Ovarian cancer patients’ perspectives on facilitators and barriers to accessing financial assistance.

64 Background: Our aim was to obtain ovarian cancer patients’ perspective on accessing financial assistance programs. Methods: We recruited ovarian cancer patients receiving systemic therapy who screened positive for financial distress using Comprehensive Score for Financial Toxicity <26. Two interviewers conducted 45-minute interviews on the costs of care, which were recorded and transcribed. Three coders used inductive thematic analysis to identify themes. Results: There were 18 of 22 interviews currently evaluable. Median age was 57 and 68% of participants reported income <$40,000. Facilitators and barriers to accessing financial assistance are shown in the table below. Conclusions: Patients’ reliance on existing support systems and cancer organizations highlight a need for health systems to leverage these relationships and improve organized efforts to provide information related to financial assistance. Proactively asking about financial needs and providing resources to all patients, regardless of income, may mitigate patient reported barriers to accessing financial assistance. [Table: see text]

Download Full-text

Predictors of high financial distress in a national, multiethnic sample of patients with cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.149 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 149-149

Author(s):

Meera Vimala Ragavan ◽

Rosie Cunningham ◽

Andrea Incudine ◽

Hala Borno ◽

Thomas Stivers

Keyword(s):

Cancer Treatment ◽

Financial Distress ◽

Financial Support ◽

Financial Stress ◽

The United States ◽

Financial Assistance ◽

Financial Toxicity ◽

Targeted Interventions ◽

Patients With Cancer ◽

Patient Reported

149 Background: Financial toxicity is characterized by financial burden that patients face. Patients and providers are seldom aware of available resource to help mitigate this growing problem. To date, our understanding of the myriad of financial repercussions of cancer treatment remains limited. Prior published research has largely been single center, thereby limiting generalizability across the United States. This study leveraged a national, multi-ethnic sample of patients who receive financial support services including comprehensive financial assistance, navigation, planning, and a guidebook with relevant resources from a non-profit entity (Family Reach) to evaluate financial stress in during cancer treatment. Methods: Patients were identified for study participation if they received at least one financial support resource from Family Reach between 1/1/2020-6/30/2020. An 11-item survey was sent electronically to all eligible participants who were given a one-month time frame to complete. A multivariate model was employed to identify sociodemographic predictors of high financial distress. Results: A total of 832 patients were contacted, of whom 330 (40%) completed the survey. Demographic information is included in table. Patient reported financial distress in the prior week was high, with 46% of patients reporting a distress level of seven or higher on a ten-point scale. In a multivariate regression, Hispanic/Latinx ethnicity was associated with a higher distress rating and higher patient reported financial stress. Lower annual household income was associated with lower reports of feeling in financial control, lower reports of meeting monthly expenses, and higher reports of financial stress. Conclusions: Patient-reported financial distress was high in a national sample of patients with cancer who had utilized at least one financial resource provided by Family Reach. Hispanic ethnicity and Lower Annual Income were predictors of higher patient-reported financial distress. Larger samples are needed to confirm these patterns. Delivery systems should develop targeted interventions, including referrals to organizations providing financial assistance, for patient populations at high risk for financial toxicity. [Table: see text]

Download Full-text

Trends in Financial Toxicity for Patients of a Community Cancer Clinic

Blood ◽

10.1182/blood.v126.23.2124.2124 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2124-2124

Author(s):

Cherupolil R. Santhosh-Kumar ◽

Stephanie Struve ◽

Sue Freier

Keyword(s):

