Changes in employment and insurance for patients with cancer receiving safety net services.

104 Background: Under-resourced patients with cancer often face financial burdens due, not only to costs of treatment, but also from side effects that prevent individuals’ ability to work, which impact employment status and may cause insurance coverage loss. Financial assistance may be sought from safety net programs, which provide both material support and financial counseling. However, knowledge of the impact of cancer on employment and insurance in a population seeking safety net services is limited. Methods: This observational, cross-sectional study uses data on safety net services from a nationwide survey conducted in July 2017 and distributed by the Patient Advocate Foundation (PAF). The survey respondents included patients with cancer who received services from PAF from July 2016 to June 2017. Descriptive statistics were calculated using frequencies for categorical variables. Results: A total of 508 patients with cancer completed the survey. Most patients had a diagnosis of breast cancer (47%), followed by myeloma (13%), and prostate cancer (8%). The majority of patients reported that their illness affected their employment (67%); by either job loss (13%), income loss (24%), or inability to work as usual (27%). Of these patients, 27% lost their insurance coverage. Those able to enroll in a new insurance plan reported having more expensive rates (40%) and fewer covered services (36%) compared to their previous coverage. The most commonly utilized governmental safety net services were Social Security Disability Insurance (19%) and Medicaid (12%). Non-governmental safety net services such as financial assistance from non-profits (27%) and free medication from drug companies (13%) were also frequently used. Beyond their insurance coverage, cancer patients still needed assistance paying for diagnostic tests (18%), clinic visit fees (23%), and prescription drugs (15%) from the safety net program. Conclusions: Cancer patients commonly experience financial burden due to losses in employment and insurance, resulting in need for safety net programs. Further work is needed to identify approaches to reducing the adverse financial impact of cancer care.

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Anticoagulation in cancer patients in hospice

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20509 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20509-e20509

Author(s):

H. M. Holmes ◽

K. T. Bain ◽

R. Luo ◽

A. Zalpour ◽

E. Bruera ◽

...

Keyword(s):

Cancer Patients ◽

Patient Characteristics ◽

Categorical Variables ◽

Continuous Variables ◽

Length Of Service ◽

Chi Square ◽

Patients With Cancer ◽

Hospice Patients ◽

The Mean ◽

The Impact

e20509 Background: Low-molecular weight heparin (LMWH) is preferred over warfarin in patients with thromboembolic disease and active cancer, but no guidelines exist in hospice. Although warfarin may be less safe in hospice patients, hospices may prefer to provide warfarin due to lower cost and less invasiveness compared to LMWHs. We sought to identify disparities in the use of warfarin vs. LMWHs in cancer patients enrolled in hospice. Methods: We analyzed a dataset from a national pharmacy provider for more than 800 hospices. We identified patients with a terminal diagnosis of cancer who were enrolled and died in hospice in 2006 and who were prescribed warfarin or LMWH. Patient characteristics included age, gender, race, cancer diagnosis, length of hospice service, and number of comorbidities. For descriptive comparisons, the Kruskal-Wallis test was used for continuous variables, and the Chi-square test was used for categorical variables. Results: Of 54,764 patients with cancer admitted and deceased in 2006, 3874 (7.1%) were prescribed warfarin, and 1137 (2.1%) were prescribed LMWH. Patients prescribed warfarin (n=576) or enoxaparin (n=5) for treatment of atrial arrhythmias were excluded. The mean age was 70.6 years for warfarin and 64.8 years for LMWH (p<0.0001). The mean and median lengths of service, respectively, were 43.6 days and 23.0 days for warfarin and 35.0 and 18.0 days for LMWH, (p<0.0001). There were no differences for gender, and a higher proportion of white patients were prescribed warfarin. Patients prescribed warfarin had an average of 2.1 comorbid conditions, versus 1.6 conditions for LMWH (p<0.0001). Cancer diagnoses were significantly different between the two groups, with a higher proportion of patients with lung and prostate cancer taking warfarin. Conclusions: Patients prescribed warfarin were older, had more comorbidities, and a longer length of service than patients prescribed LMWHs. Further research is needed to determine the impact of anticoagulation on outcomes, especially cost and quality of life, for cancer patients in hospice. This study raises the need to establish guidelines for the appropriateness of anticoagulation in hospice patients with cancer. No significant financial relationships to disclose.

