Perspectives and practices of oncology providers in addressing financial toxicity.

e18342 Background: Few studies have evaluated the perspectives and clinical practices of oncology providers in regards to assisting patients with financial toxicity. Our study sought to assess providers’ attitudes regarding their role in addressing patients’ financial concerns, understand practice patterns in discussing cost of care, and obtain feedback on potential interventions to help address existing barriers. Methods: We developed an 18-question electronic, anonymous survey informed by an extensive literature search and piloted with three physicians with health services research experience. We emailed the survey to 75 attending physicians in Medical Oncology, Hematology, and Radiation Oncology, 117 advance practice practitioners (APPs) and 46 trainees. Responses during the study period 12/12/2018-1/31/2019 were analyzed. Results: A total of 71 (response rate of 30%) participants completed the survey, including 31 attending physicians, 28 APPs, and 12 trainees. Sixty-two percent of participants agreed that oncology providers should openly discuss cost of care with patients. There was wide variation in opinion around whether providers should offer the same treatment recommendations to all patients regardless of cost, with one third stating they agreed, one third stating they disagreed, and one third stating they were neutral. Sixty-one percent of participants did not use any cost-effectiveness tools in decision making. Sixty-three percent of respondents stated that a gap in knowledge of out of pocket costs was the number one barrier to helping patients avoid financial toxicity. The highest ranked intervention of those listed was a guide on available resources for patients with financial needs, voted for by 70% of respondents. Conclusions: Providers identified many barriers at our institution to discussing cost of care, including lack of transparency of out of pocket costs and lack of awareness of available resources. Providers were overwhelmingly interested in incorporating institutional resources and cost-effectiveness tools into their clinical practices. These findings can inform provider-level interventions to better address the financial burden patients face with their cancer care.

Download Full-text

Integrating Financial Toxicity Assessment in Cancer Treatment: Implications for Medical Oncology Training

Journal of Health Science Research ◽

10.7324/jhsr/2020/25145 ◽

2021 ◽

pp. 30-38

Author(s):

Errol J. Philip ◽

Nichole Legaspi ◽

Hala T. Borno

Keyword(s):

Cancer Treatment ◽

Financial Burden ◽

Toxicity Assessment ◽

Cost Of Care ◽

Toxicity Screening ◽

Financial Toxicity ◽

Negative Outcomes ◽

Call To Action ◽

Costs Of Care ◽

Oncology Providers

Financial burden or toxicity associated with cancer treatment is defined as problems a patient may face related to the costs of medical care. Financial toxicity has been widely documented in the oncology literature and has been associated with a host of negative outcomes, including impaired quality of life, treatment non-adherence and greater risk of mortality. These negative outcomes prompted a call to action among oncology providers to take the lead in discussions of financial burden and costs of care among patients. However, to date, oncologists feel ill prepared to initiate these discussions and few patients feel this is part of their routine oncologic care. Moreover, little attention has been given to the training of future clinicians in oncology to effectively discuss costs of care. The development and implementation of provider communication training programs and integration of appropriate financial toxicity screening will enable cost of care discussions to become routine and help dissipate patient discomfort.

Download Full-text

Financial toxicity of cancer treatment at a diverse county hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.76 ◽

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]

Download Full-text

The Financial Costs of Chronic Myeloid Leukemia and Implications for Quality of Life and Adherence: Findings from the Cancer Experience Registry

Blood ◽

10.1182/blood.v124.21.2602.2602 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2602-2602 ◽

Cited By ~ 2

Author(s):

Joanne S. Buzaglo ◽

Clare Karten ◽

Elisa Weiss ◽

Melissa F. Miller ◽

Anne Morris

Keyword(s):

