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Mwobobia JM, Knettel BA, Headley J, Msoka EF, Tarimo CS, Katiti V, Juhlin E, Osazuwa-Peters N. "Let him die. He caused it": A qualitative study on cancer stigma in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003283. [PMID: 38865307 PMCID: PMC11168623 DOI: 10.1371/journal.pgph.0003283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024]
Abstract
Cancer stigma presents a critical barrier to care seeking, contributing to delayed presentation and poor cancer outcomes worldwide. The burden of cancer in Tanzania is on the rise, with cancer being the third-leading cause of death in the country. Despite rising incidence and poor outcomes of cancer, cancer-related stigma interventions have received low prioritization. There is a need for sound research that focuses on understanding attitudes driving stigma, its impact on care-seeking and treatment adherence, and intervention models to reduce stigma. We used a cross-sectional qualitative study design. We administered three open-ended qualitative questions to 140 adults newly diagnosed with cancer in Moshi, Tanzania. The questions explored common attitudes toward people with cancer, the perceived impact of cancer-related stigma on care engagement, and ideas for reducing cancer stigma. Patients were recruited during routine appointments at the Cancer Center at Kilimanjaro Christian Medical Center. Data were analyzed using a team-based, applied thematic approach and NVivo 12 software. All participants described stigma as a significant challenge for treatment and receiving support from their social networks. Perceptions of financial burden, misconceptions about cancer, such as the belief that it is contagious, and fear of death, were common attitudes driving cancer stigma. Most participants feared that symptoms would prevent them from being able to work and that the cost of cancer care would drive away loved ones. Stigma was not a ubiquitous response, as some participants reported increased care and social support from family members after a cancer diagnosis. Experiences of stigma contributed to feelings of shame, fear of burdening the family, reduced resources to access treatment, and disengagement from care. Common substitutes to medical therapies included religious interventions and traditional medicine, perceived as less expensive and less stigmatizing. Many participants felt they would benefit from improved financial support, professional counseling, and education for families and communities to reduce stigmatizing attitudes and enhance social support. There is a need for intervention studies focused on improving cancer literacy, community advocacy to reduce cancer stigma, and increasing emotional and practical support for people with cancer and their families. There is also a clear need for policy efforts to make cancer care more affordable and accessible to reduce the financial burden on patients and families.
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Affiliation(s)
- Judith M. Mwobobia
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Brandon A. Knettel
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Elizabeth F. Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Victor Katiti
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Erika Juhlin
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nosayaba Osazuwa-Peters
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Population Health Sciences, Duke University, Durham, North Carolina, United States of America
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Chen X, Yan Q, Tang Y, Zhu J, Zhang W, Zhang J. Financial toxicity, family resilience and negative emotions among young and middle-aged breast cancer patients: A multicentre cross-sectional study. Breast 2024; 75:103735. [PMID: 38640552 PMCID: PMC11031793 DOI: 10.1016/j.breast.2024.103735] [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: 01/17/2024] [Revised: 03/22/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024] Open
Abstract
PURPOSE To determine financial toxicity in young and middle-aged women with breast cancer and examine the associations between family resilience and negative emotions. METHODS A multicentre cross-sectional study was conducted, 538 women with breast cancer were recruited from four hospitals. FT, family resilience, and negative emotions were collected using the Comprehensive Score for FT, the Chinese version of the Family Resilience Assessment in Breast Cancer Patients, Patient Health Questionnaire-9 item, and Generalized Anxiety Disorder-7. This study adhered to the STROBE guidelines. RESULTS The valid response rate was 96.8 % (N = 521). Overall, the score for FT was 19.63 ± 10.13. FT was significantly correlated with family resilience (r = 0.30, p < 0.010) and depression (r = -0.11, p < 0.050). The hierarchical multiple linear regression analysis showed that career status, monthly income, religion, and family resilience were the main factors influencing FT in patients with breast cancer (R2 = 0.37; F = 6.83; p < 0.001). CONCLUSIONS FT was more prevalent among women from low-income career. Women with poor family resilience, no religious also suffer greater financial toxicity. It is necessary to pay more attention of the financial toxicity of female' low-income career, no religious belief and poor family resilience. Developing effective interventions based on family resilience might be helpful in promoting their well-being.
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Affiliation(s)
- Xuelei Chen
- Nursing Psychology Research Center, Xiangya School of Nursing, Central South University, Changsha, China; Nursing School, Guilin Medical University, Guilin, China
| | - Qilin Yan
- Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin, China
| | - Youjuan Tang
- Nursing School, Guilin Medical University, Guilin, China
| | - Jianing Zhu
- Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China
| | - Wenlu Zhang
- Nursing Psychology Research Center, Xiangya School of Nursing, Central South University, Changsha, China
| | - Jingping Zhang
- Nursing Psychology Research Center, Xiangya School of Nursing, Central South University, Changsha, China.
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Kimura G, Fujii Y, Honda K, Osawa T, Uchitomi Y, Kondo M, Otani A, Wako T, Kawai D, Mitsuda Y, Sakashita N, Shinohara N. Financial Toxicity in Japanese Patients with Metastatic Renal Cell Carcinoma: A Cross-Sectional Study. Cancers (Basel) 2024; 16:1904. [PMID: 38791981 PMCID: PMC11119599 DOI: 10.3390/cancers16101904] [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: 04/01/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0-36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL.