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A pilot study of a comprehensive financial navigation program in cancer patients and caregivers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.174 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 174-174

Author(s):

Jordan Steelquist ◽

Kate Watabayashi ◽

Karen Overstreet ◽

Tony Leahy ◽

Alan James Balch ◽

...

Keyword(s):

Pilot Study ◽

Cancer Patients ◽

Financial Burden ◽

Financial Education ◽

Case Managers ◽

Financial Assistance ◽

Patient Advocate ◽

Navigation Program ◽

Medical Bills ◽

The Impact

174 Background: Few studies have reported on interventions to alleviate financial toxicity (FT) in cancer patients (pts) and informal caregivers (cgs). We developed a financial navigation program in collaboration with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach Foundation (FRF), to offer financial coaching, insurance navigation, and assistance with unpaid non-medical bills. We conducted a pilot study to assess feasibility of enrolling cgs with pts and to describe the assistance provided. Methods: Pts with any stage solid tumor actively receiving treatment (tx) at the Seattle Cancer Care Alliance were asked to identify a cg who could participate. Pts or pt/cg dyads received an online financial education course and monthly contact for 6 months (mo) with CENTS and PAF. Subjects were referred to FRF for assistance in paying non-medical bills. We describe pt and cg characteristics, and assistance provided by the program. Results: Of 54 pts approached, 30 (median age 59.5, 61% white, 97% stage III/IV disease) were consented. Most pts (53%) had income ≤ $25,000, and all were insured (48% commercial, 28% Medicare, 21% Medicaid). 18 cgs (67% spouse/partner) were consented. At consent, 55% of pts reported debt in the prior 3 mo. Mean score using the COST PRO FT measure (range 0-44, lower score = higher FT) was 17.4 at baseline. After pts’ physical health, out-of-pocket costs were the most stressful aspects of tx for cgs. Cgs with high financial burden from caregiving more often reported taking on new debt, dipping into retirement accounts, or changing their jobs or hours. CENTS coaches assisted with budgeting, updating wills, and employment rights counsel. PAF case managers assisted with financial assistance for drugs, cost of living (e.g. transportation), disability applications, and secured $6,950 in debt relief. FRF dispersed $4,133, primarily for housing expenses. Conclusions: Implementing a financial navigation program that engages both pts and cgs is feasible. This lower income, financially stressed population received $11,000 in financial assistance. Future work will focus on evaluating the impact of this program on financial and psychosocial outcomes in pts and cgs.

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Financial assistance for fertility preservation at cancer diagnosis: An analysis of the LIVESTRONG Fertility program.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6555 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6555-6555 ◽

Cited By ~ 1

Author(s):

Lenore Omesi ◽

Aditi Narayan ◽

Rebekkah Schear ◽

Joyce Reinecke ◽

Jennifer Levine

Keyword(s):

Cancer Patients ◽

Fertility Preservation ◽

Cancer Diagnosis ◽

Financial Burden ◽

Insurance Coverage ◽

Cost Savings ◽

The United States ◽

Financial Assistance ◽

Adolescent And Young Adult ◽

Medication Costs

6555 Background: Fertility preservation (FP) is a critical component of comprehensive adolescent and young adult (AYA) cancer care that is discussed and/or offered to only a fraction of eligible patients. Barriers include lack of insurance coverage making FP prohibitively expensive for many patients. The Sharing Hope program, now known as LIVESTRONG Fertility, was created by Fertile Hope in 2004 and acquired by LIVESTRONG in 2009. LIVESTRONG Fertility provides financial assistance to AYA cancer patients through discounted FP rates and access to free medications through a pharmaceutical company. Our aims were to review demographic characteristics of patients served, identify geographic utilization patterns, and quantify the program’s financial impact. Methods: De-identified records maintained by Fertile Hope/LIVESTRONG from 2004 to 2011 were retrospectively reviewed. Patient population, treating institutions and cost savings/patient were summarized using descriptive statistics. Results: 1171 men and 1319 women were approved for financial assistance between 2004 and 2011. Median age was 24 years (range 12-67) for men and 30 years (range 13-49) for women. The most common diagnoses included testicular cancer (34%) and Hodgkin Lymphoma (HL) (18%) among males and breast cancer (48%), HL (13%) and genitourinary cancers (13%) among females. Applications were received from individuals residing in 49 of the United States, as well as Washington DC and Puerto Rico. The applicants received care from a total of 1,245 cancer centers. For men, $438,711 was saved, averaging $375/patient. For women, $3,904,303 was saved in practitioner cost and $4,665,775 in medication costs averaging $6,497/patient. Conclusions: Financial assistance for FP at the time of a cancer diagnosis for AYAs is a persistent and growing need. Female cancer patients face significantly greater costs to preserve fertility. Further studies are needed to determine the true financial burden to patients and the degree to which lack of financial resources and insurance coverage prevent FP in this population. [Table: see text]