Quality Of Life ◽

Financial Burden ◽

Depression Score ◽

Cost Of Care ◽

Outreach Program ◽

Financial Cost ◽

Assistance Programs ◽

Cancer Experience ◽

Out Of Pocket Costs

Abstract Background: US prevalence of CML is estimated at 33,990 of January 1, 2011 (SEER, 2014). In 2014, about 5,980 new CML cases will be diagnosed (ACS, 2014). The era of tyrosine kinase inhibitors has transformed CML from an often fatal disease to one with an excellent prognosis, with ongoing treatment. Many people living with CML may have to manage a significant financial burden related to care, including medication copays and coinsurance, and other out of pocket costs. Several studies have reported that the financial burden of CML care is associated with decreased adherence (Dusetzina, 2014; Abraham, 2012; Noens, 2009). Poor adherence is associated with statistically significant decreases in 5-year event-free survival and may occur more frequently than either patients or physicians recognize (Oehler, 2013). Methods: From October 2013 to June 2014, the Cancer Support Community (CSC) and The Leukemia & Lymphoma Society (LLS) registered 484 people living with CML to the Cancer Experience Registry: CML, an online initiative designed to learn and raise awareness about the psychosocial impact of CML. Registrants were recruited through an outreach program that leveraged CSC’s and LLS’s networks of community-based affiliates and chapters, online communities, CSC’s helpline and LLS’s information resource center, other advocacy organizations, social and other media channels. 393 registrants (81%) responded to a survey, including questions about the financial cost of CML and cancer-related distress. Stress-related intrusive ideation about managing the financial impact of CML was measured using the Impact of Event Scale (IES, 7 items, Horowitz, 1979); levels >13 were used to indicate clinically significant symptoms associated with anxiety. Fifteen items from a validated distress screener (α=0.93) (CancerSupportSource, Miller 2014) were summed to create a score for overall distress (mean=23, SD=14, range 0-60), and 4 items were summed for a depression score (α=0.88) with a binary variable created to indicate at risk for depression (score≥5). For these analyses, we excluded survey participants living outside the US (n=54) and bone marrow transplant patients not taking oral CML medications (n=11). The sample (n=327) was 68% female, 98% Caucasian, median age 59. Median time since CML diagnosis was 4 years. Total annual income: 32% <$40K; 30% $40-79K; 37% at least $80K. Results: Nearly half (48%) reported spending at least $100 per month on all out of pocket costs related to CML; 27% spent $250 or more; 15% spent $500 or more; 5% spent $1,000 or more. Greater out of pocket costs were associated with higher overall distress (p<0.001) and increased risk of depression (p<0.001), adjusting for income. One-third (34%) reported that CML-related out of pocket costs affect their household “quite a bit” or “very much”; 21% responded “a little bit”; 27% responded “not at all.” More than one-third (37%) reported currently experiencing clinically high levels of intrusive ideation (IES>13) about the financial cost of care. Oral CML medicine was the greatest cost burden to participants. Because of the medical costs of CML, 33% reported depleting their savings; 20% borrowed against or used money from retirement; and 35% reported cutting their grocery expenses. Nine percent enrolled in a clinical trial that paid for most of their treatment expenses. About one-third used pharmaceutical assistance programs (30%) and co-pay assistance programs (38%). In order to reduce health care costs, 10% reported skipping dosages of medicine at least sometimes, and 14% postponed filling prescriptions. Twelve percent reported they postponed seeking psychological counseling or support. Half (51%) of participants did not know if they were eligible for Social Security Disability Insurance or Supplemental Security Income; 44% wished they had received more help with financial advice and assistance. Conclusion: CML places a financial burden on patients that is associated with patients taking measures that may significantly impact quality of life and may negatively affect treatment outcomes. Implications for future research and practice include the development and evaluation of interventions to enhance oncology team-patient communication and support (e.g., financial counseling and assistance) to help ensure that the financial burden of CML does not negatively impact the patient’s quality of life, course of cancer care, and health outcomes. Disclosures No relevant conflicts of interest to declare.

Download Full-text

Multiple Myeloma Patient Experience with Financial Toxicity: Findings from the Cancer Experience Registry

Blood ◽

10.1182/blood.v126.23.874.874 ◽

2015 ◽

Vol 126 (23) ◽

pp. 874-874 ◽

Cited By ~ 3

Author(s):

Joanne S. Buzaglo ◽

Melissa F. Miller ◽

Clare Karten ◽

Margaret Longacre ◽

Victoria Kennedy ◽

...