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Affiliation(s)
- Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan;
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan;
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya 464-8681, Aichi, Japan;
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan;
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan;
| | - Miki Kondo
- Department of Nursing, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan; (M.K.); (A.O.)
| | - Ariko Otani
- Department of Nursing, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Chiba, Japan; (M.K.); (A.O.)
| | - Tetsuya Wako
- Department of Pharmacy, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan;
| | - Daisuke Kawai
- Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan; (D.K.); (Y.M.)
| | - Yoshihide Mitsuda
- Eisai Co., Ltd., 4-6-10 Koishikawa, Bunkyo-ku, Tokyo 112-8088, Japan; (D.K.); (Y.M.)
| | - Naotaka Sakashita
- Medilead, Inc., 24F Tokyo Opera City Tower, 3-20-2, Nishishinjyuku, Shinjyuku-ku, Tokyo 163-1424, Japan;
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo 060-8638, Hokkaido, Japan;
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Nguyen HT, Nguyen PTN, Lin CK, Do PM. Association between quality of life and burden of cancer caregivers: An example in a low and middle income country. Eur J Oncol Nurs 2024; 70:102596. [PMID: 38805952 DOI: 10.1016/j.ejon.2024.102596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/14/2024] [Accepted: 04/20/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Limited knowledge on burden and quality of life (QoL) among cancer caregivers is available in low and middle income countries. This study aims to investigate the QoL, levels of burden, and their associations among Vietnamese cancer caregivers. METHODS This study was conducted across three hospitals in Vietnam. 348 caregivers were recruited from January to June 2021. Data were collected by using socio-demographic questionnaires, the Zarit Burden Interview scale, and Caregiver Qol Cancer. The association between QoL and burden was analyzed by using multivariate linear regression. RESULTS Older age (p = 0.03), employed (p = 0.01), and care more than 40 h (p = 0.007) were associated with a higher burden, respectively. QoL of financial concern had the lowest score (mean = 48.03, SD = 28.87), compared to the other subscale. Caregivers who had pre-existing health conditions, unstable work, spent more than 40 h per week, and took care dependent cancer patients were associated with a lower overall QoL score. Comparing to caregivers of no burden, those of mild burden had a lower QoL score by 10.70; while those of mild severe burden had the worse QoL (lower by 23.80 scores). CONCLUSIONS Perceptional burden among caregivers is associated with QoL. Further policies are recommended to protect cancer caregivers, to alleviate the caregiving burden, and thus to improve the overall QoL.
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Affiliation(s)
- Hien Thi Nguyen
- Nursing Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam; School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | | | - Cheng-Kuan Lin
- National Yang Ming Chiao Tung University, International Health Program, College of Medicine, Taiwan; National Yang Ming Chiao Tung University, Institute of Public Health, Taiwan.
| | - Phuong Minh Do
- Nursing Department, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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Wadasadawala T, Mohanty SK, Sen S, Kanala TS, Maiti S, Puchali N, Gupta S, Sarin R, Parmar V. Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100346. [PMID: 38756158 PMCID: PMC11096681 DOI: 10.1016/j.lansea.2023.100346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/02/2023] [Accepted: 12/26/2023] [Indexed: 05/18/2024]
Abstract
Background Available data on cost of cancer treatment, out-of-pocket payment and reimbursement are limited in India. We estimated the treatment costs, out-of-pocket payment, and reimbursement in a cohort of breast cancer patients who sought treatment at a publicly funded tertiary cancer care hospital in India. Methods A prospective longitudinal study was conducted from June 2019 to March 2022 at Tata Memorial Centre (TMC), Mumbai. Data on expenditure during each visit of treatment was collected by a team of trained medical social workers. The primary outcome variables were total cost (TC) of treatment, out-of-pocket payment (OOP), and reimbursement. TC included cost incurred by breast cancer patients during treatment at TMC. OOP was defined as the total cost incurred at TMC less of reimbursement. Reimbursement was any form of financial assistance (cashless or repayment), including social health insurance, private health insurance, employee health schemes, and assistance from charitable trusts, received by the patients for breast cancer treatment. Findings Of the 500 patients included in the study, 45 discontinued treatment (due to financial or other reasons) and 26 died during treatment. The mean TC of breast cancer treatment was ₹258,095/US$3531 (95% CI: 238,225, 277,934). Direct medical cost (MC) accounted for 56.3% of the TC. Systemic therapy costs (₹50,869/US$696) were higher than radiotherapy (₹33,483/US$458) and surgery costs (₹25,075/US$343). About 74.4% patients availed some form of financial assistance at TMC; 8% patients received full reimbursement. The mean OOP for breast cancer treatment was ₹186,461/US$2551 (95% CI: 167,666, 205,257), accounting for 72.2% of the TC. Social health insurance (SHI) had a reasonable coverage (33.1%), followed by charitable trusts (29.6%), employee health insurance (5.1%), private health insurance (4.4%) and 25.6% had no reimbursement. But SHI covered only 40.1% of the TC of treatment compared to private health insurance that covered as much as 57.1% of it. Both TC and OOP were higher for patients who were younger, belonged to rural areas, had a comorbidity, were diagnosed at an advanced stage, and were from outside Maharashtra. Interpretation In India, the cost and OOP for breast cancer treatment are high and reimbursement for the treatment flows from multiple sources. Though many of the patients receive some form of reimbursement, it is insufficient to prevent high OOP. Hence both wider insurance coverage as well as higher cap of the insurance packages in the health insurance schemes is suggested. Allowing for the automatic inclusion of cancer treatment in SHI can mitigate the financial burden of cancer patients in India. Funding This work was funded by an extramural grant from the Women's Cancer Initiative and the Nag Foundation and an intramural grant from the International Institute of Population Sciences, Mumbai.