Financial Distress ◽

Conflicts Of Interest ◽

Tertiary Care ◽

Financial Assistance ◽

Financial Strain ◽

Financial Toxicity ◽

Assistance Programs ◽

Number Of Patients ◽

Cancer Clinic ◽

Over Time

Abstract Background: Rising health care costs - especially those of new medications for cancer treatment - have caused a severe financial strain on patients, leading to significant alteration of lifestyles. Published information regarding financial distress is scant with data only from large tertiary care institutions that may not be relevant to smaller communities. We sought to analyze the extent of financial toxicity over time in a community cancer clinic staffed by two medical oncologists. Methods: Since 2010, a team of two oncology social workers prospectively collected data on financial assistance for patients treated at our community cancer clinic. Data regarding medication assistance is available for 2012-2014. Results: Approximately 500 new patients and 1600 unique follow-up patients are evaluated and treated at the clinic annually. From January 2010 through December 2014, 1,012 requests for assistance were processed. The number of requests increased from 134 in 2010 to 320 in 2014. Most common requests were for medications and financial aid. Trends are shown in the table. Though the number of patients applying for medication assistance increased in 2014, the amount requested was less than previous years because of the influx of specialty pharmacies in the market with their own assistance programs. Conclusions: Financial toxicity for cancer patients is a real issue in the community clinic setting.Requests for financial assistance have increased over time. The number of FDA approvals for new cancer medications seem to correlate with the increase. Studies are in progress to further clarify the financial impact of cancer on patients.Table.Trends in requests for assistance and aid and FDA approval for new medications.Requests for20102011201220132014Financial aid6411686101143Service311112733Equipment1311111823Transport312357Medications51534449114Patient cost of medications for which aid requested$731,891$1,554,684$1,253,827FDA approvals for new Oncology medications61181513 Disclosures No relevant conflicts of interest to declare.

Download Full-text

Financial assistance programs for cancer patients

Current Cancer Reports ◽

10.25082/ccr.2021.01.007 ◽

2021 ◽

Vol 3 (1) ◽

pp. 119-123

Author(s):

Steven S. Coughlin ◽

◽

Lorraine T. Dean ◽

Jorge E. Cortes ◽

◽

...

Keyword(s):

Cancer Patients ◽

Low Income ◽

Financial Distress ◽

Well Being ◽

Small Sample ◽

Financial Assistance ◽

Sample Sizes ◽

Or Education ◽

Pilot Studies ◽

Assistance Programs

Background： The high costs of oncology care can lead to financial stress and have deleterious effects on the well-being of patients and their families. However, only a handful of financial assistance programs for cancer patients have been implemented and evaluated to date. Recent findings： Key features of reported programs include instrumental support through financial navigation or education for patients, and financial or charitable support for healthcare costs. Only one of the programs successfully reduced actual out-of-pocket costs for patients, though others were associated with psychosocial benefits or increased knowledge of financial resources. Four of the 5 programs evaluated to date were pilot studies with small sample sizes, and most lack control groups for comparison. Conclusions. Additional studies are needed that include larger sample sizes and with comparison groups of cancer patients in order to determine whether the counseling and navigator programs are effective in addressing financial distress in this patient population. Of particular interest are programs designed for low-income patients and those who lack health care insurance. Financial assistance programs that implement solutions at different levels of the healthcare system (individual patients, providers, healthcare institutions) are more likely to be effective. Multi-level interventions are needed that address the systems in which patients access care, the actual costs of services and drugs, and the individual needs of patients in order to reduce financial hardship for cancer patients.

Download Full-text

Psychometric Evaluation of the Comprehensive Score for Financial Toxicity Scale Among Iranian Cancer Patients

10.21203/rs.2.22672/v1 ◽

2020 ◽

Author(s):

Saeed Pahlevan Sharif ◽

Ong Fon Sim ◽

Mozhgan Moshtagh ◽

Navaz Naghavi ◽

Hamid Sharif Nia

Keyword(s):

