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Lam AB, Nipp RD, Hasler JS, Hu BY, Zahner GJ, Robbins S, Wheeler SB, Tagai EK, Miller SM, Peppercorn JM. National survey of patient perspectives on cost discussions among recipients of copay assistance. Oncologist 2024:oyae148. [PMID: 38864681 DOI: 10.1093/oncolo/oyae148] [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: 11/19/2023] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Individuals with cancer and other medical conditions often experience financial concerns from high costs-of-care and may utilize copay assistance programs (CAP). We sought to describe CAP recipients' experiences/preferences for cost discussions with clinicians. METHODS We conducted a national, cross-sectional electronic-survey from 10/2022 to 11/2022 of CAP recipients with cancer or autoimmune conditions to assess patient perspectives on cost discussions. We used multivariable logistic regression models to explore associations of patient perspectives on cost discussions with patient characteristics and patient-reported outcomes (eg, financial toxicity, depression/anxiety, and health literacy). RESULTS Among 1,566 participants, 71% had cancer and 29% had autoimmune conditions. Although 62% of respondents desired cost discussions, only 32% reported discussions took place. Additionally, 52% of respondents wanted their doctor to consider out-of-pocket costs when deciding the best treatment, and 61% of respondents felt doctors should ensure patients can afford treatment prescribed. Participants with depression symptoms were more likely to want doctors to consider out-of-pocket costs (OR = 1.54, P = .005) and to believe doctors should ensure patients can afford treatment (OR = 1.60, P = .005). Those with severe financial toxicity were more likely to desire cost discussions (OR = 1.65, P < .001) and want doctors to consider out-of-pocket costs (OR = 1.52, P = .001). Participants with marginal/inadequate health literacy were more likely to desire cost discussions (OR = 1.37, P = .01) and believe doctors should ensure patients can afford treatment (OR = 1.30, P = .036). CONCLUSIONS In this large sample of CAP recipients with cancer and autoimmune conditions, most reported a desire for cost discussions, but under one-third reported such discussions took place.
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Affiliation(s)
- Anh B Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
| | - Ryan David Nipp
- Section of Hematology and Oncology, Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, United States
| | - Jill S Hasler
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Bonnie Y Hu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Greg J Zahner
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarina Robbins
- HealthWell Foundation, Germantown, MD 20874, United States
| | - Stephanie B Wheeler
- University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States
| | - Erin K Tagai
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Suzanne M Miller
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA 19111, United States
| | - Jeffrey M Peppercorn
- Section of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
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Luo X, Xu H, Zhang Y, Liu S, Xu S, Xie Y, Xiao J, Hu T, Xiao H. Identifying the unmet needs of post-treatment colorectal cancer survivors: A critical literature review. Eur J Oncol Nurs 2024; 70:102570. [PMID: 38574419 DOI: 10.1016/j.ejon.2024.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Following treatment completion, colorectal cancer (CRC) survivors experience various unmet needs. This review aims to synthesize the unmet needs of CRC survivors after treatment and to identify demographic, disease or treatment-related, healthcare-related, and psychosocial factors correlated with unmet needs. METHOD English or Chinese articles that focused on CRC survivors' post-treatment unmet needs were systematically searched from the five electronic databases, which included CINAHL, PubMed, Embase, PsycINFO, and the China Academic Journal Full-text Database, from the launch of databases to July 2023. The reference lists of the subsequent articles were further screened. RESULTS 136 individual needs extracted from 50 manuscripts were classified into nine domains based on the Supportive Care Framework. The top four unmet needs identified by CRC survivors were assistance with fears of cancer recurrence, information about managing illness and side effects at home, emotional or psychological support and reassurance, and help with sexuality problems. Following surgery, CRC survivors showed strong demand in the physical, psychological, and information domains. Survivors completed treatment within 1-year had more diverse needs than those who completed 1-3 years. Unmet needs may be greater among CRC survivors who were young, female, more educated, and unmarried. Furthermore, greater unmet needs were associated with distress, anxiety, depression, and worse quality of life. CONCLUSIONS Despite diverse needs experienced by post-treatment CRC survivors, a predominant focus on fears of cancer recurrence, information, psychological support, and sexuality needs is noted. Future studies should further explore the needs of CRC survivors after specific treatment and in different post-treatment periods.
