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Siligato R, Gembillo G, Di Simone E, Di Maria A, Nicoletti S, Scichilone LM, Capone M, Vinci FM, Bondanelli M, Malaventura C, Storari A, Santoro D, Di Muzio M, Dionisi S, Fabbian F. Financial Toxicity in Renal Patients (FINTORE) Study: A Cross-Sectional Italian Study on Financial Burden in Kidney Disease-A Project Protocol. Methods Protoc 2024; 7:34. [PMID: 38668141 PMCID: PMC11053909 DOI: 10.3390/mps7020034] [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: 02/21/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Financial toxicity (FT) refers to the negative impact of health-care costs on clinical conditions. In general, social determinants of health, especially poverty, socioenvironmental stressors, and psychological factors, are increasingly recognized as important determinants of non-communicable diseases, such as chronic kidney disease (CKD), and their consequences. We aim to investigate the prevalence of FT in patients at different stages of CKD treated in our universal health-care system and from pediatric nephrology, hemodialysis, peritoneal dialysis and renal transplantation clinics. FT will be assessed with the Patient-Reported Outcome for Fighting Financial Toxicity (PROFFIT) score, which was first developed by Italian oncologists. Our local ethics committee has approved the study. Our population sample will answer the sixteen questions of the PROFFIT questionnaire, seven of which are related to the outcome and nine the determinants of FT. Data will be analyzed in the pediatric and adult populations and by group stratification. We are confident that this study will raise awareness among health-care professionals of the high risk of adverse health outcomes in patients who have both kidney disease and high levels of FT. Strategies to reduce FT should be implemented to improve the standard of care for people with kidney disease and lead to truly patient-centered care.
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Affiliation(s)
- Rossella Siligato
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
| | - Guido Gembillo
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98121 Messina, Italy;
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Emanuele Di Simone
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Alessio Di Maria
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Simone Nicoletti
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Laura Maria Scichilone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
| | - Matteo Capone
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Francesca Maria Vinci
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Marta Bondanelli
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Cristina Malaventura
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Alda Storari
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98121 Messina, Italy;
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00189 Rome, Italy; (E.D.S.); (M.D.M.)
| | - Sara Dionisi
- Nursing, Technical and Rehabilitation, Department DATeR Azienda Unità Sanitaria Locale di Bologna, 40121 Bologna, Italy;
| | - Fabio Fabbian
- Nephrology Unit, University Hospital of Ferrara, 44121 Ferrara, Italy; (R.S.); (A.D.M.); (S.N.); (L.M.S.); (M.C.); (F.M.V.); (A.S.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (M.B.); (C.M.)
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Parikh DA, Rodriguez GM, Ragavan M, Kerr E, Asuncion MK, Hansen J, Srinivas S, Fan AC, Shah S, Patel MI. Lay healthcare worker financial toxicity intervention: a pilot financial toxicity screening and referral program. Support Care Cancer 2024; 32:161. [PMID: 38366165 DOI: 10.1007/s00520-024-08357-x] [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: 07/14/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Financial toxicity is a source of significant distress for patients with urologic cancers, yet few studies have addressed financial burden in this patient population. METHODS We developed a financial toxicity screening program using a lay health worker (LHW) and social worker (SW) to assess and mitigate financial toxicity in a single academic medical clinic. As part of a quality improvement project, the LHW screened all newly diagnosed patients with advanced stages of prostate, kidney, or urothelial cancer for financial burden using three COST tool questions and referred patients who had significant financial burden to an SW who provided personalized recommendations. The primary outcome was feasibility defined as 80% of patients with financial burden completing the SW consult. Secondary outcomes were patient satisfaction, change in COST Tool responses, and qualitative assessment of financial resources utilized. RESULTS The LHW screened a total of 185 patients for financial toxicity; 82% (n = 152) were male, 65% (n = 120) White, and 75% (n = 139) reported annual household income >$100,000 US Dollars; 60% (n = 114) had prostate cancer. A total of 18 (9.7%) participants screened positive for significant financial burden and were referred to the SW for consultation. All participants (100%) completed and reported satisfaction with the SW consultation and had 0.83 mean lower scores on the COST Tool post-intervention assessment compared to pre-intervention (95% confidence interval [0.26, 1.41]). CONCLUSION This multidisciplinary financial toxicity intervention using an LHW and SW was feasible, acceptable, and associated with reduced financial burden among patients with advanced stages of urologic cancers. Future work should evaluate the effect of this intervention among cancer patients in diverse settings.
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Affiliation(s)
- Divya A Parikh
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA.
