The impact of chemotherapy use on financial strain among stage III colorectal cancer patients: A population-based survey.

505 Background: Many colorectal cancer (CRC) patients suffer personal financial hardship from the disease and its treatment. We hypothesized that chemotherapy use is associated with even greater financial burden and worry. Methods: We analyzed data from a population-based survey of patients with stage III CRC in the Georgia and Detroit SEER catchment areas focusing on the effects of CRC and its treatment on personal finances. The primary outcomes were financial burden, assessed with a seven-component composite measure, and financial worry, assessed with a 5 point Likert scale. The primary independent variable was chemotherapy use. We evaluated relationships between chemotherapy use and individual components of financial burden, as well as composite financial burden and worry, using chi square analyses. Logistic regression was used to examine the effect of chemotherapy use on financial burden and worry, after controlling for patient characteristics. Results: Financial burden scores and financial worry were significantly higher among chemotherapy users (P<0.001). Financial burden and worry were associated with younger age, lack of insurance, and lower education. After controlling for these factors, chemotherapy use remained significantly associated with both financial burden and financial worry. 717/844 respondents (85%) reported chemotherapy use. Chemotherapy users were more likely to use savings (34% vs 20%, P=0.001), borrow money/take out loans (14% vs 4%, P=0.001), fail to make credit card payments (14% vs 5%, P=0.003), reduce spending for food and/or clothing (31% vs 14%, P<0.0001), decrease recreational activities (38% vs 15%, P<0.0001), and reduce general expenses (51% vs 24%, P<0.0001) than those who did not use chemotherapy. Conclusions: Adjuvant chemotherapy confers significant survival benefit in stage III colorectal cancer (CRC), but is associated with significantly increased personal financial burden and worry. Because financial stress has the potential to preclude adherence to recommended care, CRC patients who receive chemotherapy may require additional social services and economic support.

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A population-based, community estimate of total colon examination: the impact on compliance with screening for colorectal cancer

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2002.05484.x ◽

2002 ◽

Vol 97 (2) ◽

pp. 446-451 ◽

Cited By ~ 21

Author(s):

Robert E. Schoen ◽

Joel L. Weissfeld ◽

Jeanette M. Trauth ◽

Bruce S. Ling ◽

Mutlu Hayran

Keyword(s):

Colorectal Cancer ◽

Population Based ◽

The Impact

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Adherence to clinical practice guidelines for adjuvant chemotherapy for colorectal cancer in Uruguay: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.53 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 53-53

Author(s):

Santiago Fontes ◽

Ana Marín-Jiménez ◽

Megan Berry ◽

Mauricio Cuello ◽

Juan Carlos Sánchez ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

Adjuvant Chemotherapy ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Population Based ◽

Stage Iii ◽

Disease Stage ◽

Curative Intent ◽

Factors Associated

53 Background: Despite surgery, the 5-year risk of systemic recurrence of colorectal cancer (CRC) in the absence of any further therapy is approximately 50 % for those with lymph node involvement and 20 ─ 30 % if the lymph nodes are negative. Adjuvant chemotherapy contributes to improved disease-free and overall survival for node-positive (stage III) or high-risk node negative (stage IIB) colon cancer. Similar benefits are observed for adjuvant chemoradiotherapy in rectal cancer. Previous research shows varied rates of adherence to published adjuvant chemotherapy Clinical Practice Guidelines (CPGs) for CRC, although population-based data is scarce. Purpose: The aim of this analysis was to assess adherence rates to adjuvant chemotherapy prescription within 16 weeks of surgery according to local and international CPGs for CRC patients treated with curative intent between 2008 and 2019 at the Uruguayan National Cancer Institute. Data regarding factors associated with chemotherapy receipt beyond 16 weeks from surgery and chemotherapy non receipt was also retrieved and analysed. Methods: We retrospectively reviewed medical and pathology reports of 833 patients diagnosed with CRC at our institution. Patients with stages IIB or III CRC who underwent curative-intent surgery were identified and included in the present analysis. A 16-week benchmark timeline for treatment initiation from date of surgery was considered. Fisher’s exact test was used to determine factors independently associated with receipt of chemotherapy and meeting the 16-week benchmark (p 0.05). Results: A total of 400 patients were identified of which 72% had peritoneal colorectal tumors and 28% had sub-peritoneal rectal tumors. Approximately 70% of the latter group received neoadjuvant chemo-radiotherapy. Considering the total cohort, 61% received adjuvant chemotherapy. Factors predicting chemotherapy receipt in the peritoneal colorectal group were age ≤ 70 and stage III disease. In the sub-peritoneal rectal group no significant effect was found. The 16-week benchmark was met in 72% (175) of those receiving chemotherapy and 70.6% (167) completed 6 months of systemic adjuvant treatment. A total of 156 patients (39%) did not receive adjuvant chemotherapy. The factors predicting chemotherapy non receipt were age > 70 and stage IIB in the peritoneal colorectal group. Conclusions: This analysis of adherence to CPGs identified several factors associated with chemotherapy non receipt and chemotherapy receipt outside of timeline benchmarks from date of curative-intent surgery in Montevideo, Uruguay. The two main factors significantly associated with chemotherapy non receipt were advanced age and lower disease stage. To our knowledge, our data is the first to elucidate these specific factors in the Uruguayan CRC patient population.