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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.

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The Impact Of Health Insurance Coverage On Outcomes For U.S. Gastric Cancer Patients

Journal of Surgical Research ◽

10.1016/j.jss.2010.11.166 ◽

2011 ◽

Vol 165 (2) ◽

pp. 338

Author(s):

J.K. Smith ◽

S. Ng ◽

J.S. Hill ◽

T.P. McDade ◽

S.A. Shah ◽

...

Keyword(s):

Gastric Cancer ◽

Health Insurance ◽

Cancer Patients ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Gastric Cancer Patients ◽

The Impact

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Phoenix Cancer Support Network provides non-medical assistance to reduce disparities among cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18502 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18502-e18502

Author(s):

Glen J. Weiss ◽

Adam R. Thompson ◽

Kathryn M. Pastuszak ◽

Samantha R. Torre ◽

Jeanette S. Martin

Keyword(s):

Cancer Patients ◽

Financial Support ◽

Insurance Coverage ◽

Support Network ◽

Medical Assistance ◽

Transportation Services ◽

Medical Needs ◽

Cancer Support ◽

Eligibility Requirements ◽

The Impact

e18502 Background: Social determinants of health (SDOH) can lead to gaps in supportive care resources and services available to cancer patients. Established in 2017, Phoenix Cancer Support Network (PCSN) is a non-profit that endeavors to empower cancer patients (clients) throughout their cancer journey by providing support, guidance, and direction while promoting and protecting the unique needs, lifestyle, and abilities of each client and their caregivers. In this study, we investigate the non-medical needs of patients that engaged with PCSN for assistance and the increases in services provided over time. Methods: All patients that applied for and were eligible to receive assistance from PCSN were included. Eligibility requirements include patients primarily residing in Arizona and are receiving cancer therapy. Non-medical services offered included transportation, groceries and meals, housecleaning, other domestic services (e.g., child care or dog walking), financial support, and household goods. Summary statistics were conducted. Results: Between December 2017 and November 2020, 188 clients (117 were female) were offered assistance by PCSN. The median age was 58 (range 23-92). The number of clients assisted was 2 in 2017, 81 in 2018, 58 in 2019, and 38 in 2020. 145 clients had a solid tumor and 131 were actively undergoing cancer treatment when seeking PCSN assistance. Of 67 clients with available income data, 55 clients earned less than $25,000/year including 41 clients that were unemployed and 21 clients without insurance coverage. Most frequently requested services were transportation (49%), groceries and meals (41%), financial support (34%), housecleaning (26%), and other domestic services (10%). Of those requested services, PCSN was able to provide assistance for 76% of transportation, 62% of meal services, 79% of financial assistance, 50% of housecleaning, and 100% of other domestic services requested. Details of total expenditures for these services by year are depicted in the Table.Transportation service has been the largest expenditure overall, followed by other domestic services and groceries and meals. Conclusions: PCSN clients have needs that span multiple non-medical resources, reflecting potential sources of improvement in reducing disparities in the cancer community. At least 25% of clients requesting non-medical assistance reported annual income below $25,000/year. The amount of services provided has increased yearly, particularly transportation services. Additional study and follow-up to understand these service gaps and the impact of SDOH is warranted.[Table: see text]

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Prostate cancer treatment disparities during the COVID-19 pandemic, lessons from a multi-institutional collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6542 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6542-6542