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Affiliation(s)
- Tabassum Wadasadawala
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai 410 210, India
| | - Sanjay K. Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai 400 088, India
| | - Soumendu Sen
- Department of Population and Development, International Institute for Population Sciences, Mumbai 400 088, India
| | - Tejaswi S. Kanala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai 410 210, India
| | - Suraj Maiti
- International Institute for Population Sciences, Mumbai 400 088, India
| | - Namita Puchali
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai 400 012, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai 400 012, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai 400 012, India
| | - Vani Parmar
- Department of Surgical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai 410 210, India
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6
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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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Hu Y, Gordon N, Ogg K, Kraitchman DL, Durr NJ, Surtees B. Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System. Bioengineering (Basel) 2024; 11:391. [PMID: 38671812 PMCID: PMC11048087 DOI: 10.3390/bioengineering11040391] [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: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate the potential of an affordable cryotherapy device for the accessible treatment of breast cancer, the performance of a novel carbon dioxide-based device was evaluated through both benchtop testing and an in vivo canine model. This novel device was quantitatively compared to a commercial device that utilizes argon gas as the cryogen. The thermal behavior of each device was characterized through calorimetry and by measuring the temperature profiles of iceballs generated in tissue phantoms. A 45 min treatment in a tissue phantom from the carbon dioxide device produced a 1.67 ± 0.06 cm diameter lethal isotherm that was equivalent to a 7 min treatment from the commercial argon-based device, which produced a 1.53 ± 0.15 cm diameter lethal isotherm. An in vivo treatment was performed with the carbon dioxide-based device in one spontaneously occurring canine mammary mass with two standard 10 min freezes. Following cryotherapy, this mass was surgically resected and analyzed for necrosis margins via histopathology. The histopathology margin of necrosis from the in vivo treatment with the carbon dioxide device at 14 days post-cryoablation was 1.57 cm. While carbon dioxide gas has historically been considered an impractical cryogen due to its low working pressure and high boiling point, this study shows that carbon dioxide-based cryotherapy may be equivalent to conventional argon-based cryotherapy in size of the ablation zone in a standard treatment time. The feasibility of the carbon dioxide device demonstrated in this study is an important step towards bringing accessible breast cancer treatment to women in low-resource settings.
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Affiliation(s)
- Yixin Hu
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Naomi Gordon
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Katherine Ogg
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nicholas J. Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Bailey Surtees
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
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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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Dzulkipli MR, Shafie AA, Maon SN, Ramli A, Yahaya AHM, Ho SW, Muhsin NIA, Ahmat ANMF. Determining the Willingness to Pay for Innovative Oncology Medicines in Malaysia. Value Health Reg Issues 2024; 40:19-26. [PMID: 37972430 DOI: 10.1016/j.vhri.2023.10.003] [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: 04/03/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Early access to innovative oncology medicine is crucial to provide better treatment alternatives to patients with cancer. However, innovative oncology medicines often come at higher prices, thus limiting the government's ability for its universal coverage. Hence an alternative paying mechanism is needed. This study is intended to determine the willingness to pay (WTP) for innovative oncology medicines among Malaysians. METHODS A cross-sectional contingent valuation study on 571 Malaysians was conducted to elicit respondents' WTP value via bidding game approach. A double-bounded dichotomous choice was used in 3 hypothetical scenarios: innovative diabetes medicine, innovative oncology medicine one-off (IOMO), and innovative oncology medicine insurance. Univariate logistic regression was used to determine the factors affecting respondent's WTP, whereas the mean WTP value and the factors affecting amount to WTP was determined using a parametric 2-part model. RESULTS This study received 95% response rate. The mean age of the respondents is 48 years (SD 17) with majority of the respondents female (60.3%) and from ethnic Malay (62%). About 343 (64.7%) of the respondents expressed WTP for IOMO. Those in higher income bracket were willing to pay more for the access of IOMO than the overall WTP mean value (P = .046, coefficient 351.57). CONCLUSIONS More than half of Malaysian are willing to pay for IOMO at mean value of Malaysian Ringgit 279.10 (US dollar 66.77). Collaborative funding mechanisms and appropriate financial screening among the stakeholders could be introduced as methods to expedite the access of innovative oncology medicine among patients with cancer in Malaysia.
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Affiliation(s)
- Mohd Redhuan Dzulkipli
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Faculty of Business and Management, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia
| | - Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
| | - Siti Noorsuriani Maon
- Faculty of Business and Management, Universiti Teknologi MARA Puncak Alam Campus, Selangor, Malaysia
| | - Azuana Ramli
- Centre of Product and Cosmetics Evaluation, National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | | | - See Wan Ho
- Pharmacy Policy & Strategic Planning Division, Ministry of Health Malaysia, Petaling Jaya, Malaysia
| | - Nor Ilham Ainaa Muhsin
- Pharmacy Policy & Strategic Planning Division, Ministry of Health Malaysia, Petaling Jaya, Malaysia
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10
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Sharma P, Rajagopal MR, Soto-Perez-de-Celis E, Blanchard C, Sudhakaran D, Mathew A. Local Sociocultural Practice Specific Financial Toxicity Assessment Tool for Cancer: An Emerging Need. JCO Glob Oncol 2024; 10:e2400039. [PMID: 38547439 PMCID: PMC10994434 DOI: 10.1200/go.24.00039] [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: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 04/02/2024] Open
Abstract
It is relevant to study the financial toxicity of cancer to address it. However, the existing tools fail to capture the financial destruction of cancer on patients and their families in resource-limited countries. The authors discuss the need for a new tool in this article.