- Medical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA.
| | - Gladys M Rodriguez
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Meera Ragavan
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Elizabeth Kerr
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Mary Khay Asuncion
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Jennifer Hansen
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Sandy Srinivas
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Alice C Fan
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Sumit Shah
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
| | - Manali I Patel
- Department of Medicine, Division of Oncology, Stanford University, Stanford, CA, USA
- Medical Services, VA Palo Alto Health Care System, Palo Alto, CA, USA
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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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Kircher S, Duan F, An N, Gareen IF, Sicks JD, Sadigh G, Suga JM, Kehn H, Mehan PT, Bajaj R, Hanson DS, Dalia SM, Acoba JD, Yasar DG, Park ER, Wagner LI, Carlos RC. Patient-Reported Financial Burden of Treatment for Colon or Rectal Cancer. JAMA Netw Open 2024; 7:e2350844. [PMID: 38194233 PMCID: PMC10777253 DOI: 10.1001/jamanetworkopen.2023.50844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/09/2023] [Indexed: 01/10/2024] Open
Abstract
Importance The longitudinal experience of patients is critical to the development of interventions to identify and reduce financial hardship. Objective To evaluate financial hardship over 12 months in patients with newly diagnosed colorectal cancer (CRC) undergoing curative-intent therapy. Design, Setting, and Participants This prospective, longitudinal cohort study was conducted between May 2018 and July 2020, with time points over 12 months. Participants included patients at National Cance Institute Community Oncology Research Program sites. Eligibility criteria included age at least 18 years, newly diagnosed stage I to III CRC, not started chemotherapy and/or radiation, treated with curative intent, and able to speak English. Data were analyzed from December 2022 through April 2023. Main Outcomes and Measures The primary end point was financial hardship, measured using the Comprehensive Score for Financial Toxicity (COST), which assesses the psychological domain of financial hardship (range, 0-44; higher score indicates better financial well-being). Participants completed 30-minute surveys (online or paper) at baseline and 3, 6, and 12 months. Results A total of 450 participants (mean [SD] age, 61.0 [12.0] years; 240 [53.3%] male) completed the baseline survey; 33 participants (7.3%) were Black and 379 participants (84.2%) were White, and 14 participants (3.1%) identified as Hispanic or Latino and 424 participants (94.2%) identified as neither Hispanic nor Latino. There were 192 participants (42.7%) with an annual household income of $60 000 or greater. There was an improvement in financial hardship from diagnosis to 12 months of 0.3 (95% CI, 0.2 to 0.3) points per month (P < .001). Patients with better quality of life and greater self-efficacy had less financial toxicity. Each 1-unit increase in Functional Assessment of Cancer Therapy-General (rapid version) score was associated with an increase of 0.7 (95% CI, 0.5 to 0.9) points in COST score (P < .001); each 1-unit increase in self-efficacy associated with an increase of 0.6 (95% CI, 0.2 to 1.0) points in COST score (P = .006). Patients who lived in areas with lower neighborhood socioeconomic status had greater financial toxicity. Neighborhood deprivation index was associated with a decrease of 0.3 (95% CI, -0.5 to -0.1) points in COST score (P = .009). Conclusions and Relevance These findings suggest that interventions for financial toxicity in cancer care should focus on counseling to improve self-efficacy and mitigate financial worry and screening for these interventions should include patients at higher risk of financial burden.
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Affiliation(s)
- Sheetal Kircher
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
| | - Fenghai Duan
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Na An
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilanan F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - JoRean D. Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Jennifer M. Suga
- Kaiser Permanente NCI Community Oncology Research Program and NCORP, Vallejo, California
| | - Heather Kehn
- Metro-Minnesota Community Oncology Research Consortium, St Louis Park
| | | | - Rajesh Bajaj
- Carolina Health Care and NCORP, Florence, South Carolina
| | | | | | | | | | - Elyse R. Park
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Lynne I. Wagner
- Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Ruth C. Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor
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Lam AB, Moore V, Nipp RD. Care Delivery Interventions for Individuals with Cancer: A Literature Review and Focus on Gastrointestinal Malignancies. Healthcare (Basel) 2023; 12:30. [PMID: 38200936 PMCID: PMC10779432 DOI: 10.3390/healthcare12010030] [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: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gastrointestinal malignancies represent a particularly challenging condition, often requiring a multidisciplinary approach to management in order to meet the unique needs of these individuals and their caregivers. PURPOSE In this literature review, we sought to describe care delivery interventions that strive to improve the quality of life and care for patients with a focus on gastrointestinal malignancies. CONCLUSION We highlight patient-centered care delivery interventions, including patient-reported outcomes, hospital-at-home interventions, and other models of care for individuals with cancer. By demonstrating the relevance and utility of these different care models for patients with gastrointestinal malignancies, we hope to highlight the importance of developing and testing new interventions to address the unique needs of this population.
