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

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]

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

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 64-64
Author(s):  
Margaret Irene Liang ◽  
Janice Leahgrace Simons ◽  
Ivan I. Herbey ◽  
Jaclyn Wall ◽  
Lindsay Rucker ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Patients ◽  
Financial Distress ◽  
Financial Assistance ◽  
Financial Toxicity ◽  
Assistance Programs ◽  
Patient Reported ◽  
Facilitators And Barriers ◽  
Inductive Thematic Analysis ◽  
Patients Perspective

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]

Financial Toxicity During Breast Cancer Treatment: A Qualitative Analysis to Inform Strategies for Mitigation

2021 ◽  
pp. OP.21.00182
Author(s):  
Laila A. Gharzai ◽  
Kerry A. Ryan ◽  
Lauren Szczygiel ◽  
Susan Goold ◽  
Grace Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Financial Distress ◽  
Ductal Carcinoma ◽  
Financial Burden ◽  
Unmet Need ◽  
Metastatic Breast ◽  
Financial Toxicity ◽  
Knowledge Gaps ◽  
Treatment Expectations

PURPOSE: Financial toxicity from cancer treatment is a growing concern. Its impact on patients requires refining our understanding of this phenomenon. We sought to characterize patients' experiences of financial toxicity in the context of an established framework to identify knowledge gaps and strategies for mitigation. METHODS: Semistructured interviews with patients with breast cancer who received financial aid from a philanthropic organization during treatment were conducted from February to May 2020. Interviews were transcribed and coded until thematic saturation was reached, and findings were contextualized within an existing financial toxicity framework. RESULTS: Thirty-two patients were interviewed, of whom 58% were non-Hispanic White. The mean age was 46 years. Diagnoses ranged from ductal carcinoma in situ to metastatic breast cancer. Concordant with an established framework, we found that direct and indirect costs determined objective financial burden and subjective financial distress stemmed from psychosocial, behavioral, and material impact of diagnosis and treatment. We identified expectations as a novel theme affecting financial toxicity. We identified knowledge gaps in treatment expectations, provider conversations, identification of resources, and support-finding and offer strategies for mitigating financial toxicity on the basis of participant responses, such as leveraging support from decision aids and allied providers. CONCLUSION: This qualitative study confirms an existing framework for understanding financial toxicity and identifies treatment expectations as a novel theme affecting both objective financial burden and subjective financial distress. Four knowledge gaps are identified, and strategies for mitigating financial toxicity are offered. Mitigating patients' financial toxicity is an important unmet need in optimizing cancer treatment.

scholarly journals Elevated Cancer-Specific Mortality Among HIV-Infected Patients in the United States

2015 ◽  
Vol 33 (21) ◽  
pp. 2376-2383 ◽  
Author(s):  
Anna E. Coghill ◽  
Meredith S. Shiels ◽  
Gita Suneja ◽  
Eric A. Engels
Keyword(s):  
Cancer Treatment ◽  
Cox Regression ◽  
B Cell Lymphoma ◽  
The United States ◽  
Cancer Stage ◽  
Infected People ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose Despite advances in the treatment of HIV, HIV-infected people remain at increased risk for many cancers, and the number of non–AIDS-defining cancers is increasing with the aging of the HIV-infected population. No prior study has comprehensively evaluated the effect of HIV on cancer-specific mortality. Patients and Methods We identified cases of 14 common cancers occurring from 1996 to 2010 in six US states participating in a linkage of cancer and HIV/AIDS registries. We used Cox regression to examine the association between patient HIV status and death resulting from the presenting cancer (ascertained from death certificates), adjusting for age, sex, race/ethnicity, year of cancer diagnosis, and cancer stage. We included 1,816,461 patients with cancer, 6,459 (0.36%) of whom were HIV infected. Results Cancer-specific mortality was significantly elevated in HIV-infected compared with HIV-uninfected patients for many cancers: colorectum (adjusted hazard ratio [HR], 1.49; 95% CI, 1.21 to 1.84), pancreas (HR, 1.71; 95% CI, 1.35 to 2.18), larynx (HR, 1.62; 95% CI, 1.06 to 2.47), lung (HR, 1.28; 95% CI, 1.17 to 1.39), melanoma (HR, 1.72; 95% CI, 1.09 to 2.70), breast (HR, 2.61; 95% CI, 2.06 to 3.31), and prostate (HR, 1.57; 95% CI, 1.02 to 2.41). HIV was not associated with increased cancer-specific mortality for anal cancer, Hodgkin lymphoma, or diffuse large B-cell lymphoma. After further adjustment for cancer treatment, HIV remained associated with elevated cancer-specific mortality for common non–AIDS-defining cancers: colorectum (HR, 1.40; 95% CI, 1.09 to 1.80), lung (HR, 1.28; 95% CI, 1.14 to 1.44), melanoma (HR, 1.93; 95% CI, 1.14 to 3.27), and breast (HR, 2.64; 95% CI, 1.86 to 3.73). Conclusion HIV-infected patients with cancer experienced higher cancer-specific mortality than HIV-uninfected patients, independent of cancer stage or receipt of cancer treatment. The elevation in cancer-specific mortality among HIV-infected patients may be attributable to unmeasured stage or treatment differences as well as a direct relationship between immunosuppression and tumor progression.

