scholarly journals Evaluating meaningful levels of financial toxicity in gynecologic cancers

2021 ◽  
pp. ijgc-2021-002475
Author(s):  
Katharine McKinley Esselen ◽  
Annika Gompers ◽  
Michele R Hacker ◽  
Sara Bouberhan ◽  
Meghan Shea ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Economic Cost ◽  
Financial Toxicity ◽  
Oncology Patients ◽  
Exact Test ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Instrument Measuring

ObjectiveThe Comprehensive Score for Financial Toxicity (COST) is a validated instrument measuring the economic burden experienced by patients with cancer. We evaluated the frequency of financial toxicity at different COST levels and stratified risk factors and associations with cost-coping strategies by financial toxicity severity.MethodsWe analyzed previously collected survey data of gynecologic oncology patients from two tertiary care institutions. Both surveys included the COST tool and questions assessing economic and behavioral cost-coping strategies. We adapted a proposed grading scale to define three groups: no/mild, moderate, and severe financial toxicity and used χ2, Fisher’s exact test, and Wilcoxon rank sum test to compare groups. We used Poisson regression to calculate crude and adjusted risk ratios for cost-coping strategies, comparing patients with moderate or severe to no/mild financial toxicity.ResultsAmong 308 patients, 14.9% had severe, 32.1% had moderate, and 52.9% had no/mild financial toxicity. Younger age, non-white race, lower education, unemployment, lower income, use of systemic therapy, and shorter time since diagnosis were associated with worse financial toxicity (all p<0.05). Respondents with moderate or severe financial toxicity were significantly more likely to use economic cost-coping strategies such as changing spending habits (adjusted risk ratio (aRR) 2.7, 95% CI 1.8 to 4.0 moderate; aRR 3.6, 95% CI 2.4 to 5.4 severe) and borrowing money (aRR 5.5, 95% CI 1.8 to 16.5 moderate; aRR 12.7, 95% CI 4.3 to 37.1 severe). Those with severe financial toxicity also had a significantly higher risk of behavioral cost-coping through medication non-compliance (aRR 4.6, 95% CI 1.2 to 18.1).ConclusionsAmong a geographically diverse cohort of gynecologic oncology patients, nearly half reported financial toxicity (COST <26), which was associated with economic cost-coping strategies. In those 14.9% of patients reporting severe financial toxicity (COST <14) there was also an increased risk of medication non-compliance, which may lead to worse health outcomes in this group.

Gynecologic oncology patients who are unemployed and underinsured face high distress that extends beyond financial toxicity

2021 ◽  
Vol 162 ◽  
pp. S168-S169
Author(s):  
Lindsay Kuroki ◽  
David Morris ◽  
Molly Greenwade ◽  
Megan Landon ◽  
Andrea Hagemann ◽  
...  
Keyword(s):  
Gynecologic Oncology ◽  
Financial Toxicity ◽  
Oncology Patients ◽  
High Distress

Effect of patient education on palliative care knowledge and acceptability of outpatient palliative care service among gynecologic oncology patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11583-11583 ◽  
Author(s):  
Ashley Graul ◽  
Ashley Ford Haggerty ◽  
Carolyn Stickley ◽  
Pallavi Kumar ◽  
Knashawn Morales ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Service ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Palliative Care Service ◽  
Cancer Center ◽  
Educational Video ◽  
Oncology Patients ◽  
Care Services ◽  
Palliative Care Services

11583 Background: This was a randomized control trial to estimate the effect of an interventional video on improving palliative care knowledge and acceptability of outpatient services in gynecologic oncology patients. Methods: Women receiving active treatment for gynecologic malignancy (persistent or progressive disease despite primary treatment) were recruited at an academic tertiary care center from 2/2018 to 1/2019 and randomized to: palliative care educational video or non-directive cancer center informational video (control). The primary outcome was desire for referral to palliative care. Function and knowledge were assessed using the Functional Assessment of Cancer Therapy (FACT-G) and the Palliative Care Knowledge Scales. Data analyses were performed using t-tests, Wilcoxon rank sum or Fisher’s exact tests with significance level of α=0.05. Results: 111 women were enrolled. Demographic characteristics were equally distributed between groups (mean age 63.4 vs 65.4 years; 78% vs 82% Caucasian, 58% vs 68% stage III, 71% vs 64% ovarian cancer, 65% vs 72% platinum-sensitive). There was no statistical difference in knowledge scores or in desire for referral to palliative care (29% vs 27%; p=0.79). Secondary analysis showed a statistically significant increase in utilization of palliative care services compared to historic institutional data (8.8% to 29.7%; p=<0.001). Further, those that desired referral had significantly worse FACT-G scores at time of referral choice (table). Conclusions: Use of a palliative care educational video did not increase knowledge or acceptability of palliative care services within this RCT. However, the rate of patients seeking palliative care referral tripled compared to historic rates. Further studies should investigate whether discussion regarding palliative care services alone may increase desire for referral, and if use of Fact-G scores may identify patients in greatest need of services. [Table: see text]

scholarly journals 498. High Burden of CRO Colonization and Its Association with Infection Among Patients transferred to a Tertiary Care Hospital in India

