1
|
Navas Huerga R, Salcedo de Diego I, de Miguel Jiménez C, Muñoz Martínez C, Kwon M, Pedraza García N, Calbacho M, Royuela Vicente A, Serrano Gallardo P. Financial toxicity in allogeneic haematopoietic stem cell transplant patients from a social determinants of health perspective. Eur J Oncol Nurs 2024; 70:102584. [PMID: 38631123 DOI: 10.1016/j.ejon.2024.102584] [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: 01/13/2024] [Revised: 03/25/2024] [Accepted: 03/30/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Financial toxicity (FT) refers to the subjective perception of financial distress resulting from objective economic strain due to illness, exerting a detrimental influence on health outcomes. This study aimed to describe FT among allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients within a public health framework, employing a social determinants of health approach. METHODS A multi-centre cross-sectional study involving adult allo-HSCT patients was conducted across three public hospitals in Madrid. FT was assessed using a validated COST scale (range 0-44; lower scores indicating higher FT). Patient-administered paper/online questionnaires were utilized to collect data on sociodemographic, socioeconomic, clinical, and healthcare access variables. Descriptive, non-parametric univariate statistical analysis and multiple linear regression models were performed. RESULTS Sixty-six patients, with a mean age: 52.5 years (SD: 11.5), 50% women, 28.7% displaced to Madrid for HSCT, and 71.4% lacking financial support were included. The median FT score was 20 points (IQR 12-27.25). Independent factors associated with higher FT included being females (Coef = -3.26; p = 0.079), perceived income loss after HSCT (Coef = -6.81; p < 0.001) and a monthly household income of ≤1000 € compared to 1001-2500€ (Coef = 8.29; p = 0.005) or >2500 € (Coef = 15.75; p < 0.001). CONCLUSIONS Despite the limited sample size, our findings underscore the presence of financial toxicity among allo-HSCT patients, shaped by social determinants of health. Recognizing and addressing FT within the HSCT process is essential to mitigate social inequalities in health.
Collapse
Affiliation(s)
| | - Isabel Salcedo de Diego
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain; IDIPHISA (Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana, Majadahonda, Majadahonda, Spain.
| | - Carlos de Miguel Jiménez
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain; IDIPHISA (Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana, Majadahonda, Majadahonda, Spain
| | | | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain
| | | | - María Calbacho
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Royuela Vicente
- IDIPHISA (Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana, Majadahonda, Majadahonda, Spain; Biostatistics Unit, Hospital Universitario Puerta de Hierro Majadahonda, Spain; CIBERESP, ISCIII, Madrid, Spain
| | - Pilar Serrano Gallardo
- Department of Nursing, Universidad Autónoma de Madrid, Madrid, Spain; IDIPHISA (Instituto de Investigación Sanitaria Puerta de Hierro-Segovia Arana, Majadahonda, Majadahonda, Spain; INAECU (Instituto Interuniversitario de Investigación Avanzada Sobre Evaluación de la Ciencia y la Universidad), Madrid, Spain
| |
Collapse
|
2
|
Pandya BJ, Young C, Packnett ER, Xie B, Lillehaugen T, Block A, Bernacki K, Touya M, LeBlanc TW. Work absenteeism, disability, and lost wages among patients with acute myeloid leukemia and their caregivers: a cohort study using US administrative claims and productivity data. Expert Rev Pharmacoecon Outcomes Res 2024; 24:521-532. [PMID: 38294308 DOI: 10.1080/14737167.2024.2311305] [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: 08/25/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE We describe the impact of acute myeloid leukemia (AML) diagnosis on workplace absenteeism and disability days among patients and their caregivers. METHODS This retrospective study included adults with newly diagnosed AML (2009-2019) and adult caregivers of patients with newly diagnosed AML, identified from the US Merative™ MarketScan® Commercial Database. The Merative MarketScan Health and Productivity Management Database provided linked patient-level records of workplace absence and short-term (STD) and long-term disability (LTD) data. Endpoints included workplace absence, STD and LTD for patients and caregivers during 12 months pre-AML (baseline) and ≤3 years' follow-up, and corresponding cost of work loss. RESULTS Patient workplace absence decreased in the months post-AML diagnosis, but the number of STD and LTD leave days claimed increased significantly by sixfold and fourfold, respectively. The proportion of patients making STD leave claims increased within 4-5 months of diagnosis, while the proportion making LTD leave claims increased significantly starting from month 5. Caregiver workplace absence peaked in the first 2 months post-diagnosis and remained elevated versus baseline throughout the study. CONCLUSION AML diagnosis leads to workplace absenteeism and increased economic burden for patients with AML and their caregivers.