Financial Toxicity in Cancer Treatment

2021 ◽  
pp. 616-620
Author(s):  
Victoria Blinder ◽  
Francesca M. Gany
Keyword(s):  
Cancer Treatment ◽  
Emotional Distress ◽  
Low Income ◽  
Financial Distress ◽  
Financial Burden ◽  
Symptom Burden ◽  
Indirect Costs ◽  
Young Female ◽  
Vulnerable Groups ◽  
Financial Toxicity

Financial toxicity is a preventable cancer treatment side effect, encompassing the subjective financial distress and objective financial burden that result from increased spending and decreased earning after diagnosis. The prevalence of financial toxicity has increased with new expensive cancer treatments and insurers gradually shifting costs to patients. Patients with financial toxicity experience increased symptom burden, treatment nonadherence, and cancer-related death. The patients at highest risk are young, female, and nonwhite. For low-income patients, the indirect costs of cancer care can be especially burdensome and include child/elder care, transportation, unpaid work absences or job loss, cancer-related comorbidity treatment costs, and fulfilling dietary requirements. Psychosocial impacts include depression, emotional distress, and reduced quality of life. Patients in palliative care have rated financial distress as more severe than physical, familial, and emotional distress. Interventions and policy changes are needed to ameliorate the effects of financial toxicity, especially for the most vulnerable groups.

scholarly journals High-Cost Cancer Treatment Across Borders in Conflict Zones: Experience of Iraqi Patients in Lebanon

2020 ◽  
pp. 59-66 ◽  
Author(s):  
Mac Skelton ◽  
Raafat Alameddine ◽  
Omran Saifi ◽  
Miza Hammoud ◽  
Maya Zorkot ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Financial Distress ◽  
Medical Tourism ◽  
Geographic Proximity ◽  
Conflict Zones ◽  
Tertiary Referral Center ◽  
Patients With Cancer ◽  
Cross Border ◽  
Institutional Review ◽  
The Social

PURPOSE Conflict-induced cross-border travel for medical treatment is commonly observed in the Middle East. There has been little research conducted on the financial impact this has on patients with cancer or on how cancer centers can adapt their services to meet the needs of this population. This study examines the experience of Iraqi patients seeking care in Lebanon, aiming to understand the social and financial contexts of conflict-related cross-border travel for cancer diagnosis and treatment. PATIENTS AND METHODS After institutional review board approval, 60 Iraqi patients and caregivers seeking cancer care at a major tertiary referral center in Lebanon were interviewed. RESULTS Fifty-four respondents (90%) reported high levels of financial distress. Patients relied on the sale of possessions (48%), the sale of homes (30%), and vast networks to raise funds for treatment. Thematic analysis revealed several key drivers for undergoing cross-border treatment, including the conflict-driven exodus of Iraqi oncology specialists; the destruction of hospitals or road blockages; referrals by Iraqi physicians to Lebanese hospitals; the geographic proximity of Lebanon; and the lack of diagnostic equipment, radiotherapy machines, and reliable provision of chemotherapy in Iraqi hospitals. CONCLUSION As a phenomenon distinct from medical tourism, conflict-related deficiencies in health care at home force patients with limited financial resources to undergo cancer treatment in neighboring countries. We highlight the importance of shared decision making and consider the unique socioeconomic status of this population of patients when planning treatment.