Keyword(s):

Quality Of Life ◽

Health Care ◽

Financial Burden ◽

Health Care Team ◽

Depression Score ◽

Cost Of Care ◽

Financial Counseling ◽

Cancer Experience ◽

Out Of Pocket Costs

Abstract Background: The US prevalence of multiple myeloma (MM) is estimated at 83,118 as of January 1, 2011 (SEER, 2014), and about 24,050 new MM cases will be diagnosed in 2014 (ACS, 2014). With advances in treatment, MM patients are living longer and are confronted with increasingly complex therapeutic decisions. Many people living with MM may have to manage a significant financial burden related to care, including medication copays and coinsurance, and other out of pocket costs. Financial toxicity can reduce quality of life and impede delivery of quality care. With the movement towards value-based cancer care, oncologists are encouraged to discuss costs with patients when considering treatment choices. We aimed to describe financial distress among MM patients and patient-provider communication about cost. Methods: From July 2013-2014, the Cancer Support Community (CSC) registered 495 MM patients to the "Cancer Experience Registry: MM," an online initiative to study and raise awareness about MM's psychosocial impact. Registrants were recruited through an outreach program including the CSC and The Leukemia & Lymphoma Society networks of communities and resources. 266 US-based registrants completed surveys including questions about the financial cost of MM and cancer-related distress. Stress-related intrusive ideation about managing the financial impact of MM was measured using the validated 7-item Impact of Event Scale (IES); levels >13 were used to indicate clinically significant symptoms associated with anxiety. Twenty-seven items from a validated distress screener (α=0.94) (CancerSupportSource, Miller 2014) were summed to create a score for overall distress (mean=33, SD=21, range 0-103), and 4 items were summed for a depression score (α=0.83) with a binary variable created to indicate at risk for depression (score≥5). Results: The sample (n=266) was 52% female, 91% Caucasian, median age 64. Median time since MM diagnosis was 4.5 years. Total annual income: 35% <$40K; 35% $40-79K; 30% at least $80K. 73% reported spending at least $100/mo on all out of pocket costs related to MM; nearly half (48%) spent $250 or more; and 22% spent $500 or more. Because of the medical costs of MM, 32% reported depleting their savings; 22% borrowed against or used money from retirement; and 35% reported cutting their grocery expenses. About one-third used pharmaceutical assistance programs (35%). In order to reduce health care costs, only 5% reported skipping dosages of medicine at least sometimes, and 6% postponed filling prescriptions. Seventeen percent reported they postponed seeking psychological counseling or support. Just over half (56%) reported a member of their health care team talked to them about resources related to getting financial help or financial counseling, and only 28% reported their health care team ever discussed the impact of MM on personal finances. Yet, 82% reported financial counseling would be 'quite a bit' or 'very much' helpful to someone with MM. A large proportion of participants reported they would be 'quite a bit' or 'very much' willing to receive financial assistance for medications (81%) and cost of treatment (77%), and, to a lesser extent, for transportation costs (55%) and living expenses (46%). There was a significant linear increase in overall distress (p=0.009) and risk for depression (p=0.010) with greater monthly increment in out of pocket costs, adjusting for income, until monthly out of pocket costs exceeded $1000. Nearly one-third (32%) reported currently experiencing clinically high levels of intrusive ideation (IES>13) about the financial cost of care. Similarly, 33% reported they were often or always upset about money and the cost of care, and 47% were moderately, seriously or very seriously concerned about health insurance or money worries. Conclusion: MM places a financial burden on patients that can significantly impact quality of life and may negatively affect treatment outcomes. Implications for future research and practice include the development and evaluation of interventions to enhance doctor-patient communication and support (e.g., financial counseling and assistance) to help ensure that the financial burden of MM does not negatively impact the patient's quality of life, course of cancer care, and health outcomes. Disclosures LeBlanc: Epi-Q: Consultancy; Helsinn Therapeutics: Honoraria, Research Funding; Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees; Flatiron: Consultancy.

