Opinions and strategies of Australian health professionals on tackling cancer-related financial toxicity: A nationwide survey

Out-of-pocket costs for patients diagnosed with high-grade glioma and their carers

Background

This study aimed to describe the out-of-pocket costs incurred by patients diagnosed with high-grade glioma (HGG) and their carers in the standard care arm of the Care-IS trial in the 6 to 8 months following their diagnosis.

Methods

Carers completed monthly cost surveys detailing the out-of-pocket costs incurred by patients and carers over a 6-month period. Seventy carers reported out-of-pocket costs at baseline (within 2 months following patient diagnosis), and a maximum of 50% of participants reported costs in any subsequent month. Costs were adjusted to 2023 AUD and reported as medians with an interquartile range. Demographic factors were assessed to determine if any were significantly associated with being in the first or fourth quartile of total out-of-pocket costs at baseline.

Results

Median monthly costs for patient-carer dyads were highest at baseline ($535[IQR:$170-$930]), and 2 months post-recruitment ($314 [IQR:$150-$772]). The largest contributors to patient-carer costs were patient health service use and patient medications. Patient and carer health service use and medication costs varied over time. The median health service use and medication out-of-pocket costs for patients and carers were mostly below $100 per month; however, there was a large variance in the upper 75th percentile for these cost categories. No factors were significantly associated with higher baseline out-of-pocket costs.

Conclusions

A HGG diagnosis has a significant and sustained financial impact on people who are diagnosed and their carers. Patients experience significant additional costs relating to their diagnosis and travel to receive care, and their carers also continue to experience sustained costs whilst managing the additional tasks associated with informal caregiving.

Investigating processes to support and improve informed financial consent in Australian cancer services: an implementation process mapping study and analysis

OBJECTIVES

Through implementation process mapping and thematic analysis, this study aimed to understand existing pathways of established informed financial consent (IFC) processes to develop general recommendations for implementing IFC in various cancer care settings.

DESIGN

Implementation science-based process mapping qualitative study. The Consolidated Framework for Implementation Research (CFIR) informed the development of interview questions and a process map outlining a normative process or workflow for patient consults was used during the interviews.

SETTING

Australian cancer care provider health services.

PARTICIPANTS

Australian healthcare professionals who provide services to cancer patients and indicated having an IFC process or activities in their service were approached through existing networks to participate in a semistructured interview.

RESULTS

Ten healthcare professionals who regularly worked with cancer patients were interviewed. IFC processes varied by professional specialty (ie, general practice, surgery, radiation oncology and medical oncology) and healthcare settings (eg, public and private). An aggregated process map that highlights the key components of IFC processes discussed was created and includes strategies such as centralised points of contact, consolidated information delivery, reiteration of information by others or at various time-points and the use of follow-up appointments to revisit the financial impact of treatment. Interview themes identified barriers and facilitators such as training, resources and templates that to support or hinder IFC in accordance with CFIR domains.

CONCLUSIONS

The themes and aggregated process map provide timely recommendations for healthcare professionals who provide services to cancer patients to facilitate IFC with their patients prior to treatment or as treatment changes. These practical actions will assist healthcare professionals and services providing cancer care to integrate IFC practices and processes into their routine patient interactions. Further work should identify implementation strategies to integrate and scale-up these evidence-based IFC processes and practices across the healthcare system.

Cancer Survivors' Experience of Care and Financial Toxicity: Results From a National Survey

PURPOSE

Financial toxicity (FT) can adversely affect quality of life, treatment adherence, and clinical outcomes. Patient experience of care (PEC) captures patient's perspectives on interactions with health care providers (HCPs) and systems, but the impact of PEC on FT is unknown. This study examined the relationship between PEC and FT.

METHODS

We used data from the 2016-2017 Medical Expenditure Panel Survey (MEPS) Experience with Cancer Survivorship Supplement. PEC was assessed by patient-reported frequencies of their HCPs providing explanations that were easy to understand, listening carefully, showing respect, and spending enough time with the patient. FT was assessed by nine items to measure material, psychological, and behavioral FT. Analyses were performed using multivariable logistic regression controlling for sociodemographic and clinical characteristics and weighted to produce nationally representative estimates and account for survey nonresponse.

