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Mudaranthakam DP, Hughes D, Johnson P, Mason T, Nollen N, Wick J, Welch DR, Calhoun E. Career disruption and limitation of financial earnings due to cancer. JNCI Cancer Spectr 2023; 7:pkad044. [PMID: 37326961 PMCID: PMC10359624 DOI: 10.1093/jncics/pkad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/24/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE This study investigated how cancer diagnosis and treatment lead to career disruption and, consequently, loss of income and depletion of savings. DESIGN This study followed a qualitative descriptive design that allowed us to understand the characteristics and trends of the participants. METHOD Patients recruited (n = 20) for this study were part of the University of Kansas Cancer Center patient advocacy research group (Patient and Investigator Voices Organizing Together). The inclusion criteria were that participants must be cancer survivors or co-survivors, be aged 18 years or older, be either employed or a student at the time of cancer diagnosis, have completed their cancer treatment, and be in remission. The responses were transcribed and coded inductively to identify themes. A thematic network was constructed based on those themes, allowing us to explore and describe the intricacies of the various themes and their impacts. RESULTS Most patients had to quit their jobs or take extended absences from work to handle treatment challenges. Patients employed by the same employer for longer durations had the most flexibility to balance their time between cancer treatment and work. Essential, actionable items suggested by the cancer survivors included disseminating information about coping with financial burdens and ensuring that a nurse and financial navigator were assigned to every cancer patient. CONCLUSIONS Career disruption is common among cancer patients, and the financial burden due to their career trajectory is irreparable. The financial burden is more prominent in younger cancer patients and creates a cascading effect that financially affects close family members.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Dorothy Hughes
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Peggy Johnson
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Tracy Mason
- Patient and Investigator Voices Organizing Together (PIVOT), University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Nicole Nollen
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
| | - Danny R Welch
- University of Kansas Comprehensive Cancer Center, Kansas City, KS, USA
- Department of Cancer Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elizabeth Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
- Population Health Sciences, University of Illinois Chicago, Chicago, IL, USA
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Esselen KM, Baig RA, Gompers A, Stack-Dunnbier H, Hacker MR, Jang JW. Factors associated with increased financial toxicity after the completion of radiation treatment for gynecologic cancer. Support Care Cancer 2023; 31:388. [PMID: 37300721 DOI: 10.1007/s00520-023-07849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE We evaluated financial toxicity (FT) in patients with gynecologic cancer treated with radiation and assessed the impact of the COVID-19 pandemic on patients' financial wellbeing. METHODS Patients completed a survey 1 month after completing radiation from August 2019-March 2020 and November 2020-June 2021. The survey included the COmprehensive Score for Financial Toxicity (COST) tool, EQ-5D to measure quality of life (QOL) and pandemic-related questions for the second survey period. High FT was COST score ≤ 23. RESULTS Of 97 respondents (92% response rate), 49% completed the survey pre-pandemic and 51% after; the majority were white (76%) and had uterine cancer (64%). Sixty percent received external beam radiation with or without brachytherapy; 40% had only brachytherapy. High FT was associated with worse QOL (r = -0.37, P < 0.001), younger age and type of insurance (both p ≤ 0.03). Respondents with high FT were 6.0 (95% CI 1.0-35.9) times more likely to delay/avoid medical care, 13.6 (95% CI 2.9-64.3) times more likely to borrow money, and 6.9 (95% CI 1.7-27.2) times as likely to reduce spending on basic goods. The pandemic cohort had a smaller proportion of respondents with high FT than the pre-pandemic cohort (20% vs. 35%, p = 0.10) and a higher median COST score (32 (IQR 25-35) vs. 27 (IQR 19-34), p = 0.07). CONCLUSION Privately insured, younger respondents who received radiation for gynecologic cancer were at risk for FT. High FT was associated with worse QOL and economic cost-coping strategies. We observed less FT in the pandemic cohort, though not statistically different from the pre-pandemic cohort.
