Interpreting out-of-pocket expenditures for cancer patients: The importance of considering baseline household income information

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6541-6541
Author(s):  
W. S. Oatis ◽  
N. Nonzee ◽  
T. Markossian ◽  
V. Shankaran ◽  
J. McKoy ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hodgkin Lymphoma ◽  
Household Income ◽  
Financial Burden ◽  
Indirect Costs ◽  
Medical Costs ◽  
Cost Ratio ◽  
Monthly Household Income ◽  
Non Hodgkin Lymphoma ◽  
Out Of Pocket Costs

6541 Background: Few studies have examined cancer-related out-of-pocket costs (expenses resulting from cancer morbidity and treatment that are not covered by insurance) as a function of baseline household income. We report income-adjusted out-of-pocket cost ratios for 50 patients with lymphoma and 156 patients with breast cancer. Methods: Patients with lymphoma or breast cancer provided 3-month retrospective documentation of cancer-related out-of-pocket costs. Costs were adjusted for income by dividing monthly costs by monthly household income. Direct medical costs include costs related to medications, doctor visits, and hospital stays. Direct non-medical costs are cancer-related peripheral costs, such as transportation and meals. Indirect costs are costs due to lost income. Results: Of our study patients, 83% were Caucasian, 65% were married, 53% were employed, and 65% had at least a bachelor's degree. All patients were undergoing active treatment and had insurance. Mean monthly out-of-pocket costs for patients with lymphoma were slightly greater than for those with breast cancer ($1,888 vs $1,455, respectively). Among patients with an annual income of $30,000 or less, the total monthly out-of-pocket costs were more than 3 times the monthly household income for patients with lymphoma and equal to the monthly household income for patients with breast cancer. The total mean income-adjusted cost ratio was 1.75 for patients with aggressive non-Hodgkin lymphoma versus 0.42 and 0.61 for those with indolent non-Hodgkin lymphoma or Hodgkin disease, respectively. Conclusions: Cancer-related out-of-pocket expenses disproportionately affect lower-income individuals with lymphoma or breast cancer and are primarily driven by the financial burden of co-payments for medical care. Future studies should evaluate out-of-pocket costs in relation to household income to determine more accurately the economic burden of cancer. [Table: see text] No significant financial relationships to disclose.

scholarly journals Malignancy Trends in HIV-Infected Patients Over the Past 10 Years in a Single-Center Retrospective Observational Study in the United States

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481879795 ◽  
Author(s):  
Nancy Rihana ◽  
Sowmya Nanjappa ◽  
Cara Sullivan ◽  
Ana Paula Velez ◽  
Narach Tienchai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Hodgkin Lymphoma ◽  
Anal Cancer ◽  
Invasive Cervical Cancer ◽  
Human Herpesvirus ◽  
Kaposi Sarcoma ◽  
Retrospective Chart Review ◽  
The United States ◽  
Cancer Center ◽  
Non Hodgkin Lymphoma

The introduction of antiretroviral therapy (ART) in 1995 had a dramatic impact on the morbidity and mortality of the HIV population, and subsequently, the natural history of cancer has changed. The purpose of our study was to review the prevalence of AIDS-defining malignancies and non-AIDS defining cancers (NADC), taking into consideration racial and gender variations. After the institutional review board approval, the study was conducted as a retrospective chart review of 279 HIV-infected patients who were treated at the Moffitt Cancer Center between January 1, 2000 and December 31, 2010. The demographic characteristics included gender, ethnicity, race, presence or absence of ART, and the type of malignancy reviewed. Of 233 men, 78 (33.5%) had AIDS-defining malignancies. AIDS-related non-Hodgkin lymphoma (NHL) was detected in 49 (21%) patients and Kaposi sarcoma (KS) in 29 (12%) patients. Two-thirds of male patients had NADC, with anal cancer being the most prevalent (8.5%), followed by Hodgkin lymphoma (6%). AIDS-related NHL was also the predominant malignancy for women with a prevalence of 19.5% followed by invasive cervical cancer (ICC) and breast cancer, both with a similar prevalence of 11%. Kaposi sarcoma and anal cancer were equally detected in 2% of women. The prevalence rates of AIDS-defining malignancies among those of white race were 34%, ranging from 21% for NHL to 13% for KS and 1.5% for ICC. Twenty-one (7.7%) patients had anal cancer. AIDS-defining malignancies were found in 36% of patients of black race and 60% had NHL. Non-AIDS-related NHL was the second most common malignancy, followed by breast cancer and anal cancer with a similar prevalence of 6.5%. Of 279 patients, 53% were taking ART; 39.4% were not taking ART; and in 7.5% of the patients, it was unknown if they were taking ART. In the ART era, our study found NADC to be more prevalent than AIDS-defining malignancies with 60% versus 40%, respectively. Non-Hodgkin lymphoma remained the most common AIDS-related malignancy in both genders. Among the patients with NADC, anal cancer was the predominant malignancy. The increasing incidence of some of the NADC is expected as this population is living longer with chronic exposure of viral replication of virus with oncogenic potential such as Human papillomavirus (HPV), Hepatitis B virus (HBV), Epstein-Barr virus (EBV), and Human herpesvirus 8 (HHV-8). Early ART initiation, aggressive vaccination, and judicious cancer screening are the cornerstone of cancer prevention of this growing population.