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Affiliation(s)
- Xingjuan Luo
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Haiying Xu
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yanting Zhang
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Sirun Liu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Shan Xu
- School of Basic Medicine, Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yali Xie
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Juan Xiao
- Institute of Neuroscience and Brain Diseases, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
| | - Tingting Hu
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
| | - Hong Xiao
- Nursing Department, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China.
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3
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Kobritz M, Nofi CP, Egunsola A, Zimmern AS. Financial toxicity in early-onset colorectal cancer: A National Health Interview Survey study. Surgery 2024; 175:1278-1284. [PMID: 38378347 DOI: 10.1016/j.surg.2024.01.005] [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: 10/10/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Financial toxicity is increasingly recognized as a devastating outcome of cancer treatment but is poorly characterized in patients with early-onset colorectal cancer. Young patients are particularly vulnerable to financial toxicity as they are frequently underinsured and may suffer significant disruptions to professional and financial growth. We hypothesized that financial toxicity associated with colorectal cancer treatment confers long-lasting effects on patients' well-being and disproportionately impacts patients diagnosed at <50 years of age. METHODS A retrospective cross-sectional analysis of the National Health Interview Survey from years 2019 to 2021 was performed. Patients with a history of colorectal cancer were included and stratified by age at diagnosis. Randomly selected age-matched controls with no cancer history were used for comparison. The primary endpoint was financial toxicity, as assessed by a composite score formulated from 12 National Health Interview Survey items. The secondary endpoint was food security assessed by the United States Department of Agriculture's food security scale, embedded in the National Health Interview Survey. RESULTS When compared to age-matched controls, patients with colorectal cancer experienced significant financial toxicity, as reflected by a composite financial toxicity score (P = .027). Within patients with colorectal cancer, female sex (adjusted odds ratio = 1.46, P = .046) and early-onset disease (adjusted odds ratio = 2.11, P = .002) were found to significantly increase the risk of financial toxicity. Patients with early-onset colorectal cancer more frequently experienced food insecurity (P = .011), delayed necessary medical care (P = .053), mental health counseling (P = .043), and filling prescriptions (P = .007) due to cost when compared to patients with average-onset colorectal cancer. CONCLUSION Colorectal cancer is associated with significant long-term financial toxicity, which disproportionately impacts patients diagnosed at <50 years of age. Targeted interventions are warranted to reduce financial toxicity for patients with high-risk colorectal cancer.
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Affiliation(s)
- Molly Kobritz
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY.
| | - Colleen P Nofi
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
| | - Adekemi Egunsola
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
| | - Andrea S Zimmern
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Department of Surgery, Northwell-North Shore/Long Island Jewish, Manhasset, NY
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4
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Park ER, Kirchhoff AC, Donelan K, Perez GK, McDonald A, Bliss CC, Foor A, van Thiel Berghuijs KM, Waters AR, Durieux N, Leisenring W, Armstrong GT, Ponzani C, Lopez A, Vaca Lopez PL, Battaglia T, Galbraith AA, Kuhlthau KA. Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study. JCO Oncol Pract 2024:OP2300680. [PMID: 38471048 DOI: 10.1200/op.23.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/01/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE Childhood cancer survivors are at increased risk for underinsurance and health insurance-related financial burden. Interventions targeting health insurance literacy (HIL) to improve the ability to understand and use health insurance are needed. METHODS We codeveloped a four-session health insurance navigation tools (HINT) intervention, delivered synchronously by a patient navigator, and a corresponding booklet. We conducted a randomized pilot trial with survivors from the Childhood Cancer Survivor Study comparing HINT with enhanced usual care (EUC; booklet). We assessed feasibility, acceptability, and preliminary efficacy (HIL, primary outcome; knowledge and confidence with health insurance terms and activity) on a 5-month survey and exit interviews. RESULTS Among 231 invited, 82 (32.5%) survivors enrolled (53.7% female; median age 39 years, 75.6% had employer-sponsored insurance). Baseline HIL scores were low (mean = 28.5; 16-64; lower scores better); many lacked knowledge of Affordable Care Act (ACA) provisions. 80.5% completed four HINT sessions, and 93.9% completed the follow-up survey. Participants rated HINT's helpfulness a mean of 8.9 (0-10). Exit interviews confirmed HINT's acceptability, specifically its virtual and personalized delivery and helpfulness in building confidence in understanding one's coverage. Compared with EUC, HINT significantly improved HIL (effect size = 0.94. P < .001), ACA provisions knowledge (effect size = 0.73, P = .003), psychological financial hardship (effect size = 0.64, P < .006), and health insurance satisfaction (effect size = 0.55, P = .03). CONCLUSION Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors to improve HIL. Randomized trials to assess the efficacy and sustainability of health insurance navigation on HIL and financial burden are needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Lopez
- Massachusetts General Hospital, Boston, MA
| | | | - Tracy Battaglia
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Alison A Galbraith
- Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Ng RJ, Choo WY, Ng CW, Hairi NN. Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia. Health Policy Plan 2024; 39:268-280. [PMID: 38300142 PMCID: PMC10939357 DOI: 10.1093/heapol/czae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024] Open
Abstract
The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.