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Affiliation(s)
- Parth Sharma
- Parth Sharma, MBBS, Association for Socially Applicable Research (ASAR), Pune, India, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India; Muttacaud Ramakrishnan Rajagopal, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; Enrique Soto-Perez-de-Celis, MD, PhD, FASCO, Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Charmaine Blanchard, MBBCh, MPhil, PD Dip Pall Med, Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Deepak Sudhakaran, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; and Aju Mathew, MD, DM, MBBS, MPhil, MOSC Medical College, Kolenchery, India
| | - Muttacaud Ramakrishnan Rajagopal
- Parth Sharma, MBBS, Association for Socially Applicable Research (ASAR), Pune, India, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India; Muttacaud Ramakrishnan Rajagopal, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; Enrique Soto-Perez-de-Celis, MD, PhD, FASCO, Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Charmaine Blanchard, MBBCh, MPhil, PD Dip Pall Med, Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Deepak Sudhakaran, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; and Aju Mathew, MD, DM, MBBS, MPhil, MOSC Medical College, Kolenchery, India
| | | | | | - Deepak Sudhakaran
- Parth Sharma, MBBS, Association for Socially Applicable Research (ASAR), Pune, India, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India; Muttacaud Ramakrishnan Rajagopal, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; Enrique Soto-Perez-de-Celis, MD, PhD, FASCO, Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Charmaine Blanchard, MBBCh, MPhil, PD Dip Pall Med, Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Deepak Sudhakaran, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; and Aju Mathew, MD, DM, MBBS, MPhil, MOSC Medical College, Kolenchery, India
| | - Aju Mathew
- Parth Sharma, MBBS, Association for Socially Applicable Research (ASAR), Pune, India, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India; Muttacaud Ramakrishnan Rajagopal, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; Enrique Soto-Perez-de-Celis, MD, PhD, FASCO, Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Charmaine Blanchard, MBBCh, MPhil, PD Dip Pall Med, Centre for Palliative Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Deepak Sudhakaran, MD, MBBS, Trivandrum Institute of Palliative Sciences, Trivandrum, India; and Aju Mathew, MD, DM, MBBS, MPhil, MOSC Medical College, Kolenchery, India
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11
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Villalona S, Castillo BS, Chavez Perez C, Ferreira A, Nivar I, Cisneros J, Guerra CE. Interventions to Mitigate Financial Toxicity in Adult Patients with Cancer in the United States: A Scoping Review. Curr Oncol 2024; 31:918-932. [PMID: 38392062 PMCID: PMC10888212 DOI: 10.3390/curroncol31020068] [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: 12/12/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Financial toxicity adversely affects quality of life and treatment outcomes for patients with cancer. This scoping review examined interventions aimed at mitigating financial toxicity in adult patients with cancer and their effectiveness. We utilized five bibliographical databases to identify studies that met our inclusion criteria. The review included studies conducted among adult patients with cancer in the United States and published in English between January 2011 to March 2023. The review identified eight studies that met the inclusion criteria. Each of the studies discussed the implementation of interventions at the patient/provider and/or health system level. Collectively, the findings from this scoping review highlight both the limited number of published studies that are aimed at mitigating financial toxicity and the need to create and assess interventions that directly impact financial toxicity in demographically diverse populations of adult patients with cancer.
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Affiliation(s)
- Seiichi Villalona
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Brenda S. Castillo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Carlos Chavez Perez
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Alana Ferreira
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (B.S.C.); (C.C.P.); (A.F.)
| | - Isoris Nivar
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Juan Cisneros
- Institute for Systems Biology, Seattle, WA 98109, USA;
| | - Carmen E. Guerra
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Malik M, Valiyaveettil D, Joseph DM. The Growing Burden of Cancer in Adolescent and Young Adults in Asia: A Call to Action. J Adolesc Young Adult Oncol 2024; 13:1-7. [PMID: 37327043 DOI: 10.1089/jayao.2023.0008] [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: 06/17/2023] Open
Abstract
Recent estimates suggest that the lower middle income countries in Asia carry the heaviest burden of cancer among adolescents and young adults (AYAs) (defined as age 15-39 years). A larger proportion of the population in Asia is aged 15-39 compared with the developed countries. This age group is different from the pediatric or the adult group in terms of physical, social, psychological, and financial needs. Cancer incidence, disability, survivorship needs, financial toxicity, psychosocial issues, and so on are underestimated in this group, and available literature is scarce. Global data show an increasing trend of adult-onset cancers such as colorectal, breast, pancreas, and lung in the AYA population. Data suggest that the disease biology and prognosis are different in this group; however, further research is needed. An ESMO/SIOPE/SIOP Asia survey on the care of AYA cancer patients in Asia found a suboptimal availability of AYA specialized centers in the region and identified several unmet needs including lack of training, clinical trials, and high rates of treatment abandonment. There is an urgent need for cancer care systems in Asia to develop specialized services to be able to cater to this growing burden. Training and research in this area also need to be upscaled with the goal of establishing a sustainable infrastructure and quality services to ensure that this vulnerable group receives appropriate care. Management guidelines and national health policies should consider giving special attention to this group as the World Health Assembly reinforces the inclusion of children and adolescents in cancer control programs.
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Affiliation(s)
- Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa M Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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13
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Wang S, Wang J, Kang H, Zeng L, Liu G, Qiu Y, Wei M. Assessment of the prevalence and related factors of financial toxicity in cancer patients based on the COST scale: A systematic review and meta-analysis. Eur J Oncol Nurs 2024; 68:102489. [PMID: 38118267 DOI: 10.1016/j.ejon.2023.102489] [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: 08/02/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE The high cost of cancer treatment exposes patients to financial toxicity during treatment; however, no study has comprehensively analyzed the incidence of financial toxicity using a validated assessment tool. In this study, the objective was to ascertain the incidence of financial toxicity in cancer patients and the factors influencing it. METHODS Nine electronic databases were retrieved to collect cross-sectional studies reporting financial toxicity in cancer patients. A random effects meta-analysis was applied to yield the overall prevalence of financial toxicity. Subgroup analyses were conducted depending on the factors affecting financial toxicity. RESULTS In total, 30 studies met our inclusion criteria. The pooled prevalence of financial toxicity in cancer patients was 48% (95%CI:38%-58%, I2 = 99.4%, p < 0.001). In the subgroup analysis, a higher prevalence of financial toxicity in patients aged <67 years (47%, 95%CI: 28%-66%, I2 = 97.5%, p < 0.001), female (46%, 95%CI:39%-53%, I2 = 94.9%,p < 0.001), lung cancer(57%, 95%CI:38%-75%, I2 = 96.9%, p < 0.001), developing countries (64%, 95%CI:55%-72%, I2 = 98.1%, p < 0.001), time of investigation following COVID-19 (53%, 95%CI:37%-69%, I2 = 99.4%, p < 0.001). CONCLUSION Financial toxicity is prevalent in cancer patients and is increasingly evident after COVID-19. Furthermore, the odds of financial toxicity are higher in patients who are female, younger, whose cancer type is lung cancer, and from developing countries. These findings emphasize the significance of evaluating financial toxicity in cancer patients after COVID-19, especially in developing countries. This may play a pivotal role in helping patients cope with financial toxicity.
