scholarly journals 2736. Insurance Disparity in United States Cancer Survivors’ Influenza Vaccination Rates: A Trend Study from NHIS 2005–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S963-S963
Author(s):  
Xin Zheng ◽  
Changchuan Jiang
Keyword(s):  
Cancer Survivors ◽  
Influenza Vaccination ◽  
Cancer Patients ◽  
Private Insurance ◽  
Insurance Coverage ◽  
National Level ◽  
Disease Process ◽  
Vaccination Rates ◽  
Flu Vaccination ◽  
Adult Cancer Survivors

Abstract Background Patients with underlying cancer often have suppressed immunity from disease process and cancer therapy, making this population particularly vulnerable to influenza. Few studies have investigated the overall flu vaccination rates; however, little is known regarding the trend of vaccination rates in US cancer survivors and how it varied by individuals’ insurance coverage. Methods We conducted a retrospective cross-sectional study to evaluate the temporal trend of flu vaccination rates using the National Health Interview Survey from 2005 through 2017. Adult cancer survivors (n = 24,381) were included in the analysis. The outcomes were self-reported flu vaccination during the past 12 months with either inactivated or live attenuated nasal vaccine. Insurance coverage was categorized into private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare and private (age > 65), and other coverage (age > 65). We combined every 2 years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design and NCI-Joinpoint 4.7 was used for joinpoint regression in the trend analysis. Results The overall cancer survivors’ flu vaccination rates improved from 45% in 2005 to 63% in 2017, whereas the cancer-free group improved from 18% in 2005 to 41% in 2017. With cancer survivors, influenza vaccination rates varied remarkably by insurance status (P < 0.001). Elderly survivors (age 65+) with any type of insurance consistently had higher flu vaccination rates than survivors younger than 65 (averaging 70% vs. 40%). For cancer patients age 65 or younger, whether insured or not, the overall flu vaccination rates had improved since 2005. However, for the subgroup who had coverage but not with private insurance, the vaccination rates had been declining since 2012 (50% in 2012/2013 to 45% in 2016/2017). Conclusion Despite the overall increase of flu vaccination rates in both cancer survivors and cancer-free participants since 2005, the growth rate has plateaued since 2015. This is likely related to shifts in healthcare law on the national level. Such impact is particularly significant in cancer patients who are younger and do not have private insurance coverage. Such vulnerable and underserved population will need more resources to help improve their influenza vaccination rate. Disclosures All authors: No reported disclosures.

Insurance disparity in the United States cancer survivors’ smoking rates: A trend study from NHIS 2008-2017.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1553-1553
Author(s):  
Yannan Zhao ◽  
Binbin Zheng-Lin ◽  
Biyun Wang ◽  
Xi-Chun Hu ◽  
Changchuan Jiang
Keyword(s):  
Cancer Survivors ◽  
Statistical Power ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Smoking Behavior ◽  
The United States ◽  
Current Smoking ◽  
Complex Design ◽  
Adult Cancer Survivors ◽  
Smoking Behaviors

1553 Background: Smoking rates have been decreasing in the U.S over the last decade. Smoking cessation is a critical part of cancer treatment and survivorship care. However, little is known about the trend of smoking rates in U.S. cancer survivors and how it varied by individuals’ insurance coverages. Methods: We conducted a retrospective study to evaluate the temporal trend of smoking rates using the National Health Interview Survey from 2008 through 2017. Adult cancer survivors (n = 20122) were included in the analysis. The outcomes were self-reported current smoking behavior. Insurance coverage was categorized into any private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare + any private (age > 65), and other coverage (age > 65). We combined every two years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design. Results: The smoking rates in cancer survivors decreased from 18.4% in 2008 to 12.5% in 2017. However, the smoking rates varied remarkably by insurance status (p < 0.001). There was a decreasing trend of smoking rates in participants with any private (age ≤65) (17.3% in 2008/2009 to 12.0% in 2016/2017), Medicare + any private (age > 65) (7.5% in 2008/2009 to 5.9% in 2016/2017), and other coverage (age > 65) (13.2% in 2008/2009 to 9.2% in 2016/2017) whereas the current smoking rates remains high in cancer survivors with other coverage (age ≤65) (40.1% in 2008/2009 to 34.4% in 2016/2017) and uninsured (age ≤65) (43.4% in 2008/2009 to 43,1% in 2016/2017). Conclusions: Cancer survivors report less smoking behaviors over the last decade which is similar to the general population. However, the smoking rate remains dangerously high in non-elderly cancer survivors without any private insurance.

