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Jiang JM, Eichler J, Bodner W, Fox J, Garg M, Kabarriti R, Mo A, Kalnicki S, Mehta K, Rivera A, Tang J, Yap J, Ohri N, Klein J. Predictors of Financial Toxicity in Patients Receiving Concurrent Radiation Therapy and Chemotherapy. Adv Radiat Oncol 2022; 8:101141. [PMID: 36636262 PMCID: PMC9829707 DOI: 10.1016/j.adro.2022.101141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Purpose Financial toxicity (FT) is a significant concern for patients with cancer. We reviewed prospectively collected data to explore associations with FT among patients undergoing concurrent, definitive chemoradiation therapy (CRT) within a diverse, urban, academic radiation oncology department. Methods and Materials Patients received CRT in 1 of 3 prospective trials. FT was evaluated before CRT (baseline) and then weekly using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire Core-30 questionnaire. Patients were classified as experiencing FT if they answered ≥2 on a Likert scale question (1-4 points) asking if they experienced FT. Rate of change of FT was calculated using linear regression; worsening FT was defined as increase ≥1 point per month. χ2, t tests, and logistic regression were used to assess predictors of FT. Results Among 233 patients, patients attended an average of 9 outpatient and 4 radiology appointments over the 47 days between diagnosis and starting CRT. At baseline, 52% of patients reported experiencing FT. Advanced T stage (odds ratio, 2.47; P = .002) was associated with baseline FT in multivariate analysis. The mean rate of FT change was 0.23 Likert scale points per month. In total, 26% of patients demonstrated worsening FT during CRT. FT at baseline was not associated with worsening FT (P = .98). Hospitalization during treatment was associated with worsening FT (odds ratio, 2.30; P = .019) in multivariate analysis. Conclusions Most patients reported FT before CRT. These results suggest that FT should be assessed (and, potentially, addressed) before starting definitive treatment because it develops early in a patient's cancer journey. Reducing hospitalizations may mitigate worsening FT. Further research is warranted to design interventions to reduce FT and avoid hospitalizations.
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Majd Z, Mohan A, Abughosh SM. Using group-based trajectory modeling to characterize the association of past ACEIs/ARBs adherence with subsequent statin adherence patterns among new statin users. J Am Pharm Assoc (2003) 2021; 61:829-837.e2. [PMID: 34344613 DOI: 10.1016/j.japh.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite well-documented benefits, statin adherence remains suboptimal. Studies have suggested that previous adherence to other chronic medications is a strong predictor of future adherence to newly initiated statins. Group-based trajectory modeling (GBTM) has been applied as a method to longitudinally depict the dynamic nature of adherence. OBJECTIVES This study aimed to examine the association between patients' adherence patterns to newly initiated statins and previous adherence trajectories of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) using GBTM. METHODS This retrospective cohort study was conducted among continuously enrolled statin initiators using claims data. Patients were included if they had ACEI/ARB use within 1 year before statin initiation (preindex period). Monthly adherence to ACEIs/ARBs was calculated during the preindex period and monthly adherence to statins was assessed 1 year after statin initiation using proportion of days covered (PDC). The monthly PDCs were modeled as a longitudinal response in a logistic GBTM to provide distinct patterns of adherence for ACEIs/ARBs and statins, separately. A multinomial logistic regression was conducted to determine an association between ACEI/ARB adherence trajectories and future statin trajectories, controlling for patient characteristics. RESULTS A total of 1078 patients were categorized into 4 distinct statin adherence trajectories: adherent (40.8%), gradual decline (37.4%), gaps in adherence (13.9%), and rapid decline (7.9%). Patients were further categorized into 4 groups on the basis of their distinct past ACEIs/ARBs trajectories: adherent (43%), gaps in adherence (29%), delayed nonadherence (15.2%), and gradual decline (12.8%). In the multinomial logistic regression, patients in the gaps in adherence or gradual decline groups were more likely to follow similar trajectories for future statin use than the adherent trajectory. CONCLUSION Previous adherence trajectories of ACEIs/ARBs may predict future adherence patterns for newly initiated statins. Knowledge of past medication-taking behavior could provide valuable information for developing tailored interventions to improve adherence.
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Zullig LL, Goldstein KM, Bosworth HB, Andrews SM, Danus S, Jackson GL, Provenzale D, Weinberger M, Kelley MJ, Voils CI. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis. BMC Health Serv Res 2018. [PMID: 29523146 PMCID: PMC5845139 DOI: 10.1186/s12913-018-2975-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the US. CRC survivors may have complex healthcare needs requiring care from both specialists and primary care. Our objective was to understand how CRC survivors perceive their survivorship care, especially management of their cardiovascular-related chronic diseases. METHODS We identified patients diagnosed with non-metastatic CRC between 10/1/2007 and 12/31/2015 at Veterans Affairs Medical Centers in North Carolina or Virginia. In 2016, we conducted telephone-based, semi-structured interviews to assess survivors' experiences with cancer survivorship and changes in health priorities. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed, and coded. RESULTS The 25 participants were, on average, 64 years old and approximately 4 years post-CRC diagnosis at the time of interview; most were white (60%), male (92%), and diagnosed with colon cancer (64%) as opposed to rectal cancer. CRC survivors reported: (1) a shift in focus from surviving cancer to reducing cardiovascular disease risk (e.g., by managing weight); (2) challenges with taking medications for CVD-related conditions; (3) new recognition of the importance of engaging with primary care providers. CONCLUSIONS Experiences with cancer shapes how survivors view their health. Management of cardiovascular-related chronic disease is important to veteran CRC survivors. There is a need to deliver cardiovascular disease risk reduction programs tailored for CRC survivors.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA. .,Department of Population Health Sciences, Duke University Medical Center, Durham, USA.
| | - Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Medicine, Duke University Medical Center, Durham, USA
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA.,Department of Psychiatry and Behavioral Sciences and School of Nursing, Duke University, Durham, USA
| | - Sara M Andrews
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA
| | - Susanne Danus
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA
| | - George L Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Population Health Sciences, Duke University Medical Center, Durham, USA
| | - Dawn Provenzale
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Medicine, Duke University Medical Center, Durham, USA.,Cooperative Studies Program Epidemiology Center-Durham, Durham, NC, USA
| | - Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.,Department of Health Policy and Management, University of North Carolina, Chapel Hill, USA
| | - Michael J Kelley
- Department of Veterans Affairs, Washington, DC, USA.,Hematology-Oncology Service, Durham Veterans Affairs Health Care System, Durham, USA
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA.,Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
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