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Affiliation(s)
- Anh B. Lam
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Vanessa Moore
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73117, USA;
| | - Ryan D. Nipp
- Division of Hematology and Oncology, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK 73104, USA
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Sears-Smith M, Knight TG. Financial Toxicity in Patients with Hematologic Malignancies: a Review and Need for Interventions. Curr Hematol Malig Rep 2023; 18:158-166. [PMID: 37490228 DOI: 10.1007/s11899-023-00707-6] [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] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Financial toxicity is a developing research area to quantify the financial stress experienced by patients and caregivers, as well as the mechanisms by which they manage the costs associated with treatment and the very real harms that this stress can inflict upon cancer care. Patients with blood malignancies experience increased costs associated with their diagnosis due to possible inpatient admissions for treatment, frequent office visits, and even more frequent lab evaluations and testing. PURPOSE OF REVIEW Multiple studies have examined the causes and effects of financial toxicity on patient care and outcomes, and there have been several validated tools developed to identify patients experiencing or at risk for financial harm. DISCUSSION However, few studies to date have focused on implementing successful interventions to assist in mitigating financial difficulties for patients diagnosed with hematologic malignancies and their families. In this review, we examine the current literature with an emphasis on levels of care, including providers, systems, and policies. Specifically, we discuss published interventions including physician education about treatment costs, financial navigation in cancer centers, and novel institutional multidisciplinary review of patients' financial concerns. We also discuss the urgent need for societal and governmental interventions to lessen financial distress experienced by these highly vulnerable blood cancer patients.
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Affiliation(s)
- Megan Sears-Smith
- Levine Cancer Institute, Atrium Health, 1020 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Thomas G Knight
- Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, LCI Building 2, Suite 60100, Charlotte, NC, 28204, USA.
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Cavalier D, Doherty B, Geonnotti G, Patel A, Peters W, Zona S, Shea L. Patient perceptions of copay card utilization and policies. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2254586. [PMID: 37692554 PMCID: PMC10486291 DOI: 10.1080/20016689.2023.2254586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Copay cards are intended to mitigate patient out-of-pocket (OOP) expenses. This qualitative, exploratory focus group study aimed to capture patient perceptions of copay cards and copay adjustment programs (CAPs; insurers' accumulator and maximizer policies), which redirect the copay card utilization benefits intended for patients' OOP expenses. METHODS Patients with chronic conditions were recruited through Janssen's Patient Engagement Research Council program. They completed a survey and attended a live virtual session to provide feedback on copay cards. RESULTS Among 33 participants (median age, 49 years [range, 24-78]), the most frequent conditions were cardiovascular-metabolic disease and inflammatory bowel disease. Patients associated copay cards with lessening financial burden, improving general and mental health, and enabling medication adherence. An impact on medication adherence was identified by 10 (63%) White and nine (100%) Black respondents. Some patients were unaware of CAPs despite having encountered them; they recommended greater copay card education and transparency about CAPs. CONCLUSION Patients relied on copay cards to help afford their prescribed medication OOP expenses and maintain medication adherence. Use of CAPs may increase patient OOP expenses. Patients would benefit from awareness programs and industry - healthcare provider partnerships that facilitate and ensure access to copay cards.
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Affiliation(s)
- Dimika Cavalier
- Independent contributor and patient participant in Janssen Patient Engagement Research Council, Memphis, TN, USA
| | | | | | - Aarti Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Steven Zona
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Lisa Shea
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Ragavan MV, Borno HT. The costs and inequities of precision medicine for patients with prostate cancer: A call to action. Urol Oncol 2023; 41:369-375. [PMID: 37164775 DOI: 10.1016/j.urolonc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 05/12/2023]
Abstract
Financial toxicity is a growing problem in the delivery of cancer care and contributes to inequities in outcomes across the cancer care continuum. Racial/ethnic inequities in prostate cancer, the most common cancer diagnosed in men, are well described, and threaten to widen in the era of precision oncology given the numerous structural barriers to accessing novel diagnostic studies and treatments, particularly for Black men. Gaps in insurance coverage and cost sharing are 2 such structural barriers that can perpetuate inequities in screening, diagnostic workup, guideline-concordant treatment, symptom management, survivorship, and access to clinical trials. Mitigating these barriers will be key to achieving equity in prostate cancer care, and will require a multi-pronged approach from policymakers, health systems, and individual providers. This narrative review will describe the current state of financial toxicity in prostate cancer care and its role in perpetuating racial inequities in the era of precision oncology.