Factor Analysis ◽

Cancer Patients ◽

Financial Distress ◽

Discriminant Validity ◽

Psychometric Evaluation ◽

Indirect Costs ◽

Measurement Model ◽

Financial Toxicity ◽

Convergent And Discriminant Validity ◽

Factor Measurement

Abstract Objective This study aims to evaluate the psychometric properties of the Persian version of financial toxicity (COST) scale in a sample of cancer patients in Iran. Methods A total of 398 cancer patients completed a demographic questionnaire and the 11-item Persian COST. Performing a Maximum likelihood exploratory factor analysis, extracted three factors of financial worry (four items), financial distress (three items) and direct and indirect cost of control (three items) accounting for 65.204% of the variance. The highest load was related to financial distress and the lowest was related to direct and indirect costs concerns. Results The results of conducting confirmatory factor analysis indicated that the three-factor measurement model had a good fit. Moreover, the measurement model showed good items consistency, good construct reliability, as well as good construct validity in terms of convergent and discriminant validity. Conclusion This study highlights the importance of validating the scale in different contexts as the structure and loadings of the factors have appeared diffidently in various countries. The validated Persian COST can be used in future studies in Iran as a reliable and valid scale to measure financial toxicity among cancer patients.

Download Full-text

Patient-Reported Outcomes Among Ovarian Cancer Patients Receiving Niraparib

Oncology Times ◽

10.1097/01.cot.0000723540.54498.79 ◽

2020 ◽

Vol 42 (22) ◽

pp. 15,29-29

Author(s):

Catlin Nalley

Keyword(s):

Ovarian Cancer ◽

Cancer Patients ◽

Patient Reported Outcomes ◽

Patient Reported

Download Full-text

A qualitative study on cancer patientś experiences with financial burden and financial distress

European Journal of Public Health ◽

10.1093/eurpub/ckz186.379 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

S L Schröder ◽

N Schumann ◽

M Richter

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Financial Distress ◽

Financial Burden ◽

Well Being ◽

Money Management ◽

Financial Toxicity ◽

Financial Decline ◽

The Individual

Abstract Background Financial toxicity was hardly examined in the context of public health. It is proven that financial distress following a cancer diagnosis can have an impact on the quality of life and mortality. Additionally, it was found that subjective indicators of financial toxicity have a stronger effect than objective indicators. Nevertheless, less is known about how higher costs can impact on the individual patient’s well-being. The aim of this study was to analyse the major drivers that lead from financial consequences to subjective financial distress in a country with statutory health insurance. Methods Qualitative semi-structured interviews were conducted with 39 cancer patients, aged between 40 and 86 years, in Germany. Inductive content analysis of data was performed and the individual patient's pathways are recently compared and contrasted. Results Above all, we found that financial distress is not only induced by higher costs and lower available money. Moreover, independently of whether patients experienced any financial decline, they experienced making financial adjustments and feeling financially stressed. The preliminary results show that the patient's ability of good money management and trust in one’s own skills being able to get along with less money might predict psychosocial consequences. Conclusions Screening instruments for financial toxicity are important to effectively detect patients whose quality of life might be worsened by their financial situation. It might be that rather financial skills than the amount of costs are important indicators of financial distress. Key messages Even cancer patients experiencing almost no financial decline during the period of cancer treatment might experience lower quality of life caused by financial distress. The ability and trust in oneself money management might have the strongest impact on subjective financial stress.

Download Full-text

The Role of Patient Financial Assistance Programs in Reducing Costs for Cancer Patients

Journal of Managed Care & Specialty Pharmacy ◽

10.18553/jmcp.2017.23.4.407 ◽

2017 ◽

Vol 23 (4) ◽

pp. 407-411 ◽

Cited By ~ 9

Author(s):

Leah L. Zullig ◽

Steven Wolf ◽

Lisa Vlastelica ◽

Veena Shankaran ◽

S. Yousuf Zafar

Keyword(s):

Cancer Patients ◽

Financial Assistance ◽

Assistance Programs ◽

Reducing Costs

Download Full-text

Translation and validation of the Traditional Chinese version of the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (Version 2)

Health and Quality of Life Outcomes ◽

10.1186/s12955-020-01646-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Dorothy N. S. Chan ◽

Kai Chow Choi ◽

Marques S. N. Ng ◽

Weijie Xing ◽

Bernard M. H. Law ◽

...