Download Full-text

Financial toxicity and cancer-related distress among melanoma survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.9588 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 9588-9588

Author(s):

Joanne S Buzaglo ◽

Melissa F Miller ◽

Alexandra K Zaleta ◽

Jamese Johnson ◽

Niraj K. Gupta

Keyword(s):

Quality Of Life ◽

Health Care ◽

Cancer Care ◽

Financial Burden ◽

Health Care Team ◽

Cost Of Care ◽

Care Team ◽

Financial Impact ◽

Out Of Pocket Costs

9588 Background: Melanoma survivors are at risk for significant financial burden due to cancer care and out of pocket costs. We explored 1) the financial impact of melanoma and its relationship to cancer-related distress, and 2) survivors’ experiences discussing financial burden with their health care team. Methods: Of 110 melanoma survivors enrolled in the Cancer Support Community’s online Cancer Experience Registry, 56 completed questions about financial impact of cancer and cost of care communication. Participants rated concern (0 = not at all; 4 = very seriously) about 27 items encompassing psychological, emotional, physical and practical concerns; items were summed into a total distress score (mean = 33, SD = 21, range 0-88). Financial impact and overall distress were examined via regression analysis. Results: Participants were 71% female, 89% Caucasian, median age 54, and median time since diagnosis 2.5 years. Total annual income: 34% < $60K; 46% $60K+; 20% not reported. 24% spent $101-250/month on melanoma out of pocket costs; 20% spent $251-500; and 24% spent ≥$500. The top concern was health insurance/money worries (69% moderately to very seriously concerned). Due to medical costs, 57% depleted their savings, 20% borrowed against or used retirement money, 20% used pharmaceutical assistance programs, 13% skipped medicine dosages at least sometimes, and 17% postponed filling prescriptions. Only 28% reported that their health care team spoke to them about cost of care, and 28% were asked about financial distress; 42% desired financial assistance. Financial impact was associated with an increase in overall distress for those with income < $60K (p < .05; interaction p < 0.05). Conclusions: Substantial proportions of melanoma survivors experience financial burden that can impact quality of life, particularly lower income individuals. Although oncologists are encouraged to discuss treatment costs, most patients report they have not had these discussions with providers. These results support the development/evaluation of interventions to enhance doctor-patient communication, and financial counseling to minimize financial burden of melanoma and the risks it can confer for quality of life, course of cancer care, and health outcomes.

Download Full-text

Comparison of perspectives and practices to mitigate financial toxicity between advance practice providers and attending oncologists.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.82 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 82-82

Author(s):

Meera Vimala Ragavan ◽

Divya Ahuja Parikh ◽

Manali I. Patel

Keyword(s):

Cancer Patients ◽

Response Rates ◽

Third Party ◽

Treatment Recommendation ◽

Cancer Center ◽

Extensive Literature ◽

Financial Toxicity ◽

Comparison Of Perspectives ◽

Attending Physicians ◽

Current Practices

82 Background: Characterizing the oncology provider’s role in addressing the growing epidemic of financial toxicity faced by cancer patients is of increasing importance. Advance practice providers (APPs) increasingly serve as primary providers for many cancer patients, but no studies to date have examined their perspectives and practices in addressing financial toxicity, nor compared them to that of attending physicians. Methods: We developed an 18-question electronic, anonymous survey informed by an extensive literature search regarding perspectives on the provider’s role and current practices in addressing financial toxicity. We emailed the survey to 75 attending physicians and 117 APPs at our institution’s cancer center. Responses during the study period 12/12/2018-1/31/2019 were analyzed. Results: 32 attending physicians and 28 APPs completed the survey. Response rates were higher among attending physicians (42%) compared to APPs (24%). Attending physicians were more likely than APPs to agree that providers should openly discuss cost (75% vs. 36%, p = 0.002). APPs were more likely to agree that providers should defer cost conversations to a third party (57% vs. 31%, p = 0.04) and make the same treatment recommendation regardless of cost (50% vs. 25%, p = 0.022). Use of cost-effectiveness (CE) guidelines was higher among APPs compared to attending physicians (71% vs. 31%, p = 0.0019). Awareness of out of pocket costs, frequency of referrals to financial counselors, and ranking of top barriers to cost conversations (price transparency, knowledge of resources, and time) were similar between attending physicians and APPs. Conclusions: While APPs and attending physicians differed considerably in their perspectives on the role oncology providers should take in mitigating financial toxicity, they were more consistent in current practices and identification of barriers to cost conversations. APPs were interestingly more likely to use CE guidelines than attending physicians. Higher response rates among attending physicians may reflect inherently stronger opinions regarding the provider’s role in addressing financial toxicity. Future studies should explore these differences to better inform provider-level interventions to reduce financial toxicity.