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S242-S242
Author(s):  
Smita Sarma ◽  
Matthew Robinson ◽  
Yatin Mehta
Keyword(s):  
Infection Control ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Lavage Fluid ◽  
Fisher Exact Test ◽  
New Delhi ◽  
Care Hospital ◽  
Exact Test ◽  
Increased Risk ◽  
Carbapenemase Gene

Abstract Background Infections with carbapenem-resistant organisms (CRO) are increasing worldwide and are associated with high mortality. Patients transferred from outside hospitals have been reported to be at increased risk of CRO colonization and infection. The rate of subsequent CRO infection in patients colonized with CRO is unclear in a high CRO burden setting Methods Medanta Hospital in Gurgaon, India instituted CRO colonization screening for patients transferred from outside hospitals for infection control purposes. From April 2018 to May 2018, patients transferred from other hospitals to the intensive care unit at Medanta were subjected to CRO colonization screening using Xpert Carba R (Cepheid) performed on the day of transfer. Subsequent recovery of CRO in cultures of blood, bronchoalveolar lavage fluid, urine in specimens with pyuria obtained from patients without urinary catheters, pus, and tissue were considered to be indicative of CRO infection. The association of CRO colonization with subsequent CRO infection was assessed with a Fisher exact test Results Among 457 patients screened, 205 patients (45%) were found to be colonized with CRO at admission. Genes for New Delhi Metallo-β-lactamase (NDM) were detected in 184 (40%) patients, OXA-48 in 97 (21%) patients, VIM in 18 (4%) patients, KPC in 5 (1%) patients, and IMP1 in 5 (1%) patients; >1 carbapenemase gene was detected in 95 (21%) patients. CRO infections were observed in 25 (5%) patients including 12 with bacteremia, 7 with pneumonia, 4 with urinary tract infection, and 2 with soft-tissue infection. Among patients with CRO colonization, 17 (8%) patients developed CRO infection during the course of hospitalization; among patients without admission CRO colonization, subsequent CRO infection was found in 8 (3%) patients. CRO admission colonization was associated with subsequent clinical infection with CRO (odds ratio = 2.8, P = 0.02) Conclusion CRO colonization was found in almost half of patients transferred from outside hospitals to a large tertiary care hospital in India and was associated with subsequent CRO infection. Further work is necessary to understand the role of CRO colonization screening in infection control and antimicrobial stewardship in a setting with high CRO burden Disclosures All authors: No reported disclosures.

Experience of financial toxicity among gynecologic oncology patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 90-90
Author(s):  
Sara Bouberhan ◽  
Alice Kennedy ◽  
Mary K. Buss ◽  
Laureen Moss ◽  
Kathleen Nolan ◽  
...  
Keyword(s):  
Patient Population ◽  
Clinical Care ◽  
Gynecologic Oncology ◽  
Financial Assistance ◽  
Full Time ◽  
Financial Toxicity ◽  
Cross Sectional Survey ◽  
Oncology Patient ◽  
Increased Risk ◽  
Patient Reported

90 Background: “Financial toxicity” (FT) is increasingly recognized as an adverse outcome associated with cancer treatment. The degree of FT in the gynecologic oncology patient population has not been studied. This study used the comprehensive score for financial toxicity (COST) tool, a recently-validated survey, to examine FT in the gynecologic oncology population. Methods: All follow-up patients at a gynecologic oncology practice were invited to complete a cross-sectional survey including the COST (scale = 0-44) tool and a quality-of-life (QOL) survey, the EQ-5D-5L. Demographic and treatment data were gathered with additional survey questions and chart review. We dichotomized COST scores into low FT (top two tertiles) and high FT (bottom tertile); a lower COST score indicates higher FT. We assessed the correlation between COST and QOL scores using the Spearman correlation coefficient (r) and used univariable and multivariable linear regression to identify predictors of greater FT. We used log-binomial regression to calculate risk ratios (RR) and 95% confidence intervals (CI) for patient-reported financial outcomes. Results: Approximately 75% of approached patients responded; 224 were included in this analysis. The median FT score was 29.0. Greater FT was correlated with worse QOL (r = 0.43, p < 0.01). In multivariable regression, income < $50,000 (p < 0.01) and income from $50,000-$99,999 (p < 0.01) compared to income ≥$100,000; younger age (p < 0.01); and part-time employment (p = 0.01) and unemployment (p = 0.01) compared to full time employment were significant predictors of greater FT. The high FT group had an increased risk of delaying or avoiding care (RR: 4.5, 95% CI: 1.6-12.3); borrowing money or applying for financial assistance (RR: 17.0, 95% CI: 4.0-71.6); and using savings or reducing spending to meet healthcare costs (RR: 2.5; 95% CI: 1.9-3.4) relative to the low FT group. Conclusions: High FT was common in the gynecologic oncology population and was strongly associated with delays or avoidance of clinical care, requiring financial assistance, and worse QOL scores. Further study is needed to investigate FT in a broader patient population within gynecologic oncology and to identify strategies for intervention in clinical practice.

