Financial Toxicity in Cancer Care: The Next Metric of Cancer Disparity

2021 ◽  
Vol 232 (3) ◽  
pp. 263-264
Author(s):  
Julie A. Margenthaler
Keyword(s):  
Cancer Care ◽  
Financial Toxicity ◽  
Cancer Disparity

Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems

2021 ◽  
pp. OP.20.00890
Author(s):  
Divya A. Parikh ◽  
Meera Ragavan ◽  
Ritika Dutta ◽  
Jeffrey Garnet Edwards ◽  
James Dickerson ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Medical Center ◽  
Financial Burden ◽  
Financial Toxicity ◽  
Cross Sectional Survey ◽  
Factors Associated ◽  
Care Systems ◽  
Comprehensive Score

PURPOSE: The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. METHODS: We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity. RESULTS: Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI ( P < .0001), high OOPCs ( P = .003), and employment changes as a result of cancer diagnosis ( P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS. CONCLUSION: Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.

Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

2019 ◽  
Vol 120 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Robert Lentz ◽  
Al B. Benson ◽  
Sheetal Kircher
Keyword(s):  
Cancer Care ◽  
Financial Toxicity ◽  
Reduction Strategies

How Should We Intervene on the Financial Toxicity of Cancer Care? One Shot, Four Perspectives

2017 ◽  
pp. 35-39
Author(s):  
S. Yousuf Zafar ◽  
Lee N. Newcomer ◽  
Justin McCarthy ◽  
Shelley Fuld Nasso ◽  
Leonard B. Saltz
Keyword(s):  
Pharmaceutical Industry ◽  
Cancer Care ◽  
Cost Sharing ◽  
Financial Burden ◽  
Patient Advocacy ◽  
Financial Toxicity ◽  
The Past ◽  
Order Of Magnitude ◽  
Productive Discussion ◽  
Hypothetical Question

The median price of a month of chemotherapy has increased by an order of magnitude during the past 20 years, far exceeding inflation over the same period. Along with rising prices, increases in cost sharing have forced patients to directly shoulder a greater portion of those costs, resulting in undue financial burden and, in some cases, cost-related nonadherence to treatment. What can we do to intervene on treatment-related financial toxicity of patients? No one party can single-handedly solve the problem, and the solution must be multifaceted and creative. A productive discussion of the problem must avoid casting blame and, instead, must look inward for concrete starting points toward improvement in the affordability and value of cancer care. With these points in mind, the authors—representatives from the pharmaceutical industry, insurance providers, oncologists, and patient advocacy—have each been asked to respond with a practical answer to the provocative hypothetical question, “If you could propose one thing, and one thing only, in terms of an action or change by the constituency you represent in this discussion, what would that be?”

Financial toxicity associated with conflict-induced cross-border travel for cancer care: Experience of Iraqi patients in Lebanon.

2018 ◽  
Vol 36 (15_suppl) ◽  
pp. 6562-6562 ◽  
Author(s):  
Deborah Mukherji ◽  
Mac Skelton ◽  
Raafat Alameddine ◽  
Omran Saifi ◽  
Miza Salim Hammoud ◽  
...  
Keyword(s):  
Cancer Care ◽  
Financial Toxicity ◽  
Care Experience ◽  
Cross Border

scholarly journals Financial Toxicity in Adults With Cancer: Adverse Outcomes and Noncompliance

2018 ◽  
Vol 14 (11) ◽  
pp. e665-e673 ◽  
Author(s):  
Thomas G. Knight ◽  
Allison M. Deal ◽  
Stacie B. Dusetzina ◽  
Hyman B. Muss ◽  
Seul Ki Choi ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Cancer Care ◽  
Insurance Coverage ◽  
Adverse Outcomes ◽  
Financial Toxicity ◽  
Recommended Care ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Medical Noncompliance ◽  
Health Registry

Purpose: Because of the escalating cost of cancer care coupled with high insurance deductibles, premiums, and uninsured populations, patients with cancer are affected by treatment-related financial harm, known as financial toxicity. The purpose of this study was to describe individuals reporting financial toxicity and to identify rates of and reasons for affordability-related treatment noncompliance. Methods: From May 2010 to November 2015, adult patients (age ≥ 18 years) with cancer were identified from a Health Registry/Cancer Survivorship Cohort. Financial toxicity was defined as agreement with the phrase “You have to pay for more medical care than you can afford” from the Patient Satisfaction Questionnaire-18. Logistic regression and Fisher exact tests were used to compare groups. Results: Of 1,988 participants, 524 (26%) reported financial toxicity. Patients reporting financial toxicity were more likely age 65 years or younger, female, nonwhite, non-English speaking, not married, less educated, and to have received a diagnosis more recently (all P < .001). Participants with financial toxicity were more likely to report noncompliance with medication, owing to inability to afford prescription drugs (relative risk [RR], 3.55; 95% CI, 2.53 to 4.98), and reported forgoing mental health care (RR, 3.89; 95% CI, 2.04 to 7.45), doctor’s visits (RR, 2.98; 95% CI, 1.97 to 4.51), and medical tests (RR, 2.54; 95% CI, 1.49 to 4.34). The most endorsed reasons for delayed care were not having insurance coverage and being unable to afford household expenses. Conclusion: More than 25% of adults with cancer reported financial toxicity that was associated with an increased risk for medical noncompliance. Financial toxicity remains a major issue in cancer care, and efforts are needed to ensure patients experiencing high levels of financial toxicity are able to access recommended care.