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Affiliation(s)
- Meera V Ragavan
- Division of Hematology Oncology, Department of Medicine, University of California, San Francisco, CA.
| | - Hala T Borno
- Division of Hematology Oncology, Department of Medicine, University of California, San Francisco, CA; Trial Library, Inc, San Francisco, CA
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Mileham KF, Farhangfar CJ. Expanding the Multidisciplinary Team in Prediagnostic Care of Lung Cancer: How Else Can We Improve Time to Targeted Treatment in Metastatic Non-Small-Cell Lung Cancer? JCO Oncol Pract 2023; 19:694-696. [PMID: 37607326 DOI: 10.1200/op.23.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
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Shi JJ, Maldonado JA, Wu CF, Peterson SK, Chen YS, Diao K, Volk RJ, Giordano SH, Shih YCT, Kaiser K, Smith GL. Financial toxicity in cancer patients and subsequent risk of repeat acute care utilization. Front Psychol 2023; 14:1209526. [PMID: 37663351 PMCID: PMC10469858 DOI: 10.3389/fpsyg.2023.1209526] [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: 04/20/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background Acute care (AC) visits by cancer patients are costly sources of healthcare resources and can exert a financial burden of oncology care both for individuals with cancer and healthcare systems. We sought to identify whether cancer patients who reported more severe initial financial toxicity (FT) burdens shouldered excess risks for acute care utilization. Methods In 225 adult patients who participated in the Economic Strain and Resilience in Cancer (ENRICh) survey study of individuals receiving ambulatory cancer care between March and September 2019, we measured the baseline FT (a multidimensional score of 0-10 indicating the least to most severe global, material, and coping FT burdens). All AC visits, including emergency department (ED) and unplanned hospital admissions, within 1-year follow-up were identified. The association between the severity of FT and the total number of AC visits was tested using Poisson regression models. Results A total of 18.6% (n = 42) of patients had any AC visit, comprising 64.3% hospital admissions and 35.7% ED visits. Global FT burden was associated with the risk of repeat AC visits within 1-year follow-up (RR = 1.17, 95% CI 1.07-1.29, P < 0.001 for every unit increase), even after adjusting for sociodemographic and disease covariates. When examining subdimensions of FT, the burden of depleted FT coping resources (coping FT) was strongly associated with the risk of repeat AC visits (RR = 1.27, 95% CI 1.15-1.40, P < 0.001) while material FT burden showed a trend toward association (RR = 1.07, 95% CI 0.99-1.15, P = 0.07). Conclusion In this prospective study of acute oncology care utilization outcomes among adult cancer patients, FT was a predictor of a higher burden of acute care visits. Patients with severely depleted material and also practical and social coping resources were at particular risk for repeated visits. Future studies are needed to identify whether early FT screening and intervention efforts may help to mitigate urgent acute care utilization burdens.
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Affiliation(s)
- Julia J. Shi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - J. Alberto Maldonado
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Chi-Fang Wu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ying-Shiuan Chen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ya-Chen T. Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kelsey Kaiser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Grace L. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Thom B, Sokolowski S, Abu-Rustum NR, Allen-Dicker J, Caramore A, Chino F, Doyle S, Fitzpatrick C, Gany F, Liebhaber A, Newman T, Rao N, Tappen J, Aviki EM. Financial Toxicity Order Set: Implementing a Simple Intervention to Better Connect Patients With Resources. JCO Oncol Pract 2023; 19:662-668. [PMID: 37319394 PMCID: PMC10424913 DOI: 10.1200/op.22.00669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/24/2023] [Accepted: 04/24/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE Financial toxicity of cancer treatment is well described in the literature, including characterizations of its risk factors, manifestations, and consequences. There is, however, limited research on interventions, particularly those at the hospital level, to address the issue. METHODS From March 1, 2019, to February 28, 2022, a multidisciplinary team conducted a three-cycle Plan-Do-Study-Act (PDSA) process to develop, test, and implement an electronic medical record (EMR) order set to directly refer patients to a hospital-based financial assistance program. The cycles included an assessment of the efficacy of our current practice in connecting patients experiencing financial hardship with assistance, the development and piloting of the EMR referral order, and the broad implementation of the order set across our institution. RESULTS In PDSA cycle 1, we found that approximately 25% of patients at our institution experienced some form of financial hardship, but most patients were not connected to available resources because of our referral mechanism. In PDSA cycle 2, the pilot referral order set was deemed feasible and received positive feedback. Over the 12-month study period (March 1, 2021-February 28, 2022) of PDSA cycle 3, 718 orders were placed for 670 unique patients across interdisciplinary providers from 55 treatment areas. These referrals resulted in at least $850,000 in US dollars (USD) in financial aid in 38 patients (mean = $22,368 USD). CONCLUSION The findings from our three-cycle PDSA quality improvement project demonstrate the feasibility and efficacy of interdisciplinary efforts to develop a hospital-level financial toxicity intervention. A simple referral mechanism can empower providers to connect patients in need with available resources.