scholarly journals Physical Comorbidities and Depression in Recent and Long-Term Adult Cancer Survivors: NHANES 2007–2018

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3368
Author(s):  
Dafina Petrova ◽  
Andrés Catena ◽  
Miguel Rodríguez-Barranco ◽  
Daniel Redondo-Sánchez ◽  
Eloísa Bayo-Lozano ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Patients ◽  
Cancer Diagnosis ◽  
Depression Symptoms ◽  
Depression Risk ◽  
Adult Cancer Survivors ◽  
Before And After ◽  
Nationally Representative ◽  
Risk Of Cancer

Many adult cancer patients present one or more physical comorbidities. Besides interfering with treatment and prognosis, physical comorbidities could also increase the already heightened psychological risk of cancer patients. To test this possibility, we investigated the relationship between physical comorbidities with depression symptoms in a sample of 2073 adult cancer survivors drawn from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2007–2018) in the U.S. Based on information regarding 16 chronic conditions, the number of comorbidities diagnosed before and after the cancer diagnosis was calculated. The number of comorbidities present at the moment of cancer diagnosis was significantly related to depression risk in recent but not in long-term survivors. Recent survivors who suffered multimorbidity had 3.48 (95% CI 1.26–9.55) times the odds of reporting significant depressive symptoms up to 5 years after the cancer diagnosis. The effect of comorbidities was strongest among survivors of breast cancer. The comorbidities with strongest influence on depression risk were stroke, kidney disease, hypertension, obesity, asthma, and arthritis. Information about comorbidities is usually readily available and could be useful in streamlining depression screening or targeting prevention efforts in cancer patients and survivors. A multidimensional model of the interaction between cancer and other physical comorbidities on mental health is proposed.

scholarly journals Spirituality and Gratitude as Predictors of the Quality of Life in Adult Cancer Patients

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Ms. Alvita de Souza ◽  
Dr. Shanmukh V. Kamble
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Life Stage ◽  
Empirical Support ◽  
Poor Health ◽  
Adult Cancer Survivors ◽  
Stage 1

The present study was designed to: (a) determine whether there is empirical support for a relationship between Gratitude and Spirituality in Quality of Life, (b) provide an estimate of the strength of this relationship, and (c) examine whether Spirituality and Gratitude is a predictor of quality of life. Stage 1 and Stage 2 Cancer patients were employed for this study. The sample for the study consisted of 397 Cancer patients aged between 36 to 67 years. The Spirituality Scale, Gratitude Scale and the Quality of Life for Adult Cancer Survivors were administered on the participants. Results supported previous research that Spirituality and Gratitude were positively correlated to Quality of life. It was also was a significant predictor in Quality of Life in Cancer Patients. The implication of this study is that Spirituality and Gratitude as a paradigm can be used to improve the Quality of life particularly for those who report very poor health while suffering from Cancer or are at the end of their life with disease.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

scholarly journals Patterns of Coverage Gains Among Young Adult Cancer Patients Following the Affordable Care Act

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Leticia M Nogueira ◽  
Neetu Chawla ◽  
Xuesong Han ◽  
Ahmedin Jemal ◽  
K Robin Yabroff
Keyword(s):  
Young Adult ◽  
Cancer Patients ◽  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Temporal Patterns ◽  
Patients Âgés ◽  
The Affordable Care Act ◽  
Young Adult Cancer ◽  
The Impact

Abstract The dependent coverage expansion (DCE) and Medicaid expansions (ME) under the Affordable Care Act (ACA) may differentially affect eligibility for health insurance coverage in young adult cancer patients. Studies examining temporal patterns of coverage changes in young adults following these policies are lacking. We used data from the National Cancer Database 2003–2015 to conduct a quasi-experimental study of cancer patients ages 19–34 years, grouped as DCE-eligible (19- to 25-year-olds) and DCE-ineligible (27- to 34-year-olds). Although private insurance coverage in DCE-eligible cancer patients increased incrementally following DCE implementation (0.5 per quarter; P < .001), an immediate effect on Medicaid coverage gains was observed after ME in all young adult cancer patients (3.01 for DCE-eligible and 1.62 for DCE-ineligible, both P < .001). Therefore, DCE and ME each had statistically significant and distinct effects on insurance coverage gains. Distinct temporal patterns of ACA policies’ impact on insurance coverage gains likely affect patterns of receipt of cancer care. Temporal patterns should be considered when evaluating the impact of health policies.