RESULTS

Data from 1,068 individuals diagnosed with cancer at age >18 years were assessed. A total of 30% reported material FT, 35% reported psychological FT, and 27% reported behavioral FT. Examining PEC, 64% of respondents indicated that HCPs always explained things, 60% always listened, 66% always showed respect, and 57% always spent adequate time with them. Odds of psychological FT were significantly (P < .05) lower among patients reporting HCPs always (v never/sometimes) listened to them (odds ratio [OR], 0.37 [95% CI, 0.19 to 0.70]), showed them respect (OR, 0.36 [95% CI, 0.16 to 0.81]), and spent enough time with them (OR, 0.47 [95% CI, 0.26 to 0.86]). Significant associations with PEC were also found with MEPS psychological FT items on worry about paying medical bills, family's financial stability, and keeping job/income because of cancer.

CONCLUSION

Worry/anxiety regarding costs can be a major factor affecting individuals diagnosed with cancer. Improving patient-provider interactions to enhance patient experience of care may reduce psychological financial toxicity.

Willingness to pay for exercise oncology services: a mixed methods study

PURPOSE

To evaluate cancer patients' willingness to pay for exercise services and oncology health professionals' perception of patients' willingness to pay.

METHODS

A mixed-methods design was used. Online questionnaires and semi-structured interviews were administered to people with any type of cancer and oncology health professionals delivering clinical care. Questionnaires assessed patients' willingness to pay for one consultation with a cancer-trained exercise specialist (i.e. exercise physiologist/physiotherapist) and regular group exercise sessions supervised by cancer-trained exercise specialists. Interviews probed factors associated with the out-of-pocket cost of adopting exercise guidelines. Data were analysed using standard descriptive statistics and an interpretive descriptive approach to qualitative analysis.

RESULTS

Participants included 450 cancer patients and 300 oncology health professionals. A randomly selected sub-set of 30 patients and 31 health professionals completed interviews. The majority of patients surveyed would pay for an exercise consultation (94%) and regular group exercise sessions (58.4% extremely likely; 24.7% moderately likely; standard 7-point Likert scale response options). A greater proportion of patients who were employed (97.2% p = 0.030), below average general health (97.0% p = 0.031), were female (96.1% p = 0.013), and insufficiently active (95.3% p = 0.048) were willing to pay for exercise services. Oncology health professionals perceived fewer patients would be willing to pay for exercise services (p < 0.001; consultation = 7.0% extremely likely, 32.7% moderately likely; regular supervised sessions = 5.3% extremely likely; 32.0% moderately likely).

CONCLUSIONS

When briefly informed of the benefits and costs of exercise, the majority of patients in this study would pay for cancer-specific exercise services. There is an opportunity to align perceptions of willingness to pay among patients and health professionals involved in their care to help facilitate the uptake of exercise guidelines.

A cross-sectional study of the experiences of distressed callers when accessing financial assistance from a telephone-based cancer information and support service

OBJECTIVE

The objective of this study was to explore the experiences of distressed people calling helplines regarding offer and uptake of financial services after cancer diagnosis.

METHODS

Cancer patients and caregivers reported whether they had discussed then used financial services and perceptions surrounding service uptake. Associations between being offered services and demographic, clinical and financial characteristics were explored.

RESULTS

Of the 508 patients and caregivers in this sample, 107 (21%) people who recalled discussing financial support used the service. Of those, 34 (32%) participants actioned a financial support referral, of which 32 (94%) reported that the support was helpful. Of the 401 (79%) who did not recall discussing financial support, 26 (6%) would have liked to do so. The following characteristics were significantly associated with a greater likelihood of discussing financial support: younger age, being married, metastatic disease, higher out-of-pocket costs, not having private health insurance, being on leave and being absent for more days from work.