scholarly journals Financial toxicity among privately insured gynecologic oncology patients: Silent barriers to care

2016 ◽  
Vol 141 ◽  
pp. 82-83
Author(s):  
E.L. Barber ◽  
J.T. Bensen ◽  
A.C. Snavely ◽  
P.A. Gehrig ◽  
K.M. Doll
Keyword(s):  
Barriers To Care ◽  
Gynecologic Oncology ◽  
Financial Toxicity ◽  
Oncology Patients ◽  
Privately Insured

Pelvic floor myofascial pain in gynecology oncology patients: A pilot study

2021 ◽  
pp. 228402652098441
Author(s):  
Lindsey A. McAlarnen ◽  
Jean Ricci Goodman ◽  
Anne Sarwark ◽  
Abigail D. Winder ◽  
Ronald K. Potkul ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pelvic Floor ◽  
Life Support ◽  
Myofascial Pain ◽  
Gynecologic Oncology ◽  
Tertiary Care ◽  
Social Activity ◽  
Oncology Patients ◽  
Pain Disability Index ◽  
Pain Disability

Objective: Here we present a pilot study investigating the prevalence of pelvic floor myofascial pain in patients presenting to an academic tertiary care gynecologic oncology clinic. We describe patients’ responses to a pain survey including the pain disability index. Methods: An IRB approved prospective survey and chart review was conducted. Patients underwent standard physical exam maneuvers for detection of pelvic floor myofascial pain. Consented patients completed a pain survey and pain disability index on presentation to clinic. Statistical analysis included Chi square test and Mann Whitney test. Results: Twenty-nine percent (45/155) of patients exhibited pelvic floor myofascial pain, while 71% (110/155) did not. Of those with malignancy, 28% (16/57) had pelvic floor myofascial pain and 72% (41/57) did not. Patients with pelvic floor myofascial pain had a significantly higher rating of “pain right now” ( p = 0.001) and “usual level of pain during the past week” ( p = 0.003) than those without such pain. Patients with pelvic floor myofascial pain had significantly greater disability in family/home responsibilities ( p = 0.01), recreation ( p = 0.001), social activity ( p = 0.008), occupation ( p = 0.015), sexual behavior ( p = 0.025), and life support activities ( p = 0.007) compared to those without pelvic floor myofascial pain. Conclusion: Pelvic floor myofascial pain affects 28% of patients with malignancy. Routine incorporation of a myofascial exam can identity those with such pain, which can lead to improved quality of life in gynecologic oncology patients with pelvic floor disorders.

VTE risk assessment in cancer

2016 ◽  
Vol 07 (01) ◽  
pp. 20-25
Author(s):  
I. Pabinger ◽  
C. Ay
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Medical Oncology ◽  
Clinical Importance ◽  
Cancer Surgery ◽  
Ambulatory Setting ◽  
Oncology Patients ◽  
Related Factors ◽  
Risk Assessment Models ◽  
Increased Risk

SummaryVenous thromboembolism (VTE) in patients with cancer is associated with an increased morbidity and mortality, and its prevention is of major clinical importance. However, the VTE rates in the cancer population vary between 0.5% - 20%, depending on cancer-, treatment- and patient-related factors. The most important contributors to VTE risk are the tumor entity, stage and certain anticancer treatments. Cancer surgery represents a strong risk factor for VTE, and medical oncology patients are at increased risk of developing VTE, especially when receiving chemotherapy or immunomodulatory drugs. Also biomarkers have been investigated for their usefulness to predict risk of VTE (e.g. elevated leukocyte and platelet counts, soluble P-selectin, D-dimer, etc.). In order to identify cancer patients at high risk of VTE and to improve risk stratification, risk assessment models have been developed, which contain both clinical parameters and biomarkers. While primary thromboprophylaxis with lowmolecular- weight-heparin (LMWH) is recommended postoperatively for a period of up to 4 weeks after major cancer surgery, the evidence is less clear for medical oncology patients. Thromboprophylaxis in hospitalized medical oncology patients is advocated, and is based on results of randomized controlled trials which evaluated the efficacy and safety of LMWH for prevention of VTE in hospitalized medically ill patients. In recent trials the benefit of primary thromboprophylaxis in cancer patients receiving chemotherapy in the ambulatory setting has been investigated. However, at the present stage primary thromboprophylaxis for prevention of VTE in these patients is still a matter of debate and cannot be recommended for all cancer outpatients.

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