Author(s):

Adrien Bernstein ◽

Ruchika Talwar ◽

Elizabeth A. Handorf ◽

Kaynaat Syed ◽

Serge Ginzburg ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Safety Net ◽

Mitigation Strategies ◽

Categorical Variables ◽

Gleason Grade ◽

Grade Group ◽

Black Patients ◽

The Impact ◽

White Patients

6542 Background: Minority communities have been disproportionately affected by COVID-19, however the impact of the pandemic on prostate cancer (PCa) treatment is unknown. To that end, we sought to determine the racial impact on PCa surgery during the first wave of the COVID-19 pandemic. Methods: After receiving institutional review board approval, the Pennsylvania Urologic Regional Collaborative (PURC) database was queried to evaluate practice patterns for Black and White patients with untreated non-metastatic PCa during the initial lockdown of the COVID-19 pandemic (March-May 2020) compared to prior (March-May 2019). PURC is a prospective collaborative, which includes private practice and academic institutions within both urban and rural settings including regional safety-net hospitals. As data entry was likely impacted by the pandemic, we limited our search to only practices that had data entered through June 1, 2020 (5 practice sites). We compared patient and disease characteristics by race using Fisher’s exact and Pearson’s chi-square to compare categorical variables and Wilcoxon rank sum to evaluate continuous covariates. Patients were stratified by risk factors for severe COVID-19 infection as described by the CDC. We determined the covariate-adjusted impact of year and race on surgery, using logistic regression models with a race*year interaction term. Results: 647 men with untreated non-metastatic PCa were identified, 269 during the pandemic and 378 from the year prior. During the pandemic, Black men were significantly less likely to undergo prostatectomy compared to White patients (1.3% v 25.9%;p < 0.001), despite similar COVID-19 risk-factors, biopsy Gleason grade group, and comparable surgery rates prior (17.7% vs. 19.1%;p = 0.75). White men had lower pre-biopsy PSA (7.2 vs. 8.8 vs. p = 0.04) and were older (24.4% vs. 38.2% < 60yr;p = 0.09). The regression model demonstrated an 94% decline in odds of surgery(OR = 0.06 95%CI 0.007-0.43;p = 0.006) for Black patients and increase odds of surgery for White patients (OR = 1.41 95%CI 0.89-2.21;p = 0.142), after adjusting for covariates. Changes in surgical volume varied by site (33% increase to complete shutdown), with sites that experienced the largest reduction in cancer surgery, caring for a greater proportion of Black patients. Conclusions: In a large multi-institutional regional collaborative, odds of PCa surgery declined only among Black patients during the initial wave of the COVID-19 pandemic. While localized prostate cancer does not require immediate treatment, the lessons from this study illuminate systemic inequities within healthcare, likely applicable across oncology. Public health efforts are needed to fully recognize the unintended consequence of diversion of cancer resources to the pandemic in order to develop balanced mitigation strategies as viral rates continue to fluctuate.

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Mood disorders and outcomes in lung cancer patients undergoing surgery: a brief summery

Future Oncology ◽

10.2217/fon-2018-0835 ◽

2020 ◽

Author(s):

Maria Salvina Signorelli ◽

Teresa Surace ◽

Marcello Migliore ◽

Eugenio Aguglia

Keyword(s):

Lung Cancer ◽

Cancer Patients ◽

Mood Disorders ◽

Psychiatric Symptoms ◽

Depression And Anxiety ◽

Lung Cancer Patients ◽

Patients With Cancer ◽

Treatment Of Depression ◽

The Impact

Cancer is a leading cause of death worldwide. Literature reports depression and anxiety are the most common psychiatric symptoms in cancer patients. Notably, lung cancer is associated with major depressive disorder in 5–13% of cases. The present article aims to give an overview regarding the impact of mood disorders on the outcomes of patients affected by lung cancer. Our review showed that pharmacological treatment and psychotherapy can be useful to improve the quality of life of patients with lung cancer. Moreover, the treatment of depression and anxiety can be associated with a reduced mortality. In conclusion, it is important to consider psychiatric care as important as other adjuvant oncologic therapies in patients with cancer.

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

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz001 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 4

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.

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