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Affiliation(s)
- Shuping Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Jialin Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Hua Kang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Li Zeng
- Sichuan Nursing Vocational College, Chengdu City, Sichuan province, China.
| | - Guiling Liu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Yinong Qiu
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
| | - Meng Wei
- College of Nursing, Chengdu University of Traditional Chinese Medicine, No.1166 Liutai Road, Wenjiang District, Chengdu City, Sichuan province, 611137, China.
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14
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Martei YM, Mokokwe L, Ngwako N, Kebuang K, Setlhako DI, Gabaatlhole G, Baaitse B, Segadimo T, Shulman LN, Barg F, Gaolebale BE. Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study. BMJ Open 2024; 14:e073867. [PMID: 38296302 PMCID: PMC10828869 DOI: 10.1136/bmjopen-2023-073867] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Narrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We aimed to develop, and assess acceptability and usability of survivor video narrative interventions for breast cancer treatment in Botswana. DESIGN A pilot study design. SETTING Single-centre, tertiary hospital, sub-Saharan Africa. PARTICIPANTS Eight women, ≥18 years old, with stages I-III breast cancer were enrolled for the video intervention. 106 women, ≥18 years old, with stages I-IV breast cancer viewed the narrative videos and 98 completed the acceptability and usability surveys. INTERVENTION Survivor narrative videos were developed using the theory of planned behaviour and using a purposive sample of Batswana, Setswana-speaking, breast cancer survivors, who had completed systemic treatment and surgery with high rates of adherence to the prescribed treatment plan. PRIMARY OUTCOMES We assessed acceptability and usability among prospectively enrolled patients presenting for routine breast cancer care at Princess Marina Hospital in Botswana, using a 13-item survey. RESULTS Participants expressed high acceptability and usability of the videos, including 99% (97/98) who strongly agreed/agreed that the video presentations were easy to understand, 92% (90/98) who would recommend to other survivors and 94% (92/98) who wished there were more videos. Additionally, 89% (87/98) agreed or strongly agreed that the one-on-one instruction on how to use the tablet was helpful and 87% (85/98) that the video player was easy to use. CONCLUSION Culturally appropriate survivor video narratives have high acceptability and usability among patients with breast cancer in Botswana. There is an opportunity to leverage this intervention in routine breast cancer care for treatment support. Future studies will test the implementation and effectiveness of narrative videos on a wider scale, including for patients being treated for other cancers.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Hematology - Oncology Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lebogang Mokokwe
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | | | - Lawrence N Shulman
- Department of Medicine (Hematology - Oncology Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, 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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16
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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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17
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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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18
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Yuan X, Zhang X, He J, Xing W. Interventions for financial toxicity among cancer survivors: A scoping review. Crit Rev Oncol Hematol 2023; 192:104140. [PMID: 37739147 DOI: 10.1016/j.critrevonc.2023.104140] [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: 02/03/2023] [Revised: 09/09/2023] [Accepted: 09/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Financial toxicity impairs cancer survivors' material condition, psychological wellbeing and quality of life. This scoping review aimed to identify interventions for reducing cancer-related financial toxicity (FT), and to summarize their main findings. METHODS A systematic search was performed in PubMed, Web of Science, EMBASE, CINAHL, Clinical Trials, China National Knowledge Internet, Wanfang and SinoMed from January 2010 to September 2022 following the PRISMA-ScR checklist. RESULTS From 2842 identified articles, a total of 15 were included in this review. Existing interventions can be classified into four types: financial navigation, financial counseling, insurance education and others. Previous interventions preliminarily affirmed the feasibility, satisfaction, and improvement in financial worries and knowledge. However, the effectiveness on FT was controversial. CONCLUSIONS Previous interventions affirmed the feasibility and primary effect of these interventions. Studies with more rigorous design are needed to evaluate the effectiveness and generalizability of interventions on FT across diverse healthcare systems.
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Affiliation(s)
- Xiaoyi Yuan
- School of nursing, Fudan University, Shanghai, China
| | - Xuehui Zhang
- School of nursing, Fudan University, Shanghai, China
| | - Jing He
- School of nursing, Fudan University, Shanghai, China
| | - Weijie Xing
- School of nursing, Fudan University and core research member of Fudan University Centre for Evidence-based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
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20
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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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21
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Pilleron S, Gnangnon F, Noronha V, Soto-Perez-de-Celis E. Cancer incidence estimates in adults aged 60 years and older living in low-and-middle-income countries for the years 2020 and 2040. Ecancermedicalscience 2023; 17:1594. [PMID: 37799947 PMCID: PMC10550290 DOI: 10.3332/ecancer.2023.1594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 10/07/2023] Open
Abstract
Previous studies have shown a disproportionate rise in cancer incidence in low-and-middle-income countries (LMICs) due to rapid population ageing. This study aims to describe the cancer incidence in adults aged 60 years and older in LMICs to inform cancer control planning. Using the latest GLOBOCAN estimates for 2020, we describe the cancer incidence and the top five cancer sites among adults aged 60 years and older living in LMICs. We also project the incidence in 2040 by applying population projections, assuming no changes in incidence rates and risk profiles over time. In 2020, 6.3 million new cancer cases were diagnosed in older adults in LMICs, constituting over half of the global incidence burden (55%). In females aged 60 years and older living in LMICs, breast, lung, colon, stomach, and cervix uteri were the most frequent cancer types representing 51% of the total number of new cancer cases in older females. In males aged 60 years and older living in LMICs, lung, prostate, stomach, liver and colon were the most frequent cancer types representing 58% of the total number of new cancer cases in this subgroup. Variations were observed between income categories. The number of new cancer diagnoses in adults aged 60 years and older living in LMICs will almost double by 2040, reaching 11.5 million new cancer cases. The greatest increase is expected to happen in lower-income countries (+158% in lower-middle-income countries (excluding India) and +99% in low-income countries versus +38% in upper-middle-income countries). In conclusion, our findings call for an urgent adaptation of healthcare systems in LMICs by developing geriatric oncology and by including older adults in research, clinical guidelines, insurance schemes and cancer prevention policies.