Collapse
Affiliation(s)
- Bhavik J Pandya
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | | | - Bin Xie
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Alana Block
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | | - Maelys Touya
- Astellas Pharma Global Development, Inc., Northbrook, IL, USA
| | | |
Collapse
|
3
|
Yu J, Khera N, Turnbull J, Stewart SK, Williams P, Bhatt V, Meyers O, Galvin J, Lee SJ. Impact of Chronic Graft-Versus-Host Disease (GVHD) on Patients' Employment, Income, and Informal Caregiver Burden: Findings From the Living With Chronic GVHD Patient Survey. Transplant Cell Ther 2023:S2666-6367(23)01235-6. [PMID: 37037267 DOI: 10.1016/j.jtct.2023.04.004] [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: 01/23/2023] [Revised: 03/10/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Development of chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) results in impaired physical function and quality of life. However, limited data exist regarding the employment and financial impact on patients and caregivers. OBJECTIVE The objective of this study was to describe the impact of chronic GVHD on patient employment, disability leave, income, reliance on caregivers, and effects on caregiver employment. STUDY DESIGN The Living With Chronic GVHD Patient Survey was a cross-sectional online survey administered from May to August 2020 in the United States to adult HSCT survivors diagnosed with chronic GVHD within the past 5 years. Data on respondent demographics and disease characteristics and the effects of chronic GVHD on employment, income, and need for caregiver assistance were collected. Respondents were also asked to report on the impact of their chronic GVHD on their caregivers' employment. All data were summarized using descriptive statistics; no formal statistical comparisons were conducted. RESULTS A total of 165 respondents completed the survey (median age, 57.0 years; 63.6% women; 83.0% White); respondents had been experiencing chronic GVHD for a median (range) of 4.5 (0.1-36.7) years, with a median (range of 0.5 (0-3.6) years from most recent transplant to chronic GVHD diagnosis. Among those employed full- or part-time at the time of their most recent transplant (n=80), 61.3% reported taking disability leave, 58.8% worked reduced hours, 27.5% took a less demanding job, and 33.8% left a job because of chronic GVHD. Additionally, 71.3% believed they had lost income due to chronic GVHD. Among all respondents, 72.1% reported receiving regular caregiver assistance. Respondents commonly reported employment changes among unpaid caregivers (34.5% reduced their working hours; 16.6% terminated a job). CONCLUSIONS HSCT survivors who develop chronic GVHD are vulnerable to employment changes and financial hardship. This analysis highlights the need for effective therapies and improved symptom management to reduce the multifaceted burden of chronic GVHD on patients and their caregivers and ultimately improve long-term HSCT outcomes.
Collapse
Affiliation(s)
- Jingbo Yu
- Incyte Corporation, Wilmington, DE, USA;.