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Affiliation(s)
- Katharine M Esselen
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
| | - Rasha A Baig
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Annika Gompers
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hannah Stack-Dunnbier
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Clinical Management of Financial Toxicity-Identifying Opportunities through Experiential Insights of Cancer Survivors, Caregivers, and Social Workers. Curr Oncol 2022; 29:7705-7717. [PMID: 36290886 PMCID: PMC9601156 DOI: 10.3390/curroncol29100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive sampling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers; (ii) need for clarity of role and services; (iii) importance of timely information flow; and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors' and caregivers' needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes.
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Henrikson NB, Anderson ML, Dickerson J, Ewing JJ, Garcia R, Keast E, King DA, Lewis C, Locher B, McMullen C, Norris CM, Petrik AF, Ramaprasan A, Rivelli JS, Schneider JL, Shulman L, Tuzzio L, Banegas MP. The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship. Trials 2022; 23:402. [PMID: 35562781 PMCID: PMC9099299 DOI: 10.1186/s13063-022-06344-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention. METHODS The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received. DISCUSSION The CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial's strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective. TRIAL REGISTRATION ClinicalTrials.gov NCT05018000 . August 23, 2021.
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Affiliation(s)
- Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - John J Ewing
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Robin Garcia
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Blake Locher
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Carmit McMullen
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Consuelo M Norris
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Amanda F Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Arvind Ramaprasan
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Matthew P Banegas
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of California San Diego, San Diego, CA, USA
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Bassett HK, Beck J, Coller RJ, Flaherty B, Tiedt KA, Hummel K, Tchou MJ, Kapphahn K, Walker L, Schroeder AR. Parent Preferences for Transparency of Their Child's Hospitalization Costs. JAMA Netw Open 2021; 4:e2126083. [PMID: 34546372 PMCID: PMC8456391 DOI: 10.1001/jamanetworkopen.2021.26083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/16/2021] [Indexed: 01/20/2023] Open
Abstract
Importance Health care in the US is often expensive for families; however, there is little transparency in the cost of medical services. The extent to which parents want cost transparency in their children's care is not well characterized. Objective To explore the preferences and experiences of parents of hospitalized children regarding the discussion and consideration of health care costs in the inpatient care of their children. Design, Setting, and Participants This cross-sectional multicenter survey study included 6 geographically diverse university-affiliated US children's hospitals from November 3, 2017, to November 8, 2018. Participants included a convenience sample of English- and Spanish-speaking parents of hospitalized children nearing hospital discharge. Data were analyzed from January 1, 2020, to June 25, 2021. Main Outcomes and Measures Parents' preferences and experiences regarding transparency of their child's health care costs. Multivariable linear regression examined associations between clinical and sociodemographic variables with parents' preferences for knowing, discussing, and considering costs in the clinical setting. Factors included family financial difficulties, child's level of chronic disease, insurance payer, deductible, family poverty level, race, ethnicity, parental educational level, and study site. Results Of 644 invited participants, 526 (82%) were enrolled (290 [55%] male), of whom 362 (69%) were White individuals, 400 (76%) were non-Hispanic/Latino individuals, and 274 (52%) had children with private insurance. Overall, 397 families (75%) wanted to discuss their child's medical costs, but only 36 (7%) reported having a cost conversation. If cost discussions were to occur, 294 families (56%) would prefer to speak to a financial counselor. Ninety-eight families (19%) worried discussing costs would hurt the quality of their child's care. Families with a medical financial burden unrelated to their hospitalized child had higher mean agreement that their child's physician should consider the family's costs in medical decision-making than families without a medical financial burden (effect size, 0.55 [95% CI, 0.18-0.92]). No variables were consistently associated with cost transparency preferences. Conclusions and Relevance Most parents want to discuss their child's costs during an acute hospitalization. Discussions of health care costs may be an important, relatively unexplored component of family-centered care. However, these discussions rarely occur, indicating a tremendous opportunity to engage and support families in this issue.