Clinical Outcome of Therapy-Related Acute Myeloid Leukemia Is Strongly Related to Cytogenetic Analysis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1401-1401
Author(s):  
Croix Fossum ◽  
Rhett P. Ketterling ◽  
Lindsey E. Roeker ◽  
Ajoy L. Dias ◽  
Michelle Elliott ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Alkylating Agent ◽  
De Novo ◽  
Disease Course ◽  
Primary Malignancy ◽  
Non Hodgkin Lymphoma ◽  
Cytogenetic Profile ◽  
De Novo Aml

Abstract Background: Treatment-related AML (t-AML) accounts for 10 to 20% of all AML cases and carries an especially poor prognosis (Kayser et al. 2011, Godley et al. 2008). Patients diagnosed with t-AML are likely to have abnormal cytogenetic profiles with chromosome changes that are predictive of an aggressive malignancy, poor response to therapy, and decreased overall survival(Smith et al. 2003). The simultaneous use of multiple chemotherapeutic agents of different classes makes it increasingly difficult to predict risk for developing t-AML and determining disease course. An updated analysis of predictive factors for t-AML is needed so clinicians can more accurately inform patients of their prognosis. The aim of this study was to classify t-AML according to primary malignancy, previous chemotherapy exposure, and cytogenetic profile. Methods: A retrospective chart review of patients that were diagnosed with AML at Mayo Clinic from 7/1/1990 to 5/13/2015 was performed following IRB approval. AML patients found to have a previous malignancy treated with chemotherapy were classified as t-AML. Chemotherapeutics were classified as alkylating agents, antimetabolites, anti-tubulin agents, and topoisomerase II inhibitors. Patients diagnosed with a myelodysplastic or myeloproliferative disorder prior to development of AML were excluded from this study. Previous chemotherapy exposures, duration of chemotherapy exposure, complete blood count, chromosome abnormalities, and survival data were collected for t-AML cases. Cytogenetic changes were classified as favorable, intermediate, and adverse according to the system used by Kayser et al. 2011. JMP 10.0 was used for statistical analysis. Results: Out of 584 patients, 64 patients (11%) had a primary malignancy that was treated with chemotherapy prior to being diagnosed with AML. The most common primary malignancies were breast cancer (31%), non-Hodgkin lymphoma (27%), colorectal cancer (8%), and Hodgkin lymphoma (8%). Laboratory findings showed median hemoglobin 9.6 g/dL (4.7-13.8), median white blood cells 3.2 x109 (0.6-126), median platelets 50x109 (3-320), median peripheral blood blasts of 8% (0-91), and median bone marrow blasts 38% (1-94). 95% of patients diagnosed with t-AML had been previously treated with an alkylating agent. Additional exposure to an anti-metabolite trended towards a more adverse cytogenetic profile (χ2=5.0, p=0.08) but there was not a statistically significant decrease in overall survival (KM analysis, p=0.31). The median overall survival for patients diagnosed with t-AML was 10.2 months compared to 19.2 months for patients with de-novo AML (KM analysis, p=0.04). Adverse cytogenetic profiles were associated with decreased survival (KM analysis, p <0.0001). However, there was no difference in overall survival between patients with t-AML that had intermediate cytogenetics and those with de-novo AML (KM analysis, p=0.36). None of the chemotherapy classes other than antimetabolites were associated with poor cytogenetics or survival when combined with an alkylating agent. Conclusion: Over half of all patients classified as having t-AML in this study received prior chemotherapy for breast cancer or non-Hodgkin lymphoma. Cytogenetic classification of t-AML into favorable, intermediate and adverse groups is useful in predicting disease course. Interestingly, t-AML patients with intermediate risk cytogenetics had similar overall survival to patients with de-novo AML. This suggests that the poor outcomes observed in patients with t-AML is predominantly due to the subset with adverse cytogenetics. Thus, cytogenetic analysis remains the best indicator of overall survival regardless of chemotherapy exposure. Additional work is needed to delineate the risk associated with the aforementioned chemotherapy classes. Disclosures Al-Kali: Celgene: Research Funding.