CONCLUSIONS

Although users of financial supports find them helpful, there is need for more structured approaches to referral to achieve equitable access.

IMPLICATIONS FOR PUBLIC HEALTH

A pro-active, structured approach to assessing financial toxicity and offering support is warranted in community-based organisations that offer cancer information and support.

Challenges and solutions to cancer-related financial toxicity according to Australian health professionals: qualitative results from a national survey

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.

Financial well-being as a mediator of the relationship between multimorbidity and health-related quality of life in people with cancer

BACKGROUND

It is unknown whether financial well-being mediates the impact of multimorbidity on the health-related quality of life (HRQoL) of cancer patients.

METHODS

Participants were recruited from three outpatient oncology clinics of Hong Kong public hospitals. Multimorbidity was assessed using the Charlson Comorbidity Index. Financial well-being, the mediator of the association between multimorbidity and HRQoL outcomes, was assessed using the Comprehensive Score for Financial Toxicity Functional Assessment of Chronic Illness Therapy. The HRQoL outcomes were assessed using the Functional Assessment of Cancer Therapy - General (FACT-G) and its four sub-dimensions. Mediation analyses were conducted using SPSS PROCESS v4.1.

RESULTS

Six-hundred and forty cancer patients participated in the study. Multimorbidity had a direct effect on FACT-G scores independent of financial well-being (β for path c' = -0.752, p < 0.001). In addition, multimorbidity had an indirect effect on FACT-G scores through its effect on financial well-being (β for path a = -0.517, p < 0.05; β for path b = 0.785, p < 0.001). Even after adjustments were made for the covariates, the indirect effect of multimorbidity on FACT-G via financial well-being remained significant, accounting for 38.0% of the overall effect, indicating partial mediation. Although there were no statistically significant associations between multimorbidity, social well-being, and emotional well-being, the indirect effects of multimorbidity on physical and functional well-being through financial well-being remained significant.

CONCLUSIONS

Poor financial well-being attributable to multimorbidity partially mediates the direct impact of chronic conditions on HRQoL in Chinese cancer patients, particularly their physical and functional well-being.

Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer

AIM

To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL).

METHODS

A cross-sectional survey was administered to patients with HNC 1-3 years after radiotherapy at a regional hospital in Australia. The survey included questions on sociodemographics, out-of-pocket expenses, HRQoL, and the Financial Index of Toxicity (FIT) tool. The relationship between high financial toxicity scores (top quartile) and HRQoL was explored.

RESULTS

Of the 57 participants included in the study, 41 (72%) reported out-of-pocket expenses at a median of AUD 1796 (IQR AUD 2700) and a maximum of AUD 25,050. The median FIT score was 13.9 (IQR 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs. 114.5, p < 0.001). Patients who were not married had higher FIT scores (23.1 vs. 11.1, p = 0.01), as did those with lower education (19.3 vs. 11.1, p = 0.06). Participants with private health insurance had lower financial toxicity scores (8.3 vs. 17.6, p = 0.01). Medications (41%, median AUD 400), dietary supplements (41%, median AUD 600), travel (36%, median AUD 525), and dental (29%, AUD 388) were the most common out-of-pocket expenses. Participants living in rural locations (≥100 km from the hospital) had higher out-of-pocket expenses (AUD 2655 vs. AUD 730, p = 0.01).

CONCLUSION

Financial toxicity is associated with poorer HRQoL for many patients with HNC following treatment. Further research is needed to investigate interventions aimed at reducing financial toxicity and how these can best be incorporated into routine clinical care.

New Frontiers in Child, Adolescent and Young Adult Psycho-Oncology Survivorship Care

The landscape of cancer survivorship has changed considerably from Fitzhugh Mullan's conceptualization of the three sequential phases or 'seasons of survival' that an individual might expect to pass through, from the acute (cancer diagnosis and treatment), extended (the period following treatment), and permanent (survivorship, aligned with cure) survivorship phases [...].