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Affiliation(s)
- Rui Jie Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Wan Yuen Choo
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Chiu-Wan Ng
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Noran Naqiah Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
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Azzani M, Azhar ZI, Ruzlin ANM, Wee CX, Samsudin EZ, Al-Harazi SM, Noman S. Subjective and objective financial toxicity among colorectal cancer patients: a systematic review. BMC Cancer 2024; 24:40. [PMID: 38182993 PMCID: PMC10770883 DOI: 10.1186/s12885-023-11814-1] [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: 09/13/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients. METHODS Medline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study. RESULTS Out of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management- annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795. CONCLUSIONS There is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.
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Affiliation(s)
- Meram Azzani
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Zahir Izuan Azhar
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Aimi Nadira Mat Ruzlin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia.
| | - Chen Xin Wee
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Ely Zarina Samsudin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Sabah Mohammed Al-Harazi
- Department of Early Clinical Exposure and Professional Personal Development, Faculty of Medicine, MAHSA University, Selangor, Malaysia
| | - Sarah Noman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400, Malaysia
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7
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Kirchhoff AC, van Thiel Berghuijs KM, Waters AR, Kaddas HK, Warner EL, Vaca Lopez PL, Perez GK, Ray N, Chevrier A, Allen K, Fair DB, Tsukamoto T, Lewis MA, Haaland B, Park ER. Health Insurance Literacy Improvements Among Recently Diagnosed Adolescents and Young Adults With Cancer: Results From a Pilot Randomized Controlled Trial. JCO Oncol Pract 2024; 20:93-101. [PMID: 38060990 PMCID: PMC10827289 DOI: 10.1200/op.23.00171] [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: 03/22/2023] [Revised: 07/31/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
PURPOSE Adolescents and young adults (AYAs; age 18-39 years) with cancer report needing support with health insurance. We conducted a pilot randomized controlled trial to assess the feasibility and acceptability of a virtual health insurance navigation intervention (HIAYA CHAT) to improve health insurance literacy (HIL), awareness of Affordable Care Act (ACA) protections, financial toxicity, and stress. MATERIALS AND METHODS HIAYA CHAT is a four-session navigator delivered program; it includes psychoeducation on insurance, navigating one's plan, insurance-related laws, and managing costs. Participants were eligible if they could access an internet-capable device, were <1 year from diagnosis, and received treatment from University of Utah Healthcare or Intermountain Health systems. We assessed the feasibility, acceptability, and preliminary efficacy of HIAYA CHAT compared with usual navigation care, including HIL (nine items), insurance knowledge (13 items), ACA protections (eight items), COmprehensive Score for financial Toxicity (COST; 11 items), and Perceived Stress Scale (PSS; four items), using t tests and Cohen's d. RESULTS From November 2020 to December 2021, N = 86 AYAs enrolled (44.6% participation) and 89.3% completed the 5-month follow-up survey; 68.6% were female, 72.1% were White, 23.3% were Hispanic, 65.1% were age 26-39 years, and 87.2% were privately insured. Of intervention participants (n = 45), 67.4% completed all four sessions; among an exit interview subset (n = 10), all endorsed the program (100%). At follow-up, compared with usual navigation care, intervention participants had greater improvements in HIL, insurance and ACA protections knowledge, and PSS; effect sizes ranged from moderate to large (0.42-0.77). COST did not differ. CONCLUSION The results support the feasibility and acceptability of HIAYA CHAT with related improvements in HIL.