COST OF ILLNESS PADA PASIEN PENYAKIT KANKER PAYUDARA DI RSUD ULIN BANJARMASIN

2020 ◽  
Vol 5 (2) ◽  
pp. 407-415
Author(s):  
Noor Aisyah ◽  
◽  
Shela Puji Dina
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Cost Of Illness ◽  
Medical Cost ◽  
Indirect Costs ◽  
Medical Costs ◽  
Patient Treatment ◽  
Breast Cancer Patients ◽  
Economic Burden Of Disease ◽  
Direct Medical Costs

The cost of illness is an important element in disease decision making because it can evaluate the economic burden of disease. One of them is breast cancer because breast cancer is a catastrophic disease. This study aims to determine direct medical costs, direct non-medical costs, indirect costs, and total costs based on a societal perspective in breast cancer patients at Ulin Hospital, Banjarmasin. This study is an observational analytic study with a prevalence-based cost of illness approach. Data was taken retrospectively for direct medical costs collected from patient medical records that met the inclusion and exclusion criteria, patient treatment data, and details of direct medical costs for the period January-July 2020. Direct non-medical costs and indirect costs were taken from the results of filling out a questionnaire to Breast cancer patients who have undergone treatment in the inpatient room of RSUD Ulin Banjarmasin. Data analysis used descriptive statistics to identify patient characteristics and the costs of breast cancer. The results of the study, the average direct medical cost of breast cancer patients at Ulin Banjarmasin Hospital was Rp. 6,281,700. The average direct non-medical cost was Rp. 416,780 and the average indirect cost was Rp. 229,820. Meanwhile, the average overall cost per episode of inpatient was Rp. 6,928,300

scholarly journals Financial burden experienced by patients undergoing treatment for malignant gliomas

2014 ◽  
Vol 1 (2) ◽  
pp. 71-76 ◽  
Author(s):  
Priya Kumthekar ◽  
Becky V. Stell ◽  
Daniel I. Jacobs ◽  
Irene B. Helenowski ◽  
Alfred W. Rademaker ◽  
...  
Keyword(s):  
Financial Support ◽  
Tumor Recurrence ◽  
Financial Burden ◽  
Insurance Coverage ◽  
Malignant Gliomas ◽  
Indirect Costs ◽  
Medical Costs ◽  
Health Insurance Coverage ◽  
Preferred Provider Organizations ◽  
Hospital Bill