“Flu-Floppers”: Factors Influencing Families’ Fickle Flu Vaccination Patterns

2020 ◽  
Vol 59 (4-5) ◽  
pp. 352-359 ◽  
Author(s):  
Benjamin N. Fogel ◽  
Steven D. Hicks
Keyword(s):  
Decision Making ◽  
Influenza Vaccination ◽  
Conceptual Framework ◽  
Strong Predictor ◽  
Common Reason ◽  
Vaccination Rates ◽  
Factors Associated ◽  
Flu Vaccination ◽  
Factors Influencing ◽  
Vaccine Decision Making

While influenza vaccination in the prior year is a strong predictor of subsequent vaccination, many families do not have static vaccination patterns. This study examined factors guiding influenza vaccination decisions among parents whose children sporadically received the influenza vaccination (flu-floppers). We administered surveys to 141 flu-flopper families. Surveys included 21 factors associated with vaccine decision making. A conceptual framework of “passive” and “active” decision making was used to assess parental motivators behind vaccine decisions. The most common reason for vaccinating was a desire to prevent influenza (45%). The most common reason for not vaccinating was a belief that influenza vaccination is not effective (29%). Most parents (88%) reported an active reason in years when their child was vaccinated, while only 43% reported an active reason when their child was not vaccinated ( P < .00001). These findings may guide efforts to increase influenza vaccination rates in children most amenable to vaccination.

Text Message Reminders for Child Influenza Vaccination in the Setting of School-Located Influenza Vaccination: A Randomized Clinical Trial

2019 ◽  
Vol 58 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Peter G. Szilagyi ◽  
Stanley Schaffer ◽  
Cynthia M. Rand ◽  
Nicolas P. N. Goldstein ◽  
Mary Younge ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Elementary Schools ◽  
Influenza Vaccination ◽  
Intervention Group ◽  
Text Message ◽  
Text Messages ◽  
Urban Elementary Schools ◽  
Vaccination Rates ◽  
Flu Vaccination ◽  
Percentage Points

Half of US school children receive influenza vaccine. In our previous trials, school-located influenza vaccination (SLIV) raised vaccination rates by 5 to 8 percentage points. We assessed whether text message reminders to parents could raise vaccination rates above those observed with SLIV. Within urban elementary schools we randomized families into text message + SLIV (intervention) versus SLIV alone (comparison). All parents were sent 2 backpack notifications plus 2 autodialer phone reminders about SLIV at a single SLIV clinic. Intervention group parents also were sent 3 text messages from the school nurse encouraging flu vaccination via either primary care or SLIV. Among 15 768 children at 32 schools, vaccination rates were text + SLIV (40%) and SLIV control (40%); 4% of students per group received influenza vaccination at SLIV. Text message reminders did not raise influenza vaccination rates above those observed with SLIV alone. More intensive interventions are needed to raise influenza vaccination rates.

scholarly journals Cancer Information Satisfaction among Indonesian Cancer Survivors

2021 ◽  
pp. 1
Author(s):  
Wenny Savitri ◽  
Masta Hutasoit
Keyword(s):  
Quality Of Life ◽  
Cancer Survivors ◽  
Cancer Patients ◽  
Cross Sectional Study ◽  
Cancer Information ◽  
Cross Sectional ◽  
Adult Cancer Survivors ◽  
Health Related ◽  
The Impact

Information for cancer patients is significant to overcome a cancer diagnosis and its treatment, affecting patients' quality of life. This study aimed to assess the level of satisfaction with the information on illness treatment among Indonesian cancer survivors, explore its association with the patients' demographic and health-related characteristics, and provide recommendations and improve the information. Sixty adult cancer survivors at the oncology unit of Panembahan Senopati Bantul Hospital of Yogyakarta, Indonesia, were recruited in a cross-sectional study design completing a demographic and health-related data form and the Satisfaction with Cancer Information Profile Questionnaire. The data were then analyzed using descriptive statistics and path analysis. Most patients were dissatisfied with the amount and content of cancer information provided by health care ranging from 12-67%, particularly on the information regarding managing unwanted-side effects of the treatment and the impact of their cancer treatment on long-term quality of life. The patients were also discontented with the detail of information, the timing,  and the usefulness of information to others. Demographic and health-related characteristics directly influence the patients' satisfaction of information (β= 0.461, p = 0.045). Patients who were divorced, not living with their spouses, and diagnosed with cancer for a longer time (more than two years) were the significant contributors to directly influencing their satisfaction. Nurses need to enhance the detail of information, find the best time to provide and design a better way to deliver cancer patients' information.

