Financial toxicity and patient-provider communication about cancer-related cost among prostate cancer patients and survivors.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 215-215
Author(s):  
Elissa C. Kranzler ◽  
Melissa F. Miller ◽  
Erica E. Fortune ◽  
Daniel M. Geynisman ◽  
Linda S. Bohannon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Health Care ◽  
Financial Burden ◽  
Provider Communication ◽  
Financial Toxicity ◽  
Cost Of Treatment ◽  
Related Cost ◽  
Patient Provider Communication

215 Background: With early screening and advances in treatment, prostate cancer (PC) patients are living longer and facing increasingly complex therapeutic decisions alongside significant financial burden related to care (e.g., copays, coinsurance, other out-of-pocket (OOP) costs). Conversations with providers about financial concerns can help patients navigate these decisions, thereby promoting delivery of quality care and improving quality of life. We characterized financial toxicity (FT) and patient-provider communication about cancer-related cost among PC patients and survivors. Methods: 107 PC patients and survivors enrolled in Cancer Support Community’s Cancer Experience Registry completed items assessing FT (11-item FACIT-COST measure; range = 0-44, lower scores indicate greater FT). Items include ability to meet monthly expenses, financial stress, and cancer/treatment influence on financial situation. Frequencies and correlations between FT, health care team (HCT) communication, and socio-demographics were examined. Results: Participants were 89% non-Hispanic White, 5% Black, 2% Hispanic; mean age was 68 years (SD = 7.5). Median time since diagnosis was 3 years; 19% reported experiencing symptoms of PC at the time of diagnosis. 21% were ever metastatic, 22% experienced a recurrence, and 48% reported currently receiving treatment. 29% were employed full- or part-time; 52% spent at least $100/month on all OOP PC costs, 30% spent $250 or more, 16% spent $500 or more. Mean FT score was 28 (SD = 11.9). 67% reported members of their HCT did not discuss cost of treatment, 55% did not discuss impact of PC and treatment on work, 77% did not discuss financial distress. While most participants were satisfied with their doctor’s explanation of benefits (89%) and risks/side effects (79%) for each treatment option, only 49% were satisfied with how much their HCT discussed financial costs of each option. Greater patient confidence in communicating with doctor about PC was significantly associated with less FT ( r= .19, p< .05), but experiencing more FT was not correlated with a greater likelihood of HCT discussing cost of treatment ( r= -.05, p= .63) or discussing impact of cancer and treatment on work ( r= .04, p= .67). Conclusions: Results indicate that patients with greater financial toxicity report less confidence in communicating with their doctor about PC, however providers are not frequently or systematically initiating discussions around cost and impact on work even among those experiencing the highest levels of financial burden. Findings underscore the critical value of transparency about health care costs and impact, as well as support for providers in communicating effectively with patients about costs and available resources, to improve patient quality of life and health outcomes.

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

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.

Health care cost in hormone-naive and hormonally pretreated patients with prostate cancer treated with degarelix.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 240-240
Author(s):  
Johannes Wolff ◽  
Alexander Tolle ◽  
Michael Gedamke
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Health Care ◽  
Health Care Cost ◽  
Direct Costs ◽  
Pronounced Difference ◽  
Life Improvement ◽  
Pretreated Patients ◽  
One Year

240 Background: Degarelix, is a GnRH-antagonist, which is used in the treatment of prostate cancer since 2009. We performed a non-interventional study (NIS) with prostate cancer (PCA) patients treated routinely with degarelix. This NIS focused on pharmaco-economical data, quality of life as well as efficacy and safety in patients receiving degarelix as first or second line therapy. Methods: In the interims analysis of this ongoing NIS, data from 279 out of 670 PCA-patients treated with degarelix were included. The included cohort reflects advanced PCA patients (age: 72 years, PSA: 15.8 ng/ml (median values)).Testosterone and PSA values, quality of life and pharmaco-economical data were collected at baseline, 1, 3, 6, 9 and 12 months. Quality of life was assessed by EQ-5D. Pharmaco-economical data included direct costs for physicians, drugs, hospital, emergency treatment and others. Results: Treatment costs in hormon-naïve patients treated with degarelix were lower than in the hormonally pre-treated patients. Direct costs for six month were 498,- € for hormone naïve patients treated with degarelix in contrast to 1436,- € for hormonally pre-treated patients. As expected there was a marked difference in the PSA-decline between hormone-naïve patients and hormonally pre-treated patients. Hormone-naïve patients experienced a sharp median decrease in PSA by 80.7% (n=116) at month 1. This decline remained stable in 98.7% of the patients after one year. Median PSA reduction was significantly different (p=0.013) between hormone-naïve and pre-treated patients. Furthermore treatment of degarelix improved quality of life by 14% at one year compared to baseline. Testosterone was suppressed to a median of 0.2 ng/ml from month 1 to 12. Safety results mirrored the results of clinical trials. Conclusions: First-line treatment with degarelix was supported by a marked difference in health care costs between hormone naïve and pre-treated prostate cancer patients, who received degarelix. As expected a pronounced difference in the PSA-decrease in hormone naïve and pre-treated patients was seen. However a distinct quality of life improvement was noted in all patients.