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Affiliation(s)
- Bridgette Thom
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefania Sokolowski
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nadeem R. Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of OB/GYN, Weill Cornell Medical College, New York, NY
| | - Joshua Allen-Dicker
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy Caramore
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Nursing, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Fumiko Chino
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephanie Doyle
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Patient Financial Services, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Francesca Gany
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allison Liebhaber
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tiffanny Newman
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Strategy and Innovation, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nisha Rao
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Johanna Tappen
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Social Work, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emeline M. Aviki
- Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Zafar SY, Peppercorn J. Reflections on the Financial Toxicity of Cancer: 10 Years Later. Oncologist 2023:oyad179. [PMID: 37315202 PMCID: PMC10400133 DOI: 10.1093/oncolo/oyad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023] Open
Abstract
This commentary reflects on the decade since the publication of an article on the financial toxicity of cancer treatment and the international recognition of the scope and depth of the problem, in the hope that the coming decade is characterized by evaluation and demonstration of optimal solutions to the problem.
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Affiliation(s)
- S Yousuf Zafar
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jeffrey Peppercorn
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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13
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Pail O, Knight TG. Financial toxicity in patients with leukemia undergoing hematopoietic stem cell transplantation: A systematic review. Best Pract Res Clin Haematol 2023; 36:101469. [PMID: 37353293 DOI: 10.1016/j.beha.2023.101469] [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: 02/17/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/25/2023]
Abstract
Financial toxicity (FT) is a term used to describe the objective financial burden of cancer care including the associated coping behaviors used by patients and their caregivers. FT has been shown to result in both direct financial burdens and in clinically relevant outcomes, such as non-adherence with care, diminished quality of life, and even decreased overall survival. Much of the data has been described in solid tumors, with limited investigations in the malignant hematology population. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) face a unique financial burden driven by lengthy hospitalizations and acute and chronic morbidity that have downstream implications on their income and costs. In this review, we discuss the prevalence of FT in patients with leukemia who are eligible for HSCT. We review the impact of FT on financial and clinical outcomes and the role of various interventions that have been studied within this population.
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Affiliation(s)
- Orrin Pail
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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14
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Raghavan D. Academic Hybrid Cancer Centers: Here Today, Gone Tomorrow? JCO Oncol Pract 2023:OP2300138. [PMID: 37071837 DOI: 10.1200/op.23.00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
- Derek Raghavan
- Veterans Administration Health Care Center, Charlotte, NC
- Levine Cancer Institute, Charlotte, NC
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15
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Khan HM, Ramsey S, Shankaran V. Financial Toxicity in Cancer Care: Implications for Clinical Care and Potential Practice Solutions. J Clin Oncol 2023; 41:3051-3058. [PMID: 37071839 DOI: 10.1200/jco.22.01799] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Patients with cancer face an array of financial consequences as a result of their diagnosis and treatment, collectively referred to as financial toxicity (FT). In the past 10 years, the body of literature on this subject has grown tremendously, with a recent focus on interventions and mitigation strategies. In this review, we will briefly summarize the FT literature, focusing on the contributing factors and downstream consequences on patient outcomes. In addition, we will put FT into context with our emerging understanding of the role of social determinants of health and provide a framework for understanding FT across the cancer care continuum. We will then discuss the role of the oncology community in addressing FT and outline potential strategies that oncologists and health systems can implement to reduce this undue burden on patients with cancer and their families.
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Affiliation(s)
- Hiba M Khan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA
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16
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Ragavan MV, Mora RV, Winder K, Incudine A, Cunningham R, Stivers T, Borno HT. Impact of a Comprehensive Financial Resource on Financial Toxicity in a National, Multiethnic Sample of Adult, Adolescent/Young Adult, and Pediatric Patients With Cancer. JCO Oncol Pract 2023; 19:e286-e297. [PMID: 36378994 DOI: 10.1200/op.22.00350] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Financial toxicity is a well-recognized problem for patients with cancer. However, a crucial gap remains in describing and implementing mitigation strategies. We conducted a national survey of a multiethnic adolescent/pediatric and adult patient population served by Family Reach, a nonprofit organization focused on removing financial barriers to cancer care, to evaluate the impact of a comprehensive financial resource on patient-reported financial toxicity. METHODS An electronic survey was administered to characterize patients' current financial health and the impact of Family Reach's resources on financial toxicity. The survey was e-mailed to all patients or caregivers who received resources from Family Reach between January 1, 2020, and June 30, 2020. Factors associated with higher financial stress and higher potential impact of resources on financial burden were evaluated through separate multivariate regression models. Qualitative responses were analyzed using manual coding and thematic analysis. RESULTS Three hundred thirty socioeconomically and racially diverse respondents (overall response rate 40%; 46% non-Hispanic White; 48% with incomes below the federal poverty line) completed the survey and were included in the analysis. More than half of respondents reported high financial stress in the previous week. Hispanic ethnicity, Black race, and low annual household income were associated with higher financial toxicity. A greater amount of financial assistance was associated with a higher confidence rating that resources provided would decrease financial stress. In open-ended comments, respondents highlighted the impact of the COVID-19 pandemic and resulting job loss on financial toxicity, the importance of financial navigation, the benefits of financial assistance, and anxiety about long-term financial health. CONCLUSION A comprehensive financial resource, particularly financial assistance, alleviated financial toxicity in a multiethnic national sample of patients with cancer. Ongoing work is critical to address sustainable funding sources and financial navigation to support patients during treatment and survivorship.