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Affiliation(s)
- Sophie Pilleron
- Department of Precision Health, Ageing, Cancer, and Disparities Research Unit, Luxembourg Institute of Health, 1A-B, Rue Thomas Edison, 1445 Strassen, Luxembourg
- https://orcid.org/0000-0001-7146-4740
| | - Freddy Gnangnon
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga (CNHU-HKM), Avenue Pape Jean-Paul Il, 01 BP 386, Cotonou, Benin
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City 14080, Mexico
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22
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Elder AJ, Alazawi H, Shafaq F, Ayyad A, Hazin R. Teleoncology: Novel Approaches for Improving Cancer Care in North America. Cureus 2023; 15:e43562. [PMID: 37719501 PMCID: PMC10502915 DOI: 10.7759/cureus.43562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.
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Affiliation(s)
- Adam J Elder
- Department of Medical Education, Wayne State University School of Medicine, Detroit, USA
| | - Hussein Alazawi
- Department of Medical Education, Michigan State University College of Osteopathic Medicine, East Lansing, USA
| | - Fareshta Shafaq
- Department of Medical Education, American University of the Caribbean, Cupecoy, SXM
| | - Adam Ayyad
- Department of Medical Education, Ross University School of Medicine, Bridgetown, BRB
| | - Ribhi Hazin
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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23
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McLoone J, Chan RJ, Varlow M, Whittaker K, Lindsay D, Thamm C, Leigh L, Muir L, Mackay G, Karikios DJ, Hunt L, Hobbs K, Goldsbury DE, Nabukalu D, Gordon LG. Challenges and solutions to cancer-related financial toxicity according to Australian health professionals: qualitative results from a national survey. Support Care Cancer 2023; 31:441. [PMID: 37402039 DOI: 10.1007/s00520-023-07875-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To qualitatively explore Australian healthcare professionals' perspectives on how to improve the care and management of cancer-related financial toxicity, including relevant practices, services, and unmet needs. METHODS We invited healthcare professionals (HCP) who currently provide care to people with cancer within their role to complete an online survey, which was distributed via the networks of Australian clinical oncology professional associations/organisations. The survey was developed by the Clinical Oncology Society of Australia's Financial Toxicity Working Group and contained 12 open-ended items which we analysed using descriptive content analysis and NVivo software. RESULTS HCPs (n = 277) believed that identifying and addressing financial concerns within routine cancer care was important and most believed this to be the responsibility of all HCP involved in the patient's care. However, financial toxicity was viewed as a "blind spot" within a medical model of healthcare, with a lack of services, resources, and training identified as barriers to care. Social workers reported assessment and advocacy were part of their role, but many reported lacking formal training and understanding of financial complexities/laws. HCPs reported positive attitudes towards transparent discussions of costs and actioning cost-reduction strategies within their control, but feelings of helplessness when they perceived no solution was available. CONCLUSION Identifying financial needs and providing transparent information about cancer-related costs was viewed as a cross-disciplinary responsibility, however, a lack of training and services limited the provision of support. Increased cancer-specific financial counselling and advocacy, via dedicated roles or developing HCPs' skills, is urgently needed within the healthcare system.
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Affiliation(s)
- Jordana McLoone
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital NSW, Sydney, New South Wales, Australia.