Abstract Background Patients undergoing treatment for malignant gliomas (MGs) can encounter medical costs beyond what their insurance covers. The magnitude and type of costs experienced by patients are unknown. The purpose of this study was to have patients or their families report on the medical costs incurred during the patients MG treatment. Methods Patients with MG were eligible if they were within 6 months of diagnosis or tumor recurrence. Patients had to be ≥18 years of age, fluent in English, and not aphasic. Weekly logbooks were issued to patients for recording associated costs for ∼6 months or until tumor progression. “Out-of-pocket” (OOP) costs included medical and nonmedical expenses that were not reimbursed by insurance. Direct medical costs included hospital and physician bills. Direct nonmedical costs included transportation, parking, and other related items. Indirect medical costs included lost wages. Costs were analyzed to provide mean and medians with range of expenses. Results Forty-three patients provided cost data for a median of 12 weeks. There were 25 men and 18 women with a median age of 57 years (range, 24y–73y); 79% were married, and 49% reported annual income >$75 000. Health insurance coverage was preferred provider organizations for 58% of patients, and median deductible was $1 500. Median monthly OOP cost was $1 342 (mean, $2 451; range, $333.41–$17 267.16). The highest OOP median costs were medication copayments ($710; range, $0–13 611.20), transportation ($327; range, $0–$1 927), and hospital bill copayments ($403; range, $0–$4 000). Median lost wages were $7 500, and median lost days of work were 12.8. Conclusions OOP costs for MG patients can be significant and comprise direct and indirect costs across several areas. Informing patients about expected costs could limit additional duress and allow financial support systems to be implemented.

scholarly journals Financial Burden in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study

2017 ◽  
Vol 35 (30) ◽  
pp. 3474-3481 ◽  
Author(s):  
Ryan D. Nipp ◽  
Anne C. Kirchhoff ◽  
Douglas Fair ◽  
Julia Rabin ◽  
Kelly A. Hyland ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Household Income ◽  
Comparison Group ◽  
Financial Burden ◽  
Medical Costs ◽  
Annual Income ◽  
Sibling Comparison ◽  
Childhood Cancer Survivor Study ◽  
Survivors Of Childhood Cancer

Purpose Survivors of childhood cancer may experience financial burden as a result of health care costs, particularly because these patients often require long-term medical care. We sought to evaluate the prevalence of financial burden and identify associations between a higher percentage of income spent on out-of-pocket medical costs (≥ 10% of annual income) and issues related to financial burden (jeopardizing care or changing lifestyle) among survivors of childhood cancer and a sibling comparison group. Methods Between May 2011 and April 2012, we surveyed an age-stratified, random sample of survivors of childhood cancer and a sibling comparison group who were enrolled in the Childhood Cancer Survivor Study. Participants reported their household income, out-of-pocket medical costs, and issues related to financial burden (questions were adapted from national surveys on financial burden). Logistic regression identified associations between participant characteristics, a higher percentage of income spent on out-of-pocket medical costs, and financial burden, adjusting for potential confounders. Results Among 580 survivors of childhood cancer and 173 siblings, survivors of childhood cancer were more likely to have out-of-pocket medical costs ≥ 10% of annual income (10.0% v 2.9%; P < .001). Characteristics of the survivors of childhood cancer that were associated with a higher percentage of income spent on out-of-pocket costs included hospitalization in the past year (odds ratio [OR], 2.3; 95% CI, 1.1 to 4.9) and household income < $50,000 (OR, 5.5; 95% CI, 2.4 to 12.8). Among survivors of childhood cancer, a higher percentage of income spent on out-of-pocket medical costs was significantly associated with problems paying medical bills (OR, 8.9; 95% CI, 4.4 to 18.0); deferring care for a medical problem (OR, 3.0; 95% CI, 1.6 to 5.9); skipping a test, treatment, or follow-up (OR, 2.1; 95% CI, 1.1 to 4.0); and thoughts of filing for bankruptcy (OR, 6.6; 95% CI, 3.0 to 14.3). Conclusion Survivors of childhood cancer are more likely to report spending a higher percentage of their income on out-of-pocket medical costs, which may influence their health-seeking behavior and potentially affect health outcomes. Our findings highlight the need to address financial burden in this population with long-term health care needs.

scholarly journals Risk of infertility in female adolescents and young adults with cancer: a population-based cohort study

2021 ◽  
Author(s):  
M P Velez ◽  
H Richardson ◽  
N N Baxter ◽  
Chad McClintock ◽  
E Greenblatt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Thyroid Cancer ◽  
Cancer Survivors ◽  
Hodgkin Lymphoma ◽  
Cancer Diagnosis ◽  
Population Based ◽  
Female Adolescents ◽  
Cancer Therapies ◽  
Non Hodgkin Lymphoma