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Affiliation(s)
- Hannah K. Bassett
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jimmy Beck
- Department of Pediatrics, Seattle Children’s Hospital, Seattle, Washington
| | - Ryan J. Coller
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brian Flaherty
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City
| | - Kristin A. Tiedt
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Kevin Hummel
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City
- currently affiliated with Division of Cardiology, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael J. Tchou
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
- currently affiliated with Section of Hospital Medicine, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Denver, Aurora
| | | | - Lauren Walker
- Section of Hospital Medicine, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Alan R. Schroeder
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Farrugia M, Yu H, Ma SJ, Iovoli AJ, Erickson K, Wendel E, Attwood K, Wooten KE, Gupta V, McSpadden RP, Kuriakose MA, Markiewicz MR, Chan JM, Hicks WL, Platek ME, Ray AD, Repasky EA, Singh AK. Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy. Cancers (Basel) 2021; 13:2516. [PMID: 34063890 PMCID: PMC8196601 DOI: 10.3390/cancers13112516] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. METHODS Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores. RESULTS Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre- and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = -0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC. CONCLUSIONS Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (H.Y.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (H.Y.); (K.A.)
| | - Kimberly E. Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Ryan P. McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Moni A. Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Michael R. Markiewicz
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, 3435 Main Street, Buffalo, NY 14214, USA
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, 955 Main Street, Buffalo, NY 14203, USA
| | - Jon M. Chan
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Wesley L. Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.W.); (V.G.); (R.P.M.); (M.A.K.); (M.R.M.); (J.M.C.); (W.L.H.J.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
- Department of Dietetics, D’Youville College, 270 Porter Avenue, Buffalo, NY 14201, USA
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (K.E.); (E.W.); (A.D.R.)
| | - Elizabeth A. Repasky
- Department of Immunology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA;
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA; (M.F.); (S.J.M.); (A.J.I.); (M.E.P.)
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MacLeod KE, Chapel JM, McCurdy M, Minaya-Junca J, Wirth D, Onwuanyi A, Lane RI. The implementation cost of a safety-net hospital program addressing social needs in Atlanta. Health Serv Res 2021; 56:474-485. [PMID: 33580501 DOI: 10.1111/1475-6773.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. DATA SOURCES/STUDY SETTING Costs for a heart failure health care program based in a safety-net hospital were reported by program staff for the program year May 2018-April 2019. Additional data sources included hospital records, invoices, and staff survey. STUDY DESIGN We conducted a retrospective, cross-sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities. DATA COLLECTION Program cost data were collected using a activity-based, micro-costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation. PRINCIPAL FINDINGS Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30-day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities. DISCUSSION Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.
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Affiliation(s)
- Kara E MacLeod
- ASRT, Inc., Atlanta, Georgia, USA.,Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John M Chapel
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Matthew McCurdy
- Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Jasmin Minaya-Junca
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diane Wirth
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Anekwe Onwuanyi
- Grady Memorial Hospital, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Rashon I Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Bassett HK, Coller RJ, Beck J, Hummel K, Tiedt KA, Flaherty B, Tchou MJ, Kapphahn K, Walker L, Schroeder AR. Financial Difficulties in Families of Hospitalized Children. J Hosp Med 2020; 15:652-658. [PMID: 33147127 DOI: 10.12788/jhm.3500] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND High costs of hospitalization may contribute to financial difficulties for some families. OBJECTIVE To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey of parents of hospitalized children at six children's hospitals between October 2017 and November 2018. MAIN OUTCOMES AND MEASURES The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C-CD; noncomplex chronic disease, NC-CD; no chronic disease, no-CD). RESULTS Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C-CD nor NC-CD were associated with high financial distress. Child-related medical financial burden was associated with both C-CD and NC-CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41-10.29; and AOR, 2.57; 95% CI, 1.11-5.93), compared to no-CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets. CONCLUSION Financial difficulties are common in families of hospitalized children. Low-income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.