Download Full-text

Identifying levels of financial toxicity and unmet needs in cancer patients receiving financial assistance: Exploring trends in populations lacking adequate resources to overcome healthcare barriers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.151 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 151-151

Author(s):

Brittnee Barris ◽

Katie Deehr ◽

Eric Anderson ◽

Kathleen D. Gallagher ◽

Shonta Chambers ◽

...

Keyword(s):

Cancer Patients ◽

Financial Burden ◽

Treatment Costs ◽

Cost Of Care ◽

Financial Assistance ◽

Categorical Variables ◽

Racial Groups ◽

Financial Toxicity ◽

Major Barrier ◽

Medication Costs

151 Background: The inability to afford healthcare has a widespread effect on cancer patients, notably impacting treatment decisions and outcomes. Patients receiving financial assistance to offset medication costs still face challenges overcoming cost of care barriers. This study investigated sources of concern and financial stress among racial groups and identified solutions to address patients’ needs beyond medication-related costs. Methods: This cross-sectional study utilized secondary survey data collected from cancer patients who received co-payment and/or financial aid from PAF in 2018. Respondents answered questions describing their financial distress and the COmprehensive Score for financial Toxicity (COST) tool (0-44 with lower scores indicating worse toxicity). Descriptive statistics were calculated using means and standard deviations (SD) for continuous variables and frequencies for categorical variables. Two sample t-tests were used for bivariate comparisons between racial groups. Results: Of 494 cancer patients surveyed, 72% were Caucasian, 11% were African American (AA), and 71% indicated a household income of < $48,000. Although this population received financial assistance, cost of medications was still a major barrier to adhering to treatment (59% vs 69%). AA patients reported greater financial burden caused by cost of deductibles/copay/coinsurance (58% vs 50%) and treatment costs not covered by insurance (49% vs 21%). AA patients highly rated day-to-day living expenses as an unmet need (64% vs 40%). COST scores differed significantly between Caucasian (mean 17.7, SD 8.6) and AA cohorts (mean 12.1, SD 8.6; p < .001), driven by the inability to meet monthly expenses at all (35% vs 11%). Of AA, 80% felt they do not have enough money in savings/retirement to cover treatment costs. Overall, the AA cohort reported higher frustration with not being able to work or contribute as much as usual (45% vs 26%). Conclusions: Under-resourced AA cancer patients identify a need for a comprehensive approach to cost of care conversation, to drive better adherence and improved treatment outcomes.

Download Full-text

Experience of financial burden and distress among people with ovarian cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19400 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19400-e19400

Author(s):

Branlyn W. DeRosa ◽

Alexandra Katherine Zaleta ◽

Angela J. Johnson ◽

Kelly A. Clark ◽

Jemeille Ackourey ◽

...

Keyword(s):

