Hua Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wenxuan Mou
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Jianxia Lyu
- Department of Head and Neck Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Luxi Jiang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Yu Zeng
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Aiping Hu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wei Zheng
- Department of Head and Neck Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinghua Jiang
- Department of Head and Neck Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuang Yang
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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50
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Phillips S, Raskin SE, Harrington CB, Bishop D, Gany FM. "Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City. J Psychosoc Oncol 2022; 41:411-433. [PMID: 36271879 PMCID: PMC10322638 DOI: 10.1080/07347332.2022.2136025] [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: 10/24/2022]
Abstract
OBJECTIVE To identify consequences of unmet housing needs in the period following cancer diagnosis. DESIGN Qualitative descriptive design. PARTICIPANTS New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). METHODS One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. FINDINGS Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. CONCLUSION The simultaneous experience of cancer and unmet housing needs is broadly burdensome. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.
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Affiliation(s)
- Serena Phillips
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sarah E. Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Darla Bishop
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca M. Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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