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Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-032964 ◽

2019 ◽

Vol 9 (11) ◽

pp. e032964

Author(s):

Charlotte Slagelse ◽

H Gammelager ◽

Lene Hjerrild Iversen ◽

Kathleen D Liu ◽

Henrik T Toft Sørensen ◽

...

Keyword(s):

Colorectal Cancer ◽

Acute Kidney Injury ◽

Cohort Study ◽

Angiotensin Receptor Blockers ◽

Kidney Injury ◽

Population Based ◽

Adjusted Risk ◽

Increased Risk ◽

The Impact ◽

Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

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Surgical Management of Advanced Adrenocortical Carcinoma: A 21-year Population-based Analysis

The American Surgeon ◽

10.1177/000313481307901033 ◽

2013 ◽

Vol 79 (10) ◽

pp. 1115-1118 ◽

Cited By ~ 19

Author(s):

Thuy B. Tran ◽

Douglas Liou ◽

Vijay G. Menon ◽

Nicholas N. Nissen

Keyword(s):

Surgical Resection ◽

Adrenocortical Carcinoma ◽

Univariate Analysis ◽

Survival Rates ◽

Stage Iv ◽

Population Based ◽

Stage Iii ◽

Dismal Prognosis ◽

Advanced Stages ◽

The Impact

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a dismal prognosis. When diagnosed in advanced stages of the disease, the outcomes of surgical resection are not well understood. The objective of this study is to determine the impact of surgery in patients with advanced ACC. Using the Surveillance, Epidemiology and End Results database, we identified patients diagnosed with Stage III and IVACC between 1988 and 2009. A total of 320 patients with Stage III and IV disease were included in our analysis. In patients treated with surgical resection, the Stage III 1- and 5-year survival rates were 77 and 40 per cent, respectively, whereas the Stage IV 1- and 5-year survival rates were 54 and 27.6 per cent, respectively. Patients treated without surgery had poor survival at 1 year for both Stage III (13%) and Stage IV (16%) ( P < 0.01 compared with the surgical groups). Lymph node dissection was performed in 26 per cent of the patients with advanced ACC and was associated with improved survival in univariate analysis of Stage IV patients. Overall, our results indicate that favorable survival outcomes can be achieved even in patients with Stage III and IV disease and surgery should be considered in patients with advanced ACC.

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A cross-sectional population-based survey looking at the impact of cancer survivorship care plans on meeting the needs of cancer survivors in the posttreatment stage

Supportive Care in Cancer ◽

10.1007/s00520-019-04685-5 ◽

2019 ◽

Vol 27 (10) ◽

pp. 3785-3792 ◽

Cited By ~ 2

Author(s):

Soleil Chahine ◽

Robin Urquhart

Keyword(s):

Cancer Survivors ◽

Cancer Survivorship ◽

Population Based ◽

Survivorship Care Plans ◽

Survivorship Care ◽

Cross Sectional ◽

Care Plans ◽

The Impact ◽

Population Based Survey

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The Relationship of Caregiving to Work Conflict and Supervisor Disclosure With Emotional, Physical, and Financial Strain in Employed Family Caregivers

Journal of Aging and Health ◽

10.1177/0898264319848579 ◽

2019 ◽

Vol 32 (7-8) ◽

pp. 698-707

Author(s):

Maureen E. Templeman ◽

Adrian N. S. Badana ◽

William E. Haley

Keyword(s):

Organizational Factors ◽

The United States ◽

Ordinary Least Squares ◽

Population Based ◽

Financial Strain ◽

Hierarchical Regression ◽

Full Time ◽

Work Conflict ◽

Workplace Policies ◽

The Impact

Objective: To determine whether employed family caregiver reports of caregiving to work conflict (CWC) are associated with emotional, physical, and financial strain, and whether organizational factors, including supervisor disclosure and caregiver-friendly workplace policies, attenuate these effects. Method: We examined 369 full-time employed caregivers of adults aged 50 years and above from the 2015 AARP and National Alliance for Caregiving population-based study, Caregiving in the United States, using ordinary least squares hierarchical regression and moderation analyses. Results: Regression analyses showed that caregiver reports of more CWC, in addition to disclosure of caregiving, were associated with greater emotional, physical, and financial strain after controlling for demographics and caregiving stressors, and workplace policies did not attenuate strain. Neither disclosure nor policies moderated the impact of CWC on caregiver strain. Discussion: Results suggest the importance of workplace strain in the caregiving stress process and suggest that disclosing caregiving responsibilities to supervisors should be closely examined.

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