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Affiliation(s)
- Anne C. Kirchhoff
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Austin R. Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Heydon K. Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Echo L. Warner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- University of Utah College of Nursing, Salt Lake City, UT
| | | | | | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Amy Chevrier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Karlie Allen
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Douglas B. Fair
- Department of Pediatrics, University of Utah, Salt Lake City, UT
- Primary Children's Hospital, Salt Lake City, UT
| | | | | | - Ben Haaland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
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Randhawa SE, Tenner L. Survivorship in Early-Stage Rectal Cancer Patients Who Have Received Combined Modality Therapy. Clin Colorectal Cancer 2023; 22:375-382. [PMID: 37586927 DOI: 10.1016/j.clcc.2023.08.002] [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: 06/24/2023] [Revised: 07/17/2023] [Accepted: 08/02/2023] [Indexed: 08/18/2023]
Abstract
Survival rates in early-stage rectal cancer patients have increased over the past few decades. Societies such as the National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), American Society of Clinical Oncology (ASCO), and European Society of Medical Oncology (ESMO) have proposed guidelines related to cancer survivorship care including formal recommendations to address the needs in early-stage rectal cancer survivors. These guidelines, in addition to new clinical research findings in survivorship will be reviewed, specifically looking at physical, psychosocial, and financial concerns in rectal cancer survivorship.
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Affiliation(s)
- Saboor E Randhawa
- Hematology and Medical Oncology Fellow, University of Nebraska Medical Center, Omaha, NE
| | - Laura Tenner
- Department of Gastrointestinal Oncology, University of Nebraska Medical Center, Omaha, NE.
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9
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Doherty M, Thom B, Gardner DS. Administrative Burden Associated with Cost-Related Delays in Care in U.S. Cancer Patients. Cancer Epidemiol Biomarkers Prev 2023; 32:1583-1590. [PMID: 37644659 DOI: 10.1158/1055-9965.epi-23-0119] [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: 02/07/2023] [Revised: 05/12/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND U.S. cancer patients engage in administrative tasks to pay for their healthcare. This study investigated the relationship between payment tasks and timely access to cancer care. METHODS We analyzed online survey data from 510 U.S. cancer patients and survivors to understand the relationship between administrative payment tasks and cost-related delays and nonadherence. Two-part modelling was used to determine if, and to what extent, there was a relationship between administrative burden and cost-related delays/nonadherence. RESULTS Younger patients (≤44 years) reported more payment tasks and cost-related delays/nonadherence than older patients (≥ 55 years); African American patients reported more payment tasks and cost-related delays/nonadherence than white patients. After accounting for age, race/ethnicity, education, and out-of-pocket costs, patients who reported engaging in more tasks had greater log odds of delaying/forgoing care [b = 0.18; 95% confidence interval (CI), 0.12-0.24]. Cost-related delays/nonadherence increased by 32% for every unit increase in administrative payment burden (b = 0.32; 95% CI, 0.18-0.46). CONCLUSIONS Administrative payment burden increased the odds of cost-related delays and nonadherence by 49%, taking the form of delayed or skipped doctor appointments, tests and bloodwork, and prescription fulfillment. Younger patients and those identifying as African American were more likely to engage in payment tasks and to delay or forgo care due to cost. Administrative burdens can disrupt access to care and traditionally underserved patient populations are disproportionately exposed to these hardships. IMPACT Reducing the complexity of healthcare through universal, human-centered design could reduce burdens and increase access.