Financial toxicity of cancer treatment at a diverse county hospital.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 76-76
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Debeshi Maitra ◽  
Sangeeta Aggarwal ◽  
Manali I. Patel
Keyword(s):  
Sex Education ◽  
Low Income ◽  
Cancer Care ◽  
Financial Burden ◽  
Education Level ◽  
Financial Toxicity ◽  
Demographic Information ◽  
Significant Difference ◽  
The Cost ◽  
Out Of Pocket Costs

76 Background: The rising costs of cancer care increasingly results in financial distress for patients and their families. Low-income patients face a greater burden of financial toxicity, but few studies have characterized what factors contribute to this, and what interventions can relieve toxicity. Methods: From October 2017 to December 2017, we used a validated COST survey tool to understand the extent of financial burden that patients with cancer experience. We surveyed patients who receive their oncology care in a medical system that serves predominantly minority and low-income patients in Santa Clara County. We collected demographic information including sex, education level, ethnicity, income, insurance status, monthly out of pocket costs (OOPC) and employment status prior to diagnosis. We used a multivariable linear regression to study the association between the patient factors and financial burden as demonstrated by the COST score. All data were analyzed using Stata 14. Results: Demographic information is presented in Table 1. A total of 152 patients completed all 11 items of the COST survey. In the multivariate model, there was no significant difference in COST score by sex, education level, or ethnicity. However, income ≤$25,000 was associated with higher COST scores (p = 0.019), as was higher monthly OOPC (p = 0.003). Medicare patients and patients who were employed prior to diagnosis tended to have higher COST scores although not quite statistically significant (p = 0.057, p = 0.083). Conclusions: Patient-reported financial toxicity is an unmet concern among patients in this single institution study with a high proportion of underinsured patients. Higher OOPC and low income was associated with a higher financial burden. These findings suggest that patients would benefit from targeted interventions to mediate out of pocket costs of cancer care.[Table: see text]

Financial toxicity in gynecologic cancer survivors and its impact on quality of life.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 53-53
Author(s):  
Akhil Mehta ◽  
Jukes P. Namm ◽  
Ellen D'Errico ◽  
Eric Lau ◽  
Linda Hong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Cancer Survivors ◽  
Cancer Care ◽  
Uterine Cancer ◽  
Gynecologic Cancer ◽  
Financial Toxicity ◽  
Patient Reported ◽  
The Continuum

53 Background: Financial toxicity (FT) is a critical concern for cancer survivors. There is limited data about the relationship between FT throughout the continuum of cancer care, demographics, disease factors, and quality of life (QoL) indicators in gynecologic cancer survivors. Methods: Gynecologic cancer survivors who received treatment from 2015 to 2019 at Loma Linda University Cancer Center were invited to complete an anonymous online survey. A modified version of the comprehensive score for financial toxicity (COST) survey was used to assess FT at baseline and after treatment. The patient-reported outcomes measurement information system (PROMIS) survey was used to assess QoL. Demographic data were summarized using descriptive statistics. Associations between disease factors and FT measured at baseline and after treatment were analyzed using univariable linear regression. Lower COST score coefficients indicate greater FT. Correlations between FT and QoL were evaluated using the Pearson correlation. Results: A total of 252 surveys were sent to gynecologic cancer survivors who met study criteria, of whom 28% responded. Amongst 70 patients included in this analysis, the median age was 64 (IQR 56, 70), 47% were white (n = 33), 20% were unemployed, 22% had a high school or lower level of education, and 50% had an annual income < $60,000. With respect to cancer subtype, 63% had uterine cancer (n = 44), 20% had cervical cancer (n = 14), and 17% had ovarian cancer (n = 12). The mean COST score at baseline and after treatment was 21.2 ± 9.2 and 12.9 ± 7.8, respectively. The following characteristics were associated with significantly greater FT at baseline: Hispanic ethnicity (-5.5; 95% CI: -1 to -10), Black race (-14.4; 95% CI: -3.4 to -25.4), household number > 4 (-6.9; 95% CI: -2.6 to -16.4), Medicare insurance (-6.5; 95% CI: -1.7 to -11.2), and Medicaid insurance (-11.2; 95% CI: -4.3 to -17.9) (p < 0.05). Patients who received combined modality surgery, chemotherapy, and radiation had significantly higher FT (-5.6; 95% CI: -1.3 to -9.8, p < 0.05) compared to those who received single-modality treatment. Likewise, patients with 5 or more treatment-related side effects had significantly higher FT (-6.3; 95% CI -1.13 to -11.4, p < 0.05) compared to those who reported no side effects. During treatment, 24% of patients turned down or skipped treatment, 38% quit their job, and 28% reported family members quit their job. Finally, COST scores measured after treatment correlated positively with physical and mental health (Pearson coefficient 0.57 and 0.56 respectively, p < 0.001). Conclusions: These findings support the need for assessing FT at baseline and throughout the continuum of cancer care to provide individualized assistance to patients facing financial strain. FT affects compliance to treatment which can adversely affect cancer-related outcomes and QoL. Additional policies are needed to address the increasing cost of cancer care.

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