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Affiliation(s)
- Hannah K Bassett
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ryan J Coller
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jimmy Beck
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Kevin Hummel
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kristin A Tiedt
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brian Flaherty
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Michael J Tchou
- Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado-Denver, Aurora, Colorado (current affiliation)
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (affiliation where work was conducted)
| | | | - Lauren Walker
- Section of Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alan R Schroeder
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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9
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Pisu M, Banegas MP, Liang MI, Tuzzio L, Henrikson NB. How, When, and With Whom Should Cost of Care Conversations Occur? Preferences of Two Distinct Cancer Survivor Groups. JCO Oncol Pract 2020; 16:e912-e921. [PMID: 32379563 DOI: 10.1200/jop.19.00726] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Cost of care (CoC) conversations should occur routinely in oncology practice. However, patient preferences about with whom, when, and how to have these conversations are missing and preferences may vary across patient populations. METHODS We performed a secondary qualitative analysis of quotes from interviews with 28 cancer survivors from two health care settings (Kaiser Permanente Washington and O'Neal Comprehensive Cancer Center at University of Alabama at Birmingham [UABCCC]). A targeted approach searched for three constructs: (1) Who should have CoC conversations with patients? (2) When should CoC conversations occur? and (3) How should CoC conversations happen? RESULTS Interviewees were similar in age and education, but UABCCC participants had more racial/ethnic minority representation and financial distress. Within each construct, themes were similar across both groups. As to who should have CoC conversations, we found that (1) providers' main role is medical care, not CoC; and (2) care team staff members are a more appropriate choice to address CoC needs. About the question of when, we found that (3) individuals have strong convictions about when and if they want to discuss CoC; and (4) CoC information and resources need to be available when patients are ready. About the question of how, themes were (5) provide estimates of anticipated out-of-pocket costs and insurance coverage; (6) provide reassurance, sympathy, and concrete solutions; and (7) because of their sensitivity, conduct CoC conversations in a comfortable, private space. CONCLUSION These findings offer general guidance as to who should conduct CoC conversations and when and how they should occur, with applicability across different patient populations.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.,O'Neal Comprehensive Cancer Center at University of Alabama at Birmingham, Birmingham, AL
| | | | - Margaret I Liang
- O'Neal Comprehensive Cancer Center at University of Alabama at Birmingham, Birmingham, AL.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Nora B Henrikson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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10
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Han X, Zhao J, Zheng Z, de Moor JS, Virgo KS, Yabroff KR. Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States. Cancer Epidemiol Biomarkers Prev 2020; 29:308-317. [PMID: 31941708 DOI: 10.1158/1055-9965.epi-19-0460] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States. METHODS We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18-64 or 65+ years). RESULTS Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices. CONCLUSIONS Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors. IMPACT Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.
| | - Jingxuan Zhao
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Zhiyuan Zheng
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Katherine S Virgo
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia
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11
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Banegas MP, Schneider JL, Firemark AJ, Dickerson JF, Kent EE, de Moor JS, Virgo KS, Guy GP, Ekwueme DU, Zheng Z, Varga AM, Waiwaiole LA, Nutt SM, Narayan A, Yabroff KR. The social and economic toll of cancer survivorship: a complex web of financial sacrifice. J Cancer Surviv 2019; 13:406-417. [PMID: 31123985 DOI: 10.1007/s11764-019-00761-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 04/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the financial outcomes and associated social and economic effects on cancer survivors and their families. METHODS We assessed the responses of 1656 cancer survivors to a survey with both closed- and open-ended questions about cancer-related financial sacrifices they and their family experienced and evaluated differences in financial sacrifice by reported levels of cancer-related debt. RESULTS The most commonly reported financial sacrifices included cutbacks on household budgets, challenges with health care insurance and costs, career/self-advancement constraints, reduction/depletion of assets, and inability to pay bills. Survivors who incurred $10,000 or more in debt were significantly more likely to report social and economic impacts, including housing concerns and strained relationships. CONCLUSIONS Our analysis demonstrates both the frequency with which cancer survivors and families must make financial sacrifices as a result of their cancer, and the variety of forms that this sacrifice can take, even for individuals who have health insurance. The many types of financial hardship create challenges that are unique to each survivor and family. IMPLICATIONS FOR CANCER SURVIVORS Interventions that allow for personalized assistance with the specific financial and social needs of cancer survivors and their families have the potential to address a critical aspect of the long-term wellbeing of this important population.
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Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA.
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Alison J Firemark
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Erin E Kent
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
- ICF International, Fairfax, VA, USA
| | - Janet S de Moor
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | | - Gery P Guy
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zhiyuan Zheng
- Economics & Healthcare Delivery Research, American Cancer Society, Atlanta, GA, USA
| | - Alexandra M Varga
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Lisa A Waiwaiole
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | | | | | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA
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