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Affiliation(s)
- Meera V Ragavan
- University of California, San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA
| | - Rosa V Mora
- University of California San Francisco, School of Medicine, San Francisco, CA
| | | | | | | | | | - Hala T Borno
- University of California, San Francisco, Department of Medicine, Division of Hematology/Oncology, San Francisco, CA.,Trial Library Inc, San Francisco, CA
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17
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Ong CT, Dhiman A, Smith A, Jose A, Kallakuri P, Belanski J, Sood D, Witmer HDD, Morgan RB, Turaga KK, Eng OS. Insurance Authorization Barriers in Patients Undergoing Cytoreductive Surgery and HIPEC. Ann Surg Oncol 2023; 30:417-422. [PMID: 36112250 DOI: 10.1245/s10434-022-12437-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) exist across multiple histologies, but little data exist on the impact of insurance authorization on access to these therapies. Given the evolving role of CRS/HIPEC, we sought to characterize insurance approval and delays in patients undergoing these therapies. PATIENTS AND METHODS A retrospective review was performed at a high-volume tertiary center of patients who received CRS/HIPEC from 2017 to 2021. Collected data included patient demographics, tumor histologic characteristics, insurance type, approval/denial history, and time to prior authorization approval. Descriptive statistics were performed. RESULTS In total, 367 patients received CRS/HIPEC during the study period. They had a median age of 59 (IQR 49-67) years, 35% were male, and 76% were white. Of the patients requiring prior authorization, 14 of 104 (13%) patients were denied prior authorization and required appeal. Median time between authorization request and approval was 33 (IQR 28-36) days. These cases generated 410 insurance authorization requests, 94 (23%) of which were not initially approved and required appeal. The rate of upfront denial was 21.1% in patients with public insurance compared with 23.4% in patients with private insurance. Gastric cancer was the most common histology among denied cases (55%), followed by colorectal, appendiceal, and gynecologic malignancies. CONCLUSIONS Despite the broadening indications for and data supporting CRS/HIPEC, a significant proportion of patients still face hurdles in attaining insurance approval and coverage for these therapies. Addressing barriers to insurance approval is imperative to decrease therapeutic delay and improve access to data-driven care.
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Affiliation(s)
- Cecilia T Ong
- Department of Surgery, University of Chicago, Chicago, USA
| | - Ankit Dhiman
- Department of Surgery, University of Chicago, Chicago, USA
| | - Anthony Smith
- Department of Surgery, University of Chicago, Chicago, USA
| | - Angela Jose
- Department of Surgery, University of Chicago, Chicago, USA
| | | | | | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - Ryan B Morgan
- Department of Surgery, University of Chicago, Chicago, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine, Orange, USA.
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18
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Su CT, Shankaran V. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. J Am Coll Radiol 2023; 20:51-56. [PMID: 36513257 PMCID: PMC9898149 DOI: 10.1016/j.jacr.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022]
Abstract
Financial toxicity, the cumulative financial hardships resulting from cancer diagnosis and treatment, is a growing problem in the United States. With the proliferation of costly novel therapeutics and improved cancer survival, financial toxicity will remain a major issue in cancer care delivery. Frontline oncology providers serve as gatekeepers in the medical system and, as such, could play essential roles in recognizing and addressing financial toxicity. Providers and health systems could help mitigate financial toxicity through routine financial toxicity screening, financial navigation, and advocacy. Specific strategies include developing and implementing financial screening instruments that can be integrated in electronic medical records and establishing team-based financial navigation programs to help patients with out-of-pocket medical costs, nonmedical spending, and insurance optimization. Finally, providers should continue to advocate for policies and legislation that decrease cost and promote value-based care. In this review, we examine opportunities for provider engagement in these areas and highlight gaps for future research.