Ovarian Cancer ◽

Financial Burden ◽

Clinical History ◽

Health Care Team ◽

Cost Of Care ◽

Cancer Support ◽

Depression Risk ◽

Cancer Experience ◽

The Impact ◽

Out Of Pocket Costs

e19400 Background: The impact of ovarian cancer (OC) is wide-reaching; this study explored cancer-related financial burden related to cost of care in people ever diagnosed with OC. Methods: 64 OC patients enrolled in Cancer Support Community’s Cancer Experience Registry. Participants provided demographic and clinical history, and completed 1) CancerSupportSource, a validated 25-item tool with anxiety and depression risk subscales, and 2) the 11-item COmprehensive Score for financial Toxicity (COST). Descriptive statistics were calculated for responses; Pearson/Spearman correlations and one-way ANOVA (Tukey post-hoc) were used to explore bivariate associations between financial burden, depression/anxiety risk, and demographic/clinical variables. Results: Participants were 91% non-Hispanic White, mean age = 57 years, SD= 15. 55% were currently receiving treatment (47% chemotherapy); 33% ever experienced metastatic disease. 22% reported annual income of ≤$40,000; 19% were not-employed due to disability. 13% spent $500+/month on out-of-pocket costs; 63% reported that a health care team member did not discuss cost of care with them. 36% did not know if they had enough assets to cover cancer treatment costs; 1 in 10 (11%) reported they could not meet monthly expenses. 1 in 3 reported (“quite a bit” to “very much”) worry about future financial problems resulting from illness/treatment (39%) and frustration that they cannot work or contribute as much as usual (34%). Greater financial burden was associated with lower income ( r= -.40, p= .001), greater out-of-pocket costs ( r= .24, p= .03), and not working due to disability F(5,58) = 3.84, p= .01. Among respondents, 38% were at risk for clinical depression; 44% for anxiety; greater financial burden was related to depression risk ( r = .51, p< .001) and anxiety risk ( r= .32, p= .012). Conclusions: Financial burden affects many people with ovarian cancer and is associated with poorer psychosocial outcomes. Ovarian cancer patients and survivors can benefit from access to comprehensive supportive care resources, including financial counseling. Cancer Support Community offers resources that may help, including a toll-free Helpline with a dedicated financial counselor. Future work will examine multivariate predictors of financial burden in ovarian cancer. Clinical trial information: NCT02333604 .

Download Full-text

Financial toxicity in sarcoma patients and survivors in Germany: results from the multicenter PROSa study

Supportive Care in Cancer ◽

10.1007/s00520-021-06406-3 ◽

2021 ◽

Author(s):

Matthias Büttner ◽

Susanne Singer ◽

Leopold Hentschel ◽

Stephan Richter ◽

Peter Hohenberger ◽

...

Keyword(s):

Financial Burden ◽

Clinical Importance ◽

Financial Toxicity ◽

Financial Difficulties ◽

Education Status ◽

Eortc Qlq C30 ◽

Multicenter Prospective Cohort Study ◽

Associated Risk Factors ◽

Eortc Qlq ◽

Age And Sex

Abstract Purpose Cancer patients have been shown to frequently suffer from financial burden before, during, and after treatment. However, the financial toxicity of patients with sarcoma has seldom been assessed. Therefore, the aim of this study was to evaluate whether financial toxicity is a problem for sarcoma patients in Germany and identify associated risk factors. Methods Patients for this analysis were obtained from a multicenter prospective cohort study conducted in Germany. Using the financial difficulties scale of the EORTC QLQ-C30, financial toxicity was considered to be present if the score exceeded a pre-defined threshold for clinical importance. Comparisons to an age- and sex-matched norm population were performed. A multivariate logistic regression using stepwise backward selection was used to identify factors associated with financial toxicity. Results We included 1103 sarcoma patients treated in 39 centers and clinics; 498 (44.7%) patients reported financial toxicity. Sarcoma patients had 2.5 times the odds of reporting financial difficulties compared to an age- and sex-matched norm population. Patient age < 40 and > 52.5 years, higher education status, higher income, and disease progression (compared to patients with complete remission) were associated with lower odds of reporting financial toxicity. Receiving a disability pension, being currently on sick leave, and having a disability pass were statistically significantly associated with higher odds of reporting financial toxicity. Conclusion Financial toxicity is present in about half of German sarcoma patients, making it a relevant quality of life topic for patients and decision-makers.

Download Full-text

Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study

Current Oncology ◽

10.3390/curroncol28010005 ◽

2020 ◽

Vol 28 (1) ◽

pp. 26-39

Author(s):

Abir El-Haouly ◽

Anais Lacasse ◽

Hares El-Rami ◽

Frederic Liandier ◽

Alice Dragomir

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Financial Burden ◽

Cross Sectional Study ◽

University Education ◽

School Level ◽

Sectional Study ◽

Cross Sectional ◽

Perceived Burden ◽

Out Of Pocket Costs

Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001–1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13–24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913–0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00–0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03–0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.

Download Full-text