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Affiliation(s)
- Meredith Doherty
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bridgette Thom
- Memorial Sloan Kettering Cancer Center Affordability Working Group, New York, New York
| | - Daniel S Gardner
- Silberman School of Social Work, Hunter College, City University of New York, New York
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10
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Lee MK, Durani U, Zhang N, Hilal T, Warsame RM, Borah B, Khera N, Griffin JM. Relationships Among Health Insurance Literacy, Financial Toxicity, and Sociodemographic Factors in Patients With Cancer. JCO Oncol Pract 2023; 19:888-898. [PMID: 37616546 PMCID: PMC10615437 DOI: 10.1200/op.22.00829] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/02/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE The objective of the study was to describe the prevalence of health insurance literacy (HIL) and investigate how patient-reported outcome measures assessing HIL are related to financial toxicity in patients with cancer. METHODS We assessed HIL and financial toxicity in 404 patients enrolled between December 2019 and January 2021 at two medical centers in the United States. We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and test the relationships among the factors and items. We fit structural equation models (SEMs) to find the relationships among the factors and sociodemographic/clinical characteristics. RESULTS The EFA revealed items loaded on four factors: knowledge about health insurance, confidence related to HIL (HIL confidence), information-seeking behavior related to health insurance, and financial toxicity. The four-factor CFA model had good fit statistics (comparative fit index, 0.960; Tucker-Lewis index, 0.958; root mean square error of approximation, 0.046; and standardized root mean square residual, 0.086). In SEM, income, education level, and race positively predicted knowledge about health insurance. Knowledge about health insurance and number of total lines of cancer treatment was positively associated with HIL confidence. Higher income, older age, and HIL confidence were associated with less financial toxicity. Higher levels of financial toxicity, HIL confidence, and knowledge were associated with greater information-seeking behavior. CONCLUSION Our findings showed how different aspects of HIL are related to financial toxicity even after adjustment for sociodemographic and clinical characteristics. Future studies should investigate the longitudinal relationships among these factors to help develop interventions to mitigate financial toxicity.
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Affiliation(s)
- Minji K. Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Urshila Durani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Nan Zhang
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ
| | - Talal Hilal
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ
- Division of Hematology/Oncology, University of Mississippi, Jackson, MS
| | - Rahma M. Warsame
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Bijan Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Nandita Khera
- Division of Hematology/Oncology, Mayo Clinic, Phoenix, AZ
| | - Joan M. Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
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11
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Williams CP, Platter HN, Davidoff AJ, Vanderpool RC, Pisu M, de Moor JS. "It's just not easy to understand": A mixed methods study of health insurance literacy and insurance plan decision-making in cancer survivors. Cancer Med 2023; 12:15424-15434. [PMID: 37218419 PMCID: PMC10417217 DOI: 10.1002/cam4.6133] [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: 01/30/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Understanding cancer survivors' health insurance decision-making is needed to improve insurance choice, potentially resulting in reduced financial hardship. METHODS This explanatory mixed methods study assessed health insurance decision-making in cancer survivors. Health Insurance Literacy Measure (HILM) captured HIL. Quantitative eye-tracking data collected from two simulated health insurance plan choice sets gauged dwell time (seconds), or interest, in benefits. Dwell time differences by HIL were estimated using adjusted linear models. Qualitative interviews explored survivors' insurance decision-making choices. RESULTS Cancer survivors (N = 80; 38% breast cancer) had a median age of 43 at diagnosis (IQR 34-52). When comparing traditional and high-deductible health plans, survivors were most interested in drug costs (median dwell time 58 s, IQR 34-109). When comparing health maintenance organization and preferred provider organization plans, survivors were most interested in test/imaging costs (40s, IQR 14-67). Survivors with low versus high HIL had more interest in deductible (β = 19 s, 95% CI 2-38) and hospitalization costs (β = 14 s, 95% CI 1-27) in adjusted models. Survivors with low versus high HIL more often ranked out-of-pocket (OOP) maximums and coinsurance as the most important and confusing benefits, respectively. Interviews (n = 20) revealed survivors felt alone "to do their own research" about insurance choices. OOP maximums were cited as the deciding factor since it is "how much money is going to be taken out of my pocket." Coinsurance was considered "rather than a benefit, it's a hindrance." CONCLUSION Interventions to aid in health insurance understanding and choice are needed to optimize plan choice and potentially reduce cancer-related financial hardship.