| | - Nandita Khera
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | | | - Susan K Stewart
- Blood & Marrow Transplant Information Network, Highland Park, IL, USA
| | | | | | - Oren Meyers
- Patient Centered Solutions, IQVIA, Paris, France
| | | | | |
Collapse
|
4
|
Symptom Burden and Recovery in the First Year After Allogeneic Hematopoietic Stem Cell Transplantation. Cancer Nurs 2023; 46:77-85. [PMID: 35283470 DOI: 10.1097/ncc.0000000000001077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients are affected by various symptoms after allogeneic hematopoietic stem cell transplantation (allo-HSCT) that can affect recovery. Research has mainly focused on symptom occurrence; thus, little is known about patients' overall symptom burden. OBJECTIVE The aim of this study was to examine patient-reported symptom burden in the first year after allo-HSCT and whether a high symptom burden 4 months after allo-HSCT predicts recovery, that is, general health and sick leave, 1 year after transplantation. METHODS Allo-HSCT patients aged 18 to 65 years were included (n = 189). Questionnaire data were collected on admission to the allo-HSCT unit, as well as 4 and 7 months and 1 year after allo-HSCT. Logistic regression evaluated relationships between demographic characteristics, chronic graft-versus-host disease, physical activity, and a high symptom burden. RESULTS Tiredness, susceptibility to infection, disinterest in sex, and physical weakness remained the most frequent symptoms, while distressing symptoms varied during the first year after allo-HSCT.Poor general health 1 year after allo-HSCT was associated with older age, low physical activity, and a high symptom burden 4 months after allo-HSCT. Full-time sick leave 1 year after allo-HSCT was associated with chronic graft-versus-host disease, low physical activity, and a high symptom burden 4 months after transplantation. CONCLUSIONS Experiencing a high symptom burden 4 months after allo-HSCT can affect recovery 1 year after transplantation. Furthermore, low physical activity 4 months after allo-HSCT can predict both general health and sick leave 1 year after transplantation. IMPLICATIONS FOR PRACTICE Repeated symptom assessment, including experienced distress, is central for reducing overall symptom burden and supporting recovery after allo-HSCT.
Collapse
|
5
|
Salit RB, Schoeppner K, De Biase C, Mohammed J, Gonzales AL, Hashmi SK, Gea-Banacloche J, Savani BN, Carpenter PA, Syrjala KL. American Society for Transplantation and Cellular Therapy Return to Work Guidance Committee Recommendations for Health Care Providers Who Take Care of Hematopoietic Cell Transplantation Patients. Transplant Cell Ther 2022; 28:822-828. [PMID: 36184059 DOI: 10.1016/j.jtct.2022.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022]
Abstract
Hematopoietic cell transplantation (HCT) health care providers report a desire to improve long-term outcomes and quality of life for their patients. One of the items frequently cited by patients in terms of transitioning from being a patient back to pre-HCT life is return to work (RTW). However, these patients report little support from their health care providers in facilitating this process, and only 50% to 60% achieve RTW, at a median of 3 years post-HCT. Barriers are physical, psychological, and logistical, as well as poor communication between the patient and their employer. We convened a group of experts in survivorship, rehabilitation, social work, and psychology to draft an evidence-based document to assist health care providers in guiding their patients' RTW journey. Guidance is drawn from the existing literature for HCT and general cancer patients and is divided into pre-HCT, peri-HCT, and post-HCT categories. Collaboration among health care providers, patients, and their employers is key to this transition. Suggested referrals and evaluations also are provided. The goal is for this guidance to be continually updated as we advance the field with more HCT-specific literature.
Collapse
Affiliation(s)
- Rachel B Salit
- Fred Hutchinson Cancer Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington.
| | | | | | - Jaleel Mohammed
- Rehabilitation Association for Hematopoietic Cell Transplantation, Sheffield, United Kingdom; Lincolnshire Community Health Service NHS Trust, Lincoln, United Kingdom
| | | | - Shahrukh K Hashmi
- Mayo Clinic, Rochester, Minnesota; SSMC, Abu Dhabi, United Arab Emirates
| | | | | | - Paul A Carpenter
- Vanderbilt University Medical Center, Nashville, Tennessee; Seattle Children's Medical Center, Seattle, Washington
| | - Karen L Syrjala
- Fred Hutchinson Cancer Center, Seattle, Washington; University of Washington Medical Center, Seattle, Washington
| |
Collapse
|
6
|