Abstract STUDY QUESTION Do female adolescents and young adults (AYAs) with cancer have a higher risk of subsequent infertility diagnosis than AYAs without cancer? SUMMARY ANSWER Female AYAs with breast, hematological, thyroid and melanoma cancer have a higher risk of subsequent infertility diagnosis. WHAT IS KNOWN ALREADY Cancer therapies have improved substantially, leading to dramatic increases in survival. As survival improves, there is an increasing emphasis on optimizing the quality of life among cancer survivors. Many cancer therapies increase the risk of infertility, but we lack population-based studies that quantify the risk of subsequent infertility diagnosis in female AYAs with non-gynecological cancers. The literature is limited to population-based studies comparing pregnancy or birth rates after cancer against unexposed women, or smaller studies using markers of the ovarian reserve as a proxy of infertility among female survivors of cancer. STUDY DESIGN, SIZE, DURATION We conducted a population-based cohort study using universal health care databases in the province of Ontario, Canada. Using data from the Ontario Cancer Registry, we identified all women 15–39 years of age diagnosed with the most common cancers in AYAs (brain, breast, colorectal, leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma, thyroid and melanoma) from 1992 to 2011 who lived at least 5 years recurrence-free (Exposed, n = 14,316). Women with a tubal ligation, bilateral oophorectomy or hysterectomy previous to their cancer diagnosis were excluded. We matched each exposed woman by age, census subdivision, and parity to five randomly selected unexposed women (n = 60,975) and followed subjects until 31 December 2016. PARTICIPANTS/MATERIALS, SETTING, METHODS Infertility diagnosis after 1 year of cancer was identified using information on physician billing codes through the Ontario Health Insurance Plan database (ICD-9 628). Modified Poisson regression models were used to assess the risk of infertility diagnosis (relative risk, RR) adjusted for income quintile and further stratified by parity at the time of cancer diagnosis (nulliparous and parous). MAIN RESULTS AND THE ROLE OF CHANCE Mean age at cancer diagnosis was 31.4 years. Overall, the proportion of infertility diagnosis was higher in cancer survivors compared to unexposed women. Mean age of infertility diagnosis was similar among cancer survivors and unexposed women (34.8 years and 34.9 years, respectively). The overall risk of infertility diagnosis was higher in cancer survivors (RR 1.30; 95% CI 1.23–1.37). Differences in infertility risk varied by type of cancer. Survivors of breast cancer (RR 1.46; 95% CI 1.30–1.65), leukemia (RR 1.56; 95% CI 1.09–2.22), Hodgkin lymphoma (RR 1.49; 95% CI 1.28–1.74), non-Hodgkin lymphoma (RR 1.42; 95% CI 1.14, 1.76), thyroid cancer (RR 1.20; 95% CI 1.10–1.30) and melanoma (RR 1.17; 95% CI 1.01, 1.35) had a higher risk of infertility diagnosis compared to women without cancer. After stratification by parity, the association remained in nulliparous women survivors of breast cancer, leukemia, lymphoma and melanoma, whereas it was attenuated in parous women. In survivors of thyroid cancer, the association remained statistically significant in both nulliparous and parous women. In survivors of brain or colorectal cancer, the association was not significant, overall or after stratification by parity. LIMITATIONS, REASONS FOR CAUTION Non-biological factors that may influence the likelihood of seeking a fertility assessment may not be captured in administrative databases. The effects of additional risk factors, including cancer treatment, which may modify the associations, need to be assessed in future studies. WIDER IMPLICATIONS OF THE FINDINGS Reproductive health surveillance in female AYAs with cancer is a priority, especially those with breast cancer, leukemia and lymphoma. Our finding of a potential effects of thyroid cancer (subject to over-diagnosis) and, to a lesser extent, melanoma need to be further studied, and, if an effect is confirmed, possible mechanisms need to be elucidated. STUDY FUNDING/COMPETING INTEREST(S) Funding was provided by the Faculty of Health Sciences and Department of Obstetrics and Gynecology, Queen’s University. There are no competing interests to declare. TRIAL REGISTRATION NUMBER N/A

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