- Discipline of Paediatrics & Child Health, UNSW Medicine & Health, Randwick Clinical Campus, University of NSW, Sydney, New South Wales, Australia.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Megan Varlow
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Kate Whittaker
- Cancer Council Australia, Sydney, New South Wales, Australia
| | - Daniel Lindsay
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Carla Thamm
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Lillian Leigh
- Rare Cancers Australia, Bowral, New South Wales, Australia
| | - Laura Muir
- Cancer Council NSW, Sydney, New South Wales, Australia
| | - Gillian Mackay
- Clinical Oncology Society of Australia, Sydney, New South Wales, Australia
| | - Deme J Karikios
- Department of Medical Oncology, Nepean Hospital, Kingswood, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Lee Hunt
- Cancer Voices NSW, Sydney NSW, Australia
| | - Kim Hobbs
- Oncology Social Work Australia & New Zealand/Westmead Hospital NSW, Westmead, New South Wales, Australia
| | - David E Goldsbury
- The Daffodil Centre, University of Sydney, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Doreen Nabukalu
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
| | - Louisa G Gordon
- Faculty of Medicine, University of Queensland, Brisbane, Herston, Australia
- QIMR Berghofer Medical Research Institute, Population Health Department, Brisbane, Herston, Australia
- Queensland University of Technology (QUT), School of Nursing and Cancer and Palliative Care Outcomes Centre, Brisbane, Kelvin Grove, Australia
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24
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Martina D, Segelov E. Improving Equity Across Cancer Care Continuum in Asia Pacific. JCO Glob Oncol 2023; 9:e2300056. [PMID: 37364219 PMCID: PMC10497248 DOI: 10.1200/go.23.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Diah Martina
- Division of Psychosomatic and Palliative Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Eva Segelov
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, University of Bern, Bern, Switzerland
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25
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Bian J, Shen A, Yang W, Zhang L, Qiang W. Financial toxicity experienced by patients with breast cancer-related lymphedema: a systematic review. Support Care Cancer 2023; 31:354. [PMID: 37237237 DOI: 10.1007/s00520-023-07800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/03/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE To perform a systematic review on financial toxicity of breast cancer-related lymphedema. METHODS Seven databases were searched on September 11, 2022. Eligible studies were identified, analyzed, and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Empirical studies were appraised by the Joanna Briggs Institute (JBI) tools. The Mixed Methods Appraisal Tool version 2018 was used to assess the mixed method studies. RESULTS A total of 963 articles were identified, but only 7 articles reporting on 6 studies met the eligibility criteria. A 2-year treatment for lymphedema was approximately USD$14,877 to USD$23,167 in America. In Australia, the average out-of-pocket costs ranged from A$207 to A$1400 (USD$156.26 to USD$1056.83) per year. Outpatient visits, compressed clothing, and hospital admissions were the dominant costs. The financial toxicity was associated with the severity of lymphedema, and patients with heavy financial burden had to reduce other expenses or even forgo the treatment. CONCLUSION Breast cancer-related lymphedema aggravated the economic burden of patients. The included studies showed great variation in the methods used and therefore differences in cost results. The national government should further improve the healthcare system and increase the insurance coverage of lymphedema treatment to alleviate this burden. More research is needed to focus on financial toxicity experience of breast cancer patients with lymphedema. IMPLICATIONS FOR CANCER SURVIVORS The cost of the ongoing treatment of breast cancer-related lymphedema influences patients' economic situation and quality of life. Survivors need to be informed early about the potential financial burden associated with lymphedema treatment.
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Affiliation(s)
- Jingru Bian
- School of Nursing, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Aomei Shen
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Medical & Surgical Nursing, School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, China
| | - Wanwan Yang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Beihuanan Road, Jinghai District, Tianjin, China
| | - Liyuan Zhang
- School of Nursing, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, China
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China
| | - Wanmin Qiang
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Immunology and Biotherapy, Key Laboratory of Cancer Prevention and Therapy, Huanhuxi Road, Hexi District, Tianjin, China.
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, Huanhuxi Road, Hexi District, Tianjin, China.
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26
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Ghorani E, Quartagno M, Blackhall F, Gilbert DC, O'Brien M, Ottensmeier C, Pizzo E, Spicer J, Williams A, Badman P, Parmar MKB, Seckl MJ. REFINE-Lung implements a novel multi-arm randomised trial design to address possible immunotherapy overtreatment. Lancet Oncol 2023; 24:e219-e227. [PMID: 37142383 DOI: 10.1016/s1470-2045(23)00095-5] [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: 10/07/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 05/06/2023]
Abstract
Increasing evidence suggests that some immunotherapy dosing regimens for patients with advanced cancer could result in overtreatment. Given the high costs of these agents, and important implications for quality of life and toxicity, new approaches are needed to identify and reduce unnecessary treatment. Conventional two-arm non-inferiority designs are inefficient in this context because they require large numbers of patients to explore a single alternative to the standard of care. Here, we discuss the potential problem of overtreatment with anti-PD-1 directed agents in general and introduce REFINE-Lung (NCT05085028), a UK multicentre phase 3 study of reduced frequency pembrolizumab in advanced non-small-cell lung cancer. REFINE-Lung uses a novel multi-arm multi-stage response over continuous interventions (MAMS-ROCI) design to determine the optimal dose frequency of pembrolizumab. Along with a similarly designed basket study of patients with renal cancer and melanoma, REFINE-Lung and the MAMS-ROCI design could contribute to practice-changing advances in patient care and form a template for future immunotherapy optimisation studies across cancer types and indications. This new trial design is applicable to many new or existing agents for which optimisation of dose, frequency, or duration of therapy is desirable.
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Affiliation(s)
- Ehsan Ghorani
- Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, London, UK
| | - Matteo Quartagno
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Fiona Blackhall
- Christie National Health Service Foundation Trust, Manchester, UK
| | - Duncan C Gilbert
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Mary O'Brien
- Royal Marsden Hospital, Imperial College London, London, UK
| | - Christian Ottensmeier
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, UK
| | - Elena Pizzo
- Department of Applied Health Research, University College London, London, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Alex Williams
- Imperial College Trials Unit-Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Philip Badman
- Imperial College Trials Unit-Cancer, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mahesh K B Parmar
- Institute for Clinical Trials and Methodology, University College London, London, UK.
| | - Michael J Seckl
- Department of Medical Oncology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, London, UK.