scholarly journals Oncologists’ Attitudes and Practice of Addressing Diet, Physical Activity, and Weight Management With Patients With Cancer: Findings of an ASCO Survey of the Oncology Workforce

2019 ◽  
Vol 15 (6) ◽  
pp. e520-e528 ◽  
Author(s):  
Jennifer A. Ligibel ◽  
Lee W. Jones ◽  
Abenaa M. Brewster ◽  
Steven K. Clinton ◽  
Larissa A. Korde ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Treatment ◽  
Weight Management ◽  
Online Survey ◽  
Clinical Care ◽  
The United States ◽  
Related Factors ◽  
Patients With Cancer ◽  
Physical Activity Programs ◽  
Oncology Providers

PURPOSE: Obesity and related factors have been linked to cancer risk and outcomes, but little information exists with regard to oncologists’ attention to these issues as a part of clinical care. METHODS: Oncology providers actively caring for patients with cancer in the United States and internationally were asked to complete an online survey about practice patterns and perceptions with regard to obesity and weight management during and after active cancer treatment. RESULTS: Nine hundred seventy-one practicing oncology providers completed the survey. The majority of respondents indicated a belief that the evidence linking obesity to cancer outcomes was strong and that weight and related factors should be addressed as a part of cancer treatment. The majority of respondents also reported that they frequently assessed body weight and related factors as well as counsel their patients to exercise, consume a healthy diet, and lose weight, if applicable. However, referral to providers and programs to support weight loss and increased physical activity occurred less frequently, and a number of barriers were identified for the incorporation of weight management and physical activity programs in the treatment of patients with cancer. CONCLUSION: In a survey of oncology providers, attention to weight management, physical activity, and diet in patients with cancer was high during and after cancer treatment but often did not result in referrals to support lifestyle change. Future work is needed to support education and training of oncology providers to facilitate referrals and overcome barriers to implementation of weight management and physical activity programs for patients with cancer.

scholarly journals Trends in Financial Toxicity for Patients of a Community Cancer Clinic

Blood ◽  
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.

The impact of race, education, and employment status on cost-coping strategies and patient reported benefit from interventions to mitigate financial toxicity.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 91-91
Author(s):  
Kenya Braxton ◽  
Bridgette Thom ◽  
Carol L. Brown ◽  
Francesca Gany ◽  
Fumiko Chino ◽  
...  
Keyword(s):  
Coping Strategies ◽  
Gynecologic Cancer ◽  
Bachelor's Degree ◽  
Financial Toxicity ◽  
Waiting Room ◽  
Targeted Interventions ◽  
Patient Reported ◽  
The Cost ◽  
The Impact ◽  
Hispanic White