Kurosawa S, Yamaguchi T, Mori A, Matsuura T, Masuko M, Murata M, Tashiro H, Kako S, Satake A, Hagihara M, Ota S, Saito T, Kagawa K, Matsuo Y, Itonaga H, Uoshima N, Yamaguchi H, Naito K, Takahashi M, Fukuda T. Incidence and predictors of recurrent sick leave in survivors who returned to work after allogeneic hematopoietic cell transplantation. J Cancer Surviv 2022; 17:781-794. [PMID: 36048313 DOI: 10.1007/s11764-022-01250-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Although rather favorable probabilities of return to work have been reported after allogeneic hematopoietic cell transplantation (allo-HCT), survivors often have difficulty continuing to work because of their immunocompromised status and diverse late effects after allo-HCT. We evaluated the incidence of and risk factors for recurrent sick leave in allo-HCT survivors after they initially returned to work. METHODS We targeted allo-HCT survivors who were employed at diagnosis, aged 20-64 at survey, and survived for ≥ 2 years without relapse. Of the 1904 survivors who were informed of the study, 1148 returned the questionnaire (60%), and 1048 eligible participants were included in the overall analysis. In the present study that considered recurrent sick leave after return to work, we targeted 896 participants who returned to work at least once after allo-HCT. Participants stated if they had recurrent sick leave after returning to work and its reasons, as well as associated patient-, HCT/HCT center-, and work-related factors and clinical events after allo-HCT. A logistic regression analysis was conducted to explore correlated factors for recurrent sick leave. RESULTS In survivors who returned to work, 30% required recurrent sick leave. The most frequent causes of recurrent leave were physical issues (72%), and analysis of free descriptions demonstrated that these were mainly associated with graft-versus-host disease, infection, or readmission. Other reasons included work-related issues such as gap between physical and working conditions. Multivariate analysis showed that cord blood transplantation, longer employment duration, and counseling from healthcare professionals were associated with a lower risk of recurrent leave. Readmission, immunosuppressant use, and symptoms involving the respiratory system, gut, and joints and muscles were associated with a higher risk. CONCLUSIONS Our results drawn from a large cohort study should help healthcare professionals identify and assist at-risk patients. Multi-professional teams that provide continuous support and effective communication with the workplace are necessary to improve long-term outcomes after allo-HCT. IMPLICATIONS FOR CANCER SURVIVORS In order to continue working after the initial return to work, it is important to receive counseling from healthcare professionals and obtain reasonable accommodation from workplace.
Collapse
Affiliation(s)
- Saiko Kurosawa
- Department of Oncology, Ina Central Hospital, 1313-1 Koshiro-kubo, Ina, Nagano, 396-8555, Japan. .,Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ayako Mori
- Nursing Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoko Matsuura
- Nursing Division, National Cancer Center Hospital, Tokyo, Japan.,Nursing Division, Fukuoka National Hospital, Fukuoka, Japan
| | - Masayoshi Masuko
- Department of Hematopoietic Cell Therapy, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Makoto Murata
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Haruko Tashiro
- Department of Hematology/Oncology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Atsushi Satake
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Maki Hagihara
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Takeshi Saito
- Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kumiko Kagawa
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yayoi Matsuo
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Hidehiro Itonaga
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan
| | - Nobuhiko Uoshima
- Department of Hematology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | | | - Kensuke Naito
- Department of Hematology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Miyako Takahashi
- Japan Cancer Survivorship Network, Tokyo, Japan.,Iwate Medical University, Morioka, Japan.,The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
7
|
Buchbinder D, Khera N. Psychosocial and financial issues after hematopoietic cell transplantation. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:570-577. [PMID: 34889432 PMCID: PMC8791170 DOI: 10.1182/hematology.2021000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With improvement in survival after hematopoietic cell transplantation (HCT), it has become important to focus on survivors' psychosocial issues in order to provide patient-centered care across the transplant continuum. The goals of this article are to describe updates in the literature on certain psychosocial domains (emotional/mental health and social/financial) in HCT survivors, offer a brief overview of the status of the screening and management of these complications, and identify opportunities for future practice and research. An evidence-based approach to psychosocial care can be broken down as primary (promoting health, raising awareness, and addressing risk factors), secondary (screening and directing early pharmacological and nonpharmacological interventions), and tertiary (rehabilitating, limiting disability, and improving quality of life) prevention. Implementing such an approach requires close coordination between multiple stakeholders, including transplant center staff, referring hematologist/oncologists, and other subspecialists in areas such as palliative medicine or psychiatry. Innovative models of care that leverage technology can bring these stakeholders together to fulfill unmet needs in this area by addressing barriers in the delivery of psychosocial care.
Collapse
Affiliation(s)
| | - Nandita Khera
- College of Medicine, Mayo Clinic in Arizona, Phoenix, AZ
| |
Collapse
|