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Affiliation(s)
- Courtney P. Williams
- Divison of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Heather N. Platter
- Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Amy J. Davidoff
- Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Robin C. Vanderpool
- Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
| | - Maria Pisu
- Divison of Preventive MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Janet S. de Moor
- Division of Cancer Control and Population SciencesNational Cancer InstituteRockvilleMarylandUSA
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12
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Nguyen OT, Donato U, McCormick R, Reblin M, Kim L, Hume E, Otto AK, Alishahi Tabriz A, Islam JY, Hong Y, Turner K, Patel KB. Financial toxicity among head and neck cancer patients and their caregivers: A cross‐sectional pilot study. Laryngoscope Investig Otolaryngol 2023; 8:450-457. [PMID: 37090884 PMCID: PMC10116977 DOI: 10.1002/lio2.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/25/2023] [Accepted: 02/19/2023] [Indexed: 03/11/2023] Open
Abstract
Objectives Head and neck cancer (HNC) patients experience greater financial toxicity than other cancer patients. Research on financial toxicity has concentrated on patients despite many informal caregivers sharing finances and reducing work hours to provide patient care. Thus, our pilot study: (1) assessed the feasibility of financial toxicity screening of HNC patients and their caregivers, and (2) described financial toxicity levels of HNC patients and their caregivers. Methods We surveyed English-speaking adult HNC patients initiating treatment at a National Cancer Institute-designated Comprehensive Cancer Center and their informal caregivers. This survey assessed demographics and financial toxicity through the Comprehensive Score for Financial Toxicity (COST) measure (0-44 range; lower score indicates higher financial toxicity). Screening feasibility was defined as ≥50% consent rate and ≥60% data completion rate. Results Our sample included 27 HNC patients and 9 caregivers. They both had slightly lower consent and completion rates than our goals. Patients reported a median COST score of 27 while caregivers reported a median COST score of 16. Approximately 25.9% of patients and 44.4% of caregivers reported high financial toxicity (COST < 17.5). Caregivers reported high concerns about their future financial health and their ability to control the amount of their financial contributions to the patient's care. Conclusions Patients and caregivers may require additional outreach approaches beyond emailed questionnaires to screen for their financial toxicity systematically. Future research is needed to replicate our results to determine whether differences in financial toxicity occur between patients and caregivers and identify areas of focus for interventions. Level of evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Umberto Donato
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | | | - Maija Reblin
- Department of Family Medicine University of Vermont Burlington Vermont USA
- Cancer Control and Population Health Sciences Program University of Vermont Cancer Center Burlington Vermont USA
| | - Lindsay Kim
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- College of Medicine, University of South Florida Tampa Florida USA
| | - Emma Hume
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Amy K. Otto
- Department of Public Health Sciences University of Miami Miller School of Medicine Miami Florida USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Jessica Y. Islam
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Cancer Epidemiology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Young‐Rock Hong
- Department of Health Services, Research, and Management University of Florida Gainesville Florida USA
| | - Kea Turner
- Department of Health Outcomes and Behavior H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
- Department of Oncologic Sciences University of South Florida Tampa Florida USA
- Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
| | - Krupal B. Patel
- Department of Head and Neck Oncology H. Lee Moffitt Cancer Center and Research Institute Tampa Florida USA
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13
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Nguyen OT, McCormick R, Patel K, Reblin M, Kim L, Hume E, Powers B, Otto A, Alishahi Tabriz A, Islam J, Hong Y, Kirchhoff AC, Turner K. Health insurance literacy among head and neck cancer patients and their caregivers: A cross-sectional pilot study. Laryngoscope Investig Otolaryngol 2022; 7:1820-1829. [PMID: 36544972 PMCID: PMC9764792 DOI: 10.1002/lio2.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Health insurance literacy interventions may reduce financial burden and its effects on cancer patients and their caregivers. However, little is known about the health insurance literacy levels of head and neck cancer (HNC) patients and their caregivers. We assessed the feasibility of screening for health insurance literacy in a pilot study and described the health insurance literacy levels of HNC patients and their caregivers. Methods We administered a survey that assessed demographics and subjective and objective health insurance literacy to HNC patients and their caregivers. Subjective health insurance literacy was measured through the Health Insurance Literacy Measure (score range: 0-84). Objective health insurance literacy was measured through correct answers to a previously developed 10-question knowledge test. Due to a small sample size, inferential statistics were not used; we instead descriptively reported findings. Results The pilot included 48 HNC patients and 13 caregivers. About 44.4% of patients and 30.8% of caregivers demonstrated low health insurance literacy (HILM ≤60). On the 10-item knowledge test, patients had an average of 6.8 (SD: 2.3) correct responses and caregivers had 7.8 (SD: 1.1) correct responses. Calculating out-of-pocket costs for out-of-network services was challenging; only 9.5% of patients and 0% of caregivers answered correctly. Conclusion Additional outreach strategies may be needed to supplement screening for health insurance literacy. Areas of focus for interventions include improving understanding of how to calculate financial responsibility for health care services and filing an appeal for health insurance claim denial. Level of Evidence IV.