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Affiliation(s)
- Christopher T Su
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington; and Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington; and Codirector, Hutchinson Institute for Cancer Outcome Research, Fred Hutchinson Cancer Center, Seattle, Washington
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19
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Diao K, Lei X, Smith GL, Jagsi R, Peterson SE, Sumer BD, Smith BD, Sher DJ. Patient-Reported Financial Toxicity in a Population-Based Cohort of Oropharynx Cancer Survivors. Int J Radiat Oncol Biol Phys 2022; 116:142-153. [PMID: 36812043 DOI: 10.1016/j.ijrobp.2022.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with oropharyngeal squamous cell carcinoma (OPSCC) are at high risk for financial toxicity (FT), but the nature, extent, and predictors of FT experienced after primary radiation therapy (RT) or surgery are poorly understood. METHODS AND MATERIALS We used a population-based sample of patients from the Texas Cancer Registry with stage I to III OPSCC diagnosed from 2006 to 2016 and treated with primary RT or surgery. Of 1668 eligible patients, 1600 were sampled, 400 responded, and 396 confirmed OPSCC. Measures included the MD Anderson Symptom Inventory Head and Neck, Neck Dissection Impairment Index, and a financial toxicity instrument adapted from the Individualized Cancer Care (iCanCare) study. Multivariable logistic regression evaluated associations of exposures with outcomes. RESULTS Of 396 analyzable respondents, 269 (68%) received primary RT and 127 (32%) surgery. The median time from diagnosis to survey was 7 years. Due to OPSCC, 54% of patients experienced material sacrifice (including 28% who reduced food spending and 6% who lost their housing), 45% worried about financial problems, and 29% experienced long-term FT. Independent factors associated with more long-term FT included female sex (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.23-2.40), Black non-Hispanic race (OR, 2.98; 95% CI, 1.26-7.09), unmarried status (OR, 1.50; 95% CI, 1.11-2.03), feeding tube use (OR, 3.98; 95% CI, 2.29-6.90), and worst versus best quartile on the MD Anderson Symptom Inventory Head and Neck (OR, 1.89; 95% CI, 1.23-2.90) and Neck Dissection Impairment Index (OR, 5.62; 95% CI, 3.79-8.34). Factors associated with less long-term FT included age >57 years (OR, 0.54; 95% CI, 0.41-0.71; P < .001) and household income ≥$80,000 (OR, 0.60; 95% CI, 0.44-0.82; P = .001). Primary RT versus surgery was not associated with long-term FT (OR, 0.92; 95% CI, 0.68-1.24). CONCLUSIONS Oropharynx cancer survivors experience high rates of material sacrifice and long-term FT, and we identified important risk factors. Chronic symptom burden was associated with significantly worse long-term financial status, supporting the hypothesis that toxicity mitigation strategies may reduce long-term FT.
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Affiliation(s)
| | - Xiudong Lei
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Grace L Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Susan E Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Benjamin D Smith
- Departments of Radiation Oncology; Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David J Sher
- Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas.
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20
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Tullis JA. Tumor talk: A descriptive study of communication about tumor board meetings. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2022; 6:10717. [PMID: 37440772 PMCID: PMC10336866 DOI: 10.4081/qrmh.2022.10717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/30/2022] [Indexed: 07/15/2023] Open
Abstract
Tumor board meetings are behind-the-scenes settings where communication about health and strategizing about healthcare delivery take place. Despite their wide use in hospitals and cancer centers, there is a dearth of information about the communication practices in this context. Drawing upon six weeks of observations, this study investigated communication during tumor board meetings at a tertiary cancer center in the Southeastern United States. Findings revealed differences in communication among cancer specialties, with one tumor board consistently talking about the medical and non-medical elements of patient cases, while other specialties focused primarily on plans for treatment with little discussion about quality of life, economic, or caregiver support issues. The manuscript includes suggestions for modifying tumor conferences and opportunities for future research.
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Affiliation(s)
- Jillian A. Tullis
- Department of Communication, University of San Diego, Camino 126E, San Diego, California 92107, USA 619.260.6897;619.260.4205
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21
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Smith GL, Banegas MP, Acquati C, Chang S, Chino F, Conti RM, Greenup RA, Kroll JL, Liang MI, Pisu M, Primm KM, Roth ME, Shankaran V, Yabroff KR. Navigating financial toxicity in patients with cancer: A multidisciplinary management approach. CA Cancer J Clin 2022; 72:437-453. [PMID: 35584404 DOI: 10.3322/caac.21730] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 12/21/2022] Open
Abstract
Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.