91 Background: As patient financial toxicity increases with the cost of cancer healthcare, patient outcomes and quality of life may be impaired. We sought to evaluate sociodemographic factors associated with use of cost-coping strategies, as well as strategies to mitigate financial toxicity. Methods: We conducted a survey of consecutive patients in an urban outpatient gynecologic cancer clinic waiting room over 2 weeks in August 2019. The survey included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST; scored 0-44, lower scores indicate worse outcomes), assessment of cost-coping strategies, and patient-reported anticipated benefit from possible interventions. Patients were categorized by race/ethnicity (non-Hispanic white, Hispanic white, black, Asian, other) and employment and education status. Kruskal-Wallis and Fisher’s exact tests were used to assess differences between groups. Results: Of 101 patients, 75 completed the survey. Most patients were non-Hispanic white (60%), retired (45%), and had at minimum a bachelor’s degree (65%). The median COST score was 32 (range 6-44). For cost-coping strategies, among renters (n=48), black and other race patients compared to white patients more often indicated skipping a rent payment (25% and 50% vs 0%; p<.01). Employed patients compared to retired patients more often indicated reducing leisure spending (58% vs 27%; p=.02). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated borrowing money to pay for medical bills (24% vs 6%; p=.04). For proposed interventions to lessen financial toxicity, non-Hispanic white and Asian patients compared to black patients more often indicated they wanted to know the cost of their healthcare upfront (38% and 33% vs 0%; p =.26). Employed patients compared to unemployed and retired patients more often indicated that minimizing copays would be beneficial (36% vs 13% and 12%, p=.05). Patients with less than a bachelor’s degree compared to those with a bachelor’s degree or higher more often indicated that transportation assistance would be helpful (76% vs 24%; p<.01). Conclusions: As the needs of different sociodemographic groups vary, so do their cost-coping strategies and preferred interventions to ameliorate financial toxicity. Varying patient needs should be considered when developing interventions to mitigate financial toxicity. Next steps should assess the benefit of targeted interventions on coping strategies in specific sociodemographic groups.

Safety and efficacy of COVID-19 vaccination in patients receiving systemic anticancer therapy.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 245-245
Author(s):  
Mahir Khan ◽  
Ryan Huu-Tuan Nguyen ◽  
James Love ◽  
Alexander Krule ◽  
Michael Weinfeld ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Vaccine Dose ◽  
Female Gender ◽  
Anticancer Therapy ◽  
The United States ◽  
Hospitalization Rate ◽  
Asian Ethnicity ◽  
Treatment Regimens ◽  
Patients With Cancer ◽  
Increased Risk

245 Background: Patients with cancer who have been treated with systemic anticancer therapy are at increased risk of morbidity and mortality from COVID-19 and have been considered a high-priority group for COVID-19 vaccination in the United States. There is limited guidance and data on the appropriate timing of COVID-19 vaccination relative to receipt of systemic anticancer therapy. Methods: We queried the electronic medical record at the University of Illinois Hospital for patients with gastrointestinal, breast, lung, genitourinary, and head and neck tumors who had received intravenous systemic anticancer therapy between January 1, 2021 and May 25, 2021. Baseline variables were obtained as well as details of cancer treatment, vaccination timing relative to cancer treatment, and clinical outcomes. Results: A total of 274 patients received intravenous systemic anticancer therapy during the study period, of which 161 (58.8%) received at least one vaccine dose, and 138 (42.7%) were fully vaccinated. Of the 122 patients who received cancer treatment within 30 days of any vaccine dose, the median age was 64, and 72 (59%) were female gender. Race distribution was 50% Black, 15.6% White, 3.3% Asian; ethnicity was 24.6% Hispanic and 73% not-Hispanic. Treatment regimens consisted of 37.7% chemotherapy, 25.4% immunotherapy, 27.9% combination therapy, and 9.0% targeted therapy. For those who received anticancer therapy within 30 days of a vaccine, median time between any vaccination and treatment was 10 days (range 0-29 days). For those who had at least 60 days of follow-up after first vaccination, all-cause hospitalization rate was 22.4% (23/106). There was no statistical difference in all-cause 60-day hospitalization rate between those who received vaccination within 5 days of anticancer therapy versus those who received it between 6 and 30 days from anticancer therapy (14.3% vs 28.1%, p = 0.1). One patient (0.8%) developed a COVID-19 illness after any vaccine and did not require hospitalization. Conclusions: We observed safe and efficacious COVID-19 vaccination of patients with cancer receiving systemic IV anticancer therapy. COVID-19 infection after vaccination was rare, with no cases requiring hospitalization for COVID-19 illness post-vaccination in this cohort. All-cause hospitalization rates were similar among patients who received a vaccine within or after 5 days of receiving systemic anticancer therapy, suggesting vaccination side effect tolerability. Further quality improvement studies are needed on interventions to increase vaccination rates in this vulnerable population.

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

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.

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