Does health plan type influence receipt of an annual influenza vaccination?

2019 ◽  
Vol 74 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Ian W Watson ◽  
Sanda Cristina Oancea
Keyword(s):  
Health Plan ◽  
Health Care Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Behavioral Risk ◽  
Logistic Regression Models ◽  
Vaccination Rates ◽  
Care Access ◽  
Flu Vaccination ◽  
The Usa

BackgroundThe influenza virus caused 48.8 million people to fall ill and 79 400 deaths during the 2017–2018 influenza season, yet less than 50% of US adults receive an annual flu vaccination (AFV). Having health insurance coverage influences whether individuals receive an AFV. The current study aims to determine if an association exists between an individual’s health plan type (HPT) and their receipt of an AFV.MethodsData from the 2017 Behavioral Risk Factor Surveillance System and the optional ‘Health Care Access’ module were used for this study. The final study sample size was 35 684. Multivariable weighted and adjusted logistic regression models were conducted to investigate the association between HPT and AFV.ResultsMedicare coverage was significantly associated with an increase in AFV for both men (adjusted OR (AOR) 1.62 (95% CI 1.28 to 2.06)) and women (AOR 1.28 (95% CI 1.00 to 1.53)). For men, other sources of coverage were also significantly positively associated with AFV (AOR 1.67 (95% CI 1.27 to 2.19)), while for women obtaining coverage on their own was significantly negatively associated with AFV (AOR 0.75 (95% CI 0.59 to 0.97)).ConclusionThese findings are of interest to health policy makers as these show there are HPTs which are effective at improving vaccination rates. Adopting methods used by these HPTs could help the USA reach its Healthy People 2020 AFV coverage goal of 70%.

Implementation of insurance marketplaces and changes in diagnosis stage in low-income cancer patients.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1576-1576
Author(s):  
Uriel Kim ◽  
Siran M. Koroukian ◽  
Kurt C Stange ◽  
James Spilsbury ◽  
Johnie Rose
Keyword(s):  
Cancer Patients ◽  
Low Income ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Control Analysis ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Poverty Level ◽  
Patients Âgés ◽  
The Impact

1576 Background: Millions of low-income Americans gained insurance coverage through Medicaid expansion and the “Marketplaces” of the Affordable Care Act (ACA). How Marketplaces have specifically improved cancer outcomes among these individuals is unclear. Thus, we examined changes in insurance status and diagnosis stage following the ACA among low-income (139-250% of the Federal Poverty Level [FPL]), non-elderly patients (ages 30-64). Methods: In Ohio’s cancer registry, we identified patients diagnosed with one of the top 16 cancers before (2011-2013, “Pre-ACA”) and after (Q3 of 2014-2016, “Post-ACA”) the implementation of the ACA’s insurance Marketplaces and either had private insurance or no insurance. Low-income patients were isolated using a novel, geographically-driven approach called probability weighting. Results: The uninsured percentage dropped from 12.9% to 4.9% between the Pre- and Post-ACA periods in the study sample (N = 10,747). An estimated 11.1% of individuals had Marketplace insurance Post-ACA. A significant but modest Post-ACA (versus Pre-ACA) shift toward non-metastatic disease was identified (Adjusted Odds Ratio [AOR]: 0.95, 95%CI: 0.90-0.99). The largest site-specific shifts were observed for thyroid (AOR: 0.50, 95%CI: 0.30-0.83) and ovarian (AOR: 0.74, 95%CI: 0.58-0.93) cancers. In a control analysis of wealthier (400%+ FPL), privately insured individuals, no significant shifts were identified (AOR: 0.97, 95%CI: 0.92-1.02). Conclusions: This is the first study to show an effect in cancer stage at diagnosis from the Affordable Care Act’s Insurance Marketplaces. We found that the Marketplaces greatly reduced the number of low-income, uninsured cancer patients, translating to significant improvements in cancer stage at diagnosis. As policy makers contemplate modifications to the ACA, they should carefully consider the impact of those changes on the highly vulnerable population of low-income cancer patients.

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