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Affiliation(s)
- Grace L Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, Texas
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shine Chang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University School of Business, Boston, Massachusetts
| | - Rachel A Greenup
- Division of Surgical Oncology, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Juliet L Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Department of Internal Medicine, The University of Alabama, Birmingham, Alabama
| | - Kristin M Primm
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael E Roth
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Veena Shankaran
- Seattle Cancer Care Alliance/University of Washington Medicine and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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22
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Knight TG, Aguiar M, Robinson M, Morse A, Chen T, Bose R, Ai J, Ragon BK, Chojecki AL, Shah NA, Sanikommu SR, Symanowski J, Copelan EA, Grunwald MR. Financial Toxicity Intervention Improves Outcomes in Patients With Hematologic Malignancy. JCO Oncol Pract 2022; 18:e1494-e1504. [DOI: 10.1200/op.22.00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Patients with hematologic malignancies are extremely vulnerable to financial toxicity (FT) because of the high costs of treatment and health care utilization. This pilot study identified patients at high risk because of FT and attempted to improve clinical outcomes with comprehensive intervention. METHODS: All patients who presented to the Levine Cancer Institute's Leukemia Clinic between May 26, 2019, and March 10, 2020, were screened for inclusion by standardized two question previsit survey. Patients screening positive were enrolled in the comprehensive intervention that used nurse navigators, clinical pharmacists, and community pro bono financial planners. Primary outcomes were defined as improvement in mental and physical quality of life in all patients and improvement in overall survival in the high-risk disease group. RESULTS: One hundred seven patients completed comprehensive intervention. Patients experiencing FT had increased rates of noncompliance including to prescription (16.8%) and over-the-counter medications (15.9%). The intervention resulted in statistically significantly higher quality of life when measured by using Patient-Reported Outcomes Measurement Information System physical (12.5 ± 2.2 v 13.7 ± 1.8) and mental health scores (11.4 ± 2.2 v 12.4 ± 2.2; all P < .001). In patients with high-risk disease (as determined by using disease-specific scoring systems), risk of death in those receiving the intervention was 0.44 times the risk of death in those without the intervention after adjusting for race, and treatment with stem-cell transplant, oral chemotherapy, or immunotherapy (95% CI, 0.21 to 0.94; P = .034). CONCLUSION: Screening and intervention on FT for patients with hematologic malignancies is associated with increased quality of life and survival.
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Affiliation(s)
- Thomas G. Knight
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | | | - Myra Robinson
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Allison Morse
- Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Tommy Chen
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Rupali Bose
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jing Ai
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Brittany K. Ragon
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Aleksander L. Chojecki
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Nilay A. Shah
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Srinivasa R. Sanikommu
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - James Symanowski
- Department of Cancer Biostatistics, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Edward A. Copelan
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Michael R. Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC
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23
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Corry J, Ng WT, Ma SJ, Singh AK, de Graeff P, Oosting SF. Disadvantaged Subgroups Within the Global Head and Neck Cancer Population: How Can We Optimize Care? Am Soc Clin Oncol Educ Book 2022; 42:1-10. [PMID: 35439036 DOI: 10.1200/edbk_359482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Within the global head and neck cancer population, there are subgroups of patients with poorer cancer outcomes independent from tumor characteristics. In this article, we review three such groups. The first group comprises patients with nasopharyngeal cancer in low- and middle-income countries where access to high-volume, well-resourced radiotherapy centers is limited. We discuss a recent study that is aiming to improve outcomes through the instigation of a comprehensive radiotherapy quality assurance program. The second group comprises patients with low socioeconomic status in a high-income country who experience substantial financial toxicity, defined as financial hardship for patients due to health care costs. We review causes and consequences of financial toxicity and discuss how it can be mitigated. The third group comprises older patients who may poorly tolerate and not benefit from intensive standard-of-care treatment. We discuss the role of geriatric assessment, particularly in relation to the use of chemotherapy. Through better recognition and understanding of disadvantaged groups within the global head and neck cancer population, we will be better placed to instigate the necessary changes to improve outcomes and quality of life for patients with head and neck cancer.
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Affiliation(s)
- June Corry
- Division Radiation Oncology, GenesisCare Radiation OncologySt Vincent's Hospital, Melbourne, Australia.,Department of MedicineThe University of Melbourne, Parkville, Australia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of MedicineThe University of Hong Kong, Hong Kong, China.,Clinical Oncology CentreThe University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Anurag K Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Pauline de Graeff
- University Center for Geriatric MedicineUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical OncologyUniversity Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Offodile AC, Gallagher K, Angove R, Tucker-Seeley RD, Balch A, Shankaran V. Financial Navigation in Cancer Care Delivery: State of the Evidence, Opportunities for Research, and Future Directions. J Clin Oncol 2022; 40:2291-2294. [PMID: 35353552 DOI: 10.1200/jco.21.02184] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anaeze C Offodile
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.,Baker Institute for Public Policy, Rice University, Houston, TX
| | | | | | - Reginald D Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA.,University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alan Balch
- Patient Advocate Foundation, Hampton, VA
| | - Veena Shankaran
- Hutchinson Institute for Cancer Outcomes Research, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
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25
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Giap F, Chino F, Gupta A. Systems-Level Changes to Address Financial Toxicity in Cancer Care. JCO Oncol Pract 2022; 18:310-311. [PMID: 35271297 DOI: 10.1200/op.22.00085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fantine Giap
- Fantine Giap, MD, Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; Fumiko Chino, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Arjun Gupta, MD, Department of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Fumiko Chino
- Fantine Giap, MD, Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; Fumiko Chino, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Arjun Gupta, MD, Department of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Arjun Gupta
- Fantine Giap, MD, Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL; Fumiko Chino, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; and Arjun Gupta, MD, Department of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
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