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Affiliation(s)
- Oliver T. Nguyen
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | | | - Krupal Patel
- Department of Head and Neck OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Maija Reblin
- Department of Family MedicineUniversity of VermontBurlingtonVermontUSA,Cancer Control & Population Health Sciences ProgramUniversity of Vermont Cancer CenterBurlingtonVermontUSA
| | - Lindsay Kim
- College of Medicine, University of South FloridaTampaFloridaUSA
| | - Emma Hume
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Benjamin Powers
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Amy Otto
- Department of Public Health SciencesUniversity of MiamiCoral GablesFloridaUSA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
| | - Jessica Islam
- Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Cancer EpidemiologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Center for Immunization and Infection Research in CancerH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Young‐Rock Hong
- Department of Health Services Research and ManagementUniversity of Florida College of Public Health and Health ProfessionsGainesvilleFloridaUSA
| | - Anne C. Kirchhoff
- Cancer Control and Population Sciences Research Program Huntsman Cancer Institute, University of UtahSalt Lake CityUtahUSA,Department of PediatricsUniversity of UtahSalt Lake CityUtahUSA
| | - Kea Turner
- Department of Health Outcomes and BehaviorH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Gastrointestinal OncologyH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA,Department of Oncological SciencesUniversity of South FloridaTampaFloridaUSA
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14
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Ali HJR, Valero-Elizondo J, Wang SY, Cainzos-Achirica M, Bhimaraj A, Khan SU, Khan MS, Mossialos E, Khera R, Nasir K. Subjective Financial Hardship from Medical Bills Among Patients with Heart Failure in the United States: The 2014-2018 Medical Expenditure Panel Survey. J Card Fail 2022; 28:1424-1433. [PMID: 35839928 DOI: 10.1016/j.cardfail.2022.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/04/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heart failure (HF) poses a substantial economic burden to the United States (US) healthcare system. In contrast, little is known about the financial challenges faced by patients with HF. In this study, we examined the scope and sociodemographic predictors of subjective financial hardship from medical bills in patients with HF. METHODS In the Medical Expenditure Panel Survey (MEPS; years 2014-2018), a US nationally representative database, we identified all patients who reported having HF. Any subjective financial hardship from medical bills was assessed based on patients reporting either themselves or their families 1) having difficulties paying medical bills in the past 12 months, 2) paid bills late, or 3) unable to pay bills at all. Logistic regression was used to evaluate independent predictors of financial hardship among patients with HF. All analyses took into consideration the survey's complex design. RESULTS A total of 116,563 MEPS participants were included in the analysis, of whom 858 (0.7%) had a diagnosis of HF, representing 1.8 million (95% CI 1.6 to 2.0) patients annually. Overall, 33% (95% CI 29% to 38%) reported any financial hardship from medical bills with 13.2% not being able to pay bills at all. Age ≤65 years and lower educational attainment were independently associated with higher odds of subjective financial hardship from medical bills. CONCLUSION Subjective financial hardship is a prevalent issue among patients with HF in the US, particularly those who are younger and have lower educational attainment. There is a need for policies that reduce out-of-pocket costs in the care of HF, an enhanced identification of this phenomenon in the clinical setting, and approaches to help minimize financial toxicity in patients with HF while ensuring optimal quality of care.
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Affiliation(s)
- Hyeon-Ju Ryoo Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA.
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Stephen Y Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Safi U Khan
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA; Center for Outcomes Research, Houston Methodist, Houston, TX, USA.
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15
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Corkum J, Zhu V, Agbafe V, Sun SX, Chu C, Colen JS, Greenup R, Offodile AC. Area Deprivation Index and Rurality in Relation to Financial Toxicity among Breast Cancer Surgical Patients: Retrospective Cross-Sectional Study of Geospatial Differences in Risk Profiles. J Am Coll Surg 2022; 234:816-826. [PMID: 35426394 DOI: 10.1097/xcs.0000000000000127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. STUDY DESIGN A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients' home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT. RESULTS A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT. CONCLUSIONS FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.