Keyword(s):

Chronic Illness ◽

Cancer Patients ◽

Functional Assessment ◽

Financial Distress ◽

Service Use ◽

Health Care Service ◽

Face Validity ◽

Financial Toxicity ◽

Chronic Illness Therapy ◽

The Cost

Abstract Background Cancer patients often experience severe financial distress due to the high cost of their treatment, and strategies are needed to objectively measure this financial distress. The COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is one instrument used to measure such financial distress. This study aimed to translate the COST-FACIT (Version 2) [COST-FACIT-v2] instrument into traditional Chinese (COST-FACIT-v2 [TC]) and evaluate its psychometric properties. Methods The Functional Assessment of Chronic Illness Therapy (FACIT) translation method was adopted. The translated version was reviewed by an expert panel and by 20 cancer patients for content validity and face validity, respectively, and 640 cancer patients, recruited from three oncology departments, completed the translated scale. Its reliability was evaluated in terms of internal consistency and test–retest reliability. Confirmatory factor analysis has been used to evaluate the one- and two-factor structures of the instrument reported in the literature. The convergent validity was examined by the correlation with health-related quality of life (HRQoL) and psychological distress. Known-group validity was examined by the difference in the COST-FACIT-v2 (TC) total mean score between groups with different income levels and frequency of health care service use. Results The COST-FACIT-v2 (TC) showed good content and face validity and demonstrated high internal consistency (Cronbach’s alpha, 0.86) and acceptable test–retest reliability (intraclass correlation coefficient, 0.71). Confirmatory factor analysis showed that the one- and two-factor structures of the instrument that have been reported in the literature could not be satisfactorily fitted to the data. Psychological distress correlated significantly with the COST-FACIT-v2 (TC) score (r = 0.47; p < 0.001). HRQOL showed a weak to moderate negative correlation with the COST-FACIT-v2 (TC) score (r = − 0.23 to − 0.46; p < 0.001). Significant differences were seen among the COST-FACIT-v2 (TC) scores obtained in groups of different income level and frequency of health care service use. Conclusions The COST-FACIT-v2 (TC) showed some desirable psychometric properties to support its validity and reliability for assessing cancer patients’ level of financial toxicity.

Download Full-text

Identifying missing links in the conceptualization of financial toxicity: a qualitative study

Supportive Care in Cancer ◽

10.1007/s00520-021-06643-6 ◽

2021 ◽

Author(s):

Sara L. Lueckmann ◽

Nadine Schumann ◽

Christoph Kowalski ◽

Matthias Richter

Keyword(s):

Financial Distress ◽

Financial Burden ◽

Subjective Evaluation ◽

Subjective Assessment ◽

Patient Reported Outcome ◽

Financial Toxicity ◽

Perceived Burden ◽

Conceptual Clarity ◽

Patient Reported ◽

The Impact

Abstract Purpose Financial toxicity can have a major impact on the quality of life of cancer survivors but lacks conceptual clarity and understanding of the interrelationships of the various aspects that constitute financial toxicity. This study aims to extract major drivers and mediators along the pathway from cancer-related costs to subjective financial distress from the patients’ experiences to establish a better understanding of financial toxicity as a patient-reported outcome. Methods Qualitative semistructured interviews with 39 cancer patients were conducted in Germany and addressed patient experiences with cancer-related financial burden and distress in a country with a statutory health care system. Transcripts were analyzed using content analysis. Results Several aspects of financial burden need to be considered to understand financial toxicity. The assessment of the ability to make ends meet now or in the future and the subjective evaluation of financial adjustments—namely, the burden of applied financial adjustments and the availability of financial adjustment options—mediate the connection between higher costs and subjective financial distress. Moreover, bureaucracy can influence financial distress through a feeling of helplessness during interactions with authorities because of high effort, non-traceable decisions, or one’s own lack of knowledge. Conclusion We identified four factors that mediate the impact of higher costs on financial distress that should be addressed in further studies and targeted by changes in policies and support measures. Financial toxicity is more complex than previously thought and should be conceptualized and understood more comprehensively in measurements, including the subjective assessment of available adjustment options and perceived burden of financial adjustments.

Download Full-text