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27
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Cardone C, Arnold D. The Cancer Treatment Gap in Lower- to Middle-Income Countries. Oncology 2023; 101 Suppl 1:2-4. [PMID: 37044080 PMCID: PMC10413785 DOI: 10.1159/000530416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Claudia Cardone
- Experimental Clinical Abdominal Oncology Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Dirk Arnold
- Department of Hematology, Oncology, Palliative Care and Rheumatology, Asklepios Tumorzentrum Hamburg, AK Altona, Hamburg, Germany
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28
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Yong ASJ, Cheong MWL, Hamzah E, Teoh SL. A qualitative study of lived experiences and needs of advanced cancer patients in Malaysia: Gaps and steps forward. Qual Life Res 2023:10.1007/s11136-023-03401-5. [PMID: 36964453 PMCID: PMC10038386 DOI: 10.1007/s11136-023-03401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Due to the high burden of cancer-related suffering, it is paramount to understand the gaps in cancer care that lead to suffering. Advanced cancer patients have unmet needs and challenges that differ from those with early-stage cancer due to the rapid disease progression. By exploring advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects, this study aims to identify gaps in the Malaysian health system and propose contextualised measures to improve cancer care. METHODS Semi-structured, in-depth interviews were conducted to explore advanced cancer patients' lived experiences and needs from the physical, psychological, social, and spiritual aspects. The interviews were then transcribed and coded. Themes were developed from the codes using iterative thematic approach. RESULTS The lived experiences and needs of nineteen patients converged into four major themes: disruption to daily lives, psychosocial and spiritual support system, information needs, and financial needs. This study described predominantly how cancer impacted patients' lives and livelihood, how patients coped with their psychological conditions after diagnosis, the need for effective communication and trust in a multicultural society, and how finance affected access to and experience of cancer care. CONCLUSION Advanced cancer patients had different needs beyond receiving medical treatments. A concerted effort is required from clinicians, allied health professionals, social workers, support groups, and family members to understand and fulfil these needs.
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Affiliation(s)
- Alene Sze Jing Yong
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | | | | | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia.
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29
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Koczwara B, Chan A, Jefford M, Lam WWT, Taylor C, Wakefield CE, Bhoo-Pathy N, Gyawali B, Harvet G, Lou Y, Pramesh CS, Takahashi M, Ke Y, Chan RJ. Cancer Survivorship in the Indo-Pacific: Priorities for Progress. JCO Glob Oncol 2023; 9:e2200305. [PMID: 36749908 PMCID: PMC10166466 DOI: 10.1200/go.22.00305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Bogda Koczwara
- Department of Medical Oncology, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, CA.,Department of Oncology Pharmacy, National Cancer Centre Singapore, Singapore
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Wendy W T Lam
- Jockey Club Institute of Cancer Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong, China
| | | | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine & Health, Discipline of Paediatrics and Child Health, Sydney, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence Based Practice, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bishal Gyawali
- Queen's Global Oncology Program, Department of Oncology, Queen's University, Kingston, Canada
| | - Gregory Harvet
- Department of Paediatrics, Centre Hospitalier Territorial, Nouméa, New Caledonia
| | - Yan Lou
- School of Nursing, Department of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Miyako Takahashi
- Japan Cancer Survivorship Network, Tokyo, Japan.,Iwate Medical University, Iwate, Japan
| | - Yu Ke
- Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
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Burden of respiratory problems in low-income and middle-income countries. Curr Opin Support Palliat Care 2022; 16:210-215. [PMID: 36102933 DOI: 10.1097/spc.0000000000000615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW Chronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middle-income countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems. RECENT FINDINGS We report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs. SUMMARY Prevention and treatment of respiratory diseases is essential for improved wellbeing. We identify missed opportunities for measurement and understanding of burden caused by respiratory problems within efforts to measure illness prevalence. We highlight need for symptom management interventions, developed in context of local cultural beliefs and behaviours.
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Auguste A, Cox S, Oliver JS, Phillip D, Gabriel O, St. Catherine J, Radix C, Luce D, Barul C. Cancer Survivors in Saint Lucia Deeply Value Social Support: Considerations for Cancer Control in Under-Resourced Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116531. [PMID: 35682118 PMCID: PMC9180699 DOI: 10.3390/ijerph19116531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
Understanding the views of cancer survivors on their experience is important for informing community-based interventions. We studied, for the first time, the views of cancer survivors residing in Saint Lucia on their overall care experience. We used interview data from a cohort of adult cancer survivors from Saint Lucia between 2019 and 2020. We performed a thematic analysis to derive themes from codes. Forty-four survivors provided responses to at least one of the three questions. The majority of survivors were black, female and diagnosed with breast cancer. Survivors were interviewed on average five years after diagnosis. Four common themes emerged; "Availability of support groups", "Importance of support from family and friends", "Access to finances" and "Health education and patient navigation". Travel overseas for health services was common among survivors. Survivors expressed emotional distress during travel due to isolation from family and local providers. This is typical among island populations and is distinct from existing patient frameworks. Survivors also suggested that networking amongst providers and interventions assisted families of cancer survivors. Although tertiary care services are limited, we showed that survivors deeply value and depend on their inter-personal relationships during care. Interventions aimed at strengthening the inter-personal environment of survivors are warranted.
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Affiliation(s)
- Aviane Auguste
- Vaughan Arthur Lewis Institute for Research and Innovation (VALIRI), Sir Arthur Lewis Community College, Morne Fortune, Castries LC06 101, Saint Lucia;
- Correspondence:
| | - Shania Cox
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
- Faculté de Médecine, Campus de Fouillole, Université des Antilles, 97157 Pointe-à-Pitre, France
| | - JoAnn S. Oliver
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, AL 35401, USA;
| | - Dorothy Phillip
- Faces of Cancer Saint Lucia, Tapion Ridge, Castries LC04 201, Saint Lucia;
| | - Owen Gabriel
- Department of Oncology, Owen King European Union Hospital, Millenium Highway, Castries LC04 201, Saint Lucia;
- Caribbean Association for Oncology and Hematology, Belmont, Port of Spain 150123, Trinidad and Tobago
| | - James St. Catherine
- Vaughan Arthur Lewis Institute for Research and Innovation (VALIRI), Sir Arthur Lewis Community College, Morne Fortune, Castries LC06 101, Saint Lucia;
| | - Carlene Radix
- Organisation of Eastern Caribbean States (OECS) Commission-Franck Johnson Avenue, Morne Fortune, Castries LC06 101, Saint Lucia;
| | - Danièle Luce
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
| | - Christine Barul
- Univ Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, 97100 Pointe-à-Pitre, France; (S.C.); (D.L.); (C.B.)
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