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Affiliation(s)
- Joseph Corkum
- From the Department of Plastic Surgery (Corkum, Chu, Offodile), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Victor Zhu
- Division of Plastic Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX (Zhu)
| | - Victor Agbafe
- University of Michigan Medical School, Ann Arbor, MI (Agbafe)
| | - Susie X Sun
- Department of Breast Surgical Oncology (Sun, Colen), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carrie Chu
- From the Department of Plastic Surgery (Corkum, Chu, Offodile), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Suarez Colen
- Department of Breast Surgical Oncology (Sun, Colen), University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rachel Greenup
- Section of Breast Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT (Greenup)
| | - Anaeze C Offodile
- From the Department of Plastic Surgery (Corkum, Chu, Offodile), University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research (Offodile), University of Texas MD Anderson Cancer Center, Houston, TX
- Baker Institute for Public Policy, Rice University, Houston, TX (Offodile)
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16
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Waters AR, Mann K, Warner EL, Vaca Lopez PL, Kaddas HK, Ray N, Tsukamoto T, Fair DB, Lewis MA, Perez GK, Park ER, Kirchhoff AC. "I thought there would be more I understood": health insurance literacy among adolescent and young adult cancer survivors. Support Care Cancer 2022; 30:4457-4464. [PMID: 35107600 PMCID: PMC10512194 DOI: 10.1007/s00520-022-06873-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health insurance literacy is crucial for navigating the US healthcare system. Low health insurance literacy may be especially concerning for adolescent and young adult (AYA) cancer survivors. To describe AYAs' health insurance literacy, we conducted semi-structured interviews with AYA survivors, on and off of treatment. METHODS We interviewed 24 AYA cancer survivors (aged 18-39 years) between November 2019 and March 2020. Interviews were recorded, transcribed, and quality-checked. Using two cycles of structured coding, we explored AYAs' health insurance literacy and examined thematic differences by policy holder status and age. RESULTS AYAs were 58.3% female, 79.2% non-Hispanic White, 91.7% heterosexual, and 62.5% receiving cancer treatment. Most participants had employer-sponsored health insurance (87.5%), and 41.7% were their own policy holder. Four themes emerged; in the first theme, most AYAs described beginning their cancer treatment with little to no understanding of their health insurance. This led to the three subsequent themes in which AYAs reported: unclear expectations of what their insurance would cover and their out-of-pocket costs; learning about insurance and costs by trial and error; and how their health insurance literacy negatively impacted their ability to navigate the healthcare system. CONCLUSIONS Our findings, while requiring confirmation in larger samples and in other health systems, suggest that the health insurance literacy needed to navigate insurance and cancer care is low among US AYA survivors and may have health and financial implications. As the burden of navigating insurance is often put on patients, health insurance education is an important supportive service for AYA survivors on and off of treatment.
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Affiliation(s)
- Austin R Waters
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Karely Mann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, AZ, USA
- University of Arizona College of Nursing, Tucson, AZ, USA
| | | | - Heydon K Kaddas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Nicole Ray
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Douglas B Fair
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mark A Lewis
- Intermountain Healthcare, 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
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17
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Parsons JRM, Hanley C, Prichard C, Vanderford NL. The Appalachian Career Training in Oncology (ACTION) Program: Preparing Appalachian Kentucky High School and Undergraduate Students for Cancer Careers. JOURNAL OF STEM OUTREACH 2021; 4:10.15695/jstem/v4i1.15. [PMID: 35965651 PMCID: PMC9373832 DOI: 10.15695/jstem/v4i1.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Appalachian Career Training In ONcology or ACTION Program is a National Cancer Institute (NCI) Youth Enjoy Science (YES) research education grant program that recruits and trains early-career undergraduate and high school students from underrepresented, socioeconomically distressed areas of Appalachian Kentucky in cancer research and outreach. The two-year program is a multifaceted experience that includes participation in cross-disciplinary, mentored cancer research projects. In addition to research projects, participants also shadow faculty mentors in clinical medical settings, engage in multiple types of educational activities, and participate in cancer-focused outreach projects within their communities. Participants also engage in peer-to-peer networking and receive career mentorship, training, and coaching. Highlights of program activities include a student-led photovoice project to promote cancer awareness and participant publications including a book featuring participant essays focused on their experiences and thoughts on cancer. Initial impact data show high school participants have a higher than state and county average four-year college-going rate and all undergraduate participants are gaining positive outcomes related to educational and career attainment. This article provides an overview of the significant benefits of the ACTION Program, the program's activities, and highlights from program implementation. Potential impacts of the program and barriers to implementation are also shared.
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Affiliation(s)
| | - Carol Hanley
- International Programs in Agriculture, College of Agriculture, Food and Environment, University of Kentucky
| | | | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky
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