Exploring the role of digital health coaching for men with prostate cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS1586-TPS1586
Author(s):  
Nathan Handley ◽  
Kuang-Yi Wen ◽  
Sameh Gomaa ◽  
Kelly Jean Brassil ◽  
Lindsey Jackson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Global Health ◽  
Self Efficacy ◽  
Digital Health ◽  
Health Coaching ◽  
Summary Statistics ◽  
Financial Toxicity ◽  
Cancer Management

TPS1586 Background: Toxicity leading to impaired quality of life is common among men receiving treatment for Prostate Cancer (PCa). Digital interventions may be beneficial in enhancing health self-efficacy in managing symptom burden. This study evaluates the feasibility and preliminary outcomes of digital health coaching intervention on men with PCa. Methods: This pilot study aims to recruit up to 100 adult, English-speaking men with PCa who in the last 2 years have required active treatment, defined as cancer management via active surveillance, surgery, radiation, androgen deprivation, chemotherapy, hormonal therapy, immunotherapy or a combination of these modalities. Men will be enrolled across the catchment area of Jefferson Health using social media and a variety of other outreach tools approved by the Institutional Review Board. Consented patients are enrolled in a 3-month digital health coaching program which combines weekly calls with up to 4 nudges of evidence-based content delivered via text or email weekly. The program focuses on a weekly health topic, such as physical, mental, social, or financial health, and managing symptoms, and empowers participants to set health goals of importance to them. Primary endpoints include feasibility, defined as 60% of participants completing the 3-month program. The main secondary endpoints measured are health self-efficacy as measured by the Cancer Behavior Inventory-Brief (CBI-B), quality of life, as measured by the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), financial toxicity as measured by the Comprehensive Score of Financial Toxicity (COST) and physical and mental health as measured by the Patient Reported Outcomes Measurement Information System-Global Health 10 (PROMIS-10). Outcomes are captured on enrollment and monthly through program completion for a total of 4 data points. Summary statistics will be used to describe patient demographic and clinical characteristics of the study population. Summary statistics will also be used to describe CBI, EPIC-CP, PROMIS and COST by assessment time. The change in CBI-B scores from baseline to 3 months will be calculated along with 95% confidence intervals. Additional LMMs will be created to assess the relationship between self-efficacy (CBI) and quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10).

Outcomes of a pilot study exploring the role of digital health coaching for men with prostate cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 102-102
Author(s):  
Nathan Handley ◽  
Kuang-Yi Wen ◽  
Sameh Gomaa ◽  
Ayako Shimada ◽  
Benjamin Leiby ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Pilot Study ◽  
Global Health ◽  
Self Efficacy ◽  
Digital Health ◽  
Community Setting ◽  
Health Coaching ◽  
Financial Toxicity

102 Background: As the most common cancer among men in the US, prostate cancer (PCa) affects nearly 250,000 men annually, accounting for over 13% of all new cancer cases. Health-related quality of life (HRQoL) during and post-treatment is impacted by sexual, urinary and bowel function which can persist for months or years after treatment completion. As individuals primarily manage such symptoms in the community setting there is a need for interventions that can address overall health and wellness concerns needs of men with PCa beyond the clinical setting. Digital health coaching (DHC) is one such solution that has potential to address HRQoL for individuals with cancer. Methods: The aim of this pilot study was to evaluate the feasibility of a DHC program for individuals with PCa. One hundred English-speaking men with PCa requiring active treatment within the past 2 years were recruited from across the Delaware Valley. Consented individuals were enrolled in a 3-month DHC program, consisting of a weekly call from a health advisor along with delivery of evidence-based supplemental content via text or email focused on exercise nutrition, physical, emotional and sexual health, as well as financial toxicity. Secondary endpoints evaluated the relationship between the DHC intervention and health self-efficacy, as measured by the Cancer Behavior Inventory-Brief Form (CBI-B), quality of life (EPIC-CP), financial toxicity (COST) and global health (PROMIS- SF10). Results: 82 individuals enrolled in the study for which the mean age was 68 years old (1.2 % Black, 2.4% Rural). The feasibility threshold of 60% was met with 58 individuals completing the 3-month program (proportion = 70.7%, 90% CI: 61.4, 78.9). Health self-efficacy improved with a mean change in CBI-B of 4.1 (95% CI: 0.4, 7.8). The financial toxicity improved with a mean score change of 2.5 (95% CI: 1.0, 4.0). All symptom scores of EPIC-CP were improved by showing a decrease of mean scores. PROMIS-GH also improved in both mental and physical health domains with mean changes of 0.5 and 1.4 (95% CIs for mental: -1.6, 2.6, for physical: -0.1, 2.8). Conclusions: DHC demonstrated feasibility in a cross-sectional population of men with PCA recruited in the community setting. Data suggest that HRQoL, health-self efficacy and global health can be positively impacted by DHC. Results support the further evaluation of DHC in larger RCTs.

Access to Health Care and Quality of Life for Underserved Men with Prostate Cancer

2011 ◽  
Vol 27 (4) ◽  
pp. 267-277 ◽  
Author(s):  
Sally L. Maliski ◽  
Sarah E. Connor ◽  
Charlotte Oduro ◽  
Mark S. Litwin
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Health Care ◽  
Access To Health Care ◽  
Access To Health

Chronic pain-related patient-provider communication: The significance of health related quality of life and satisfaction

2015 ◽  
Vol 8 (1) ◽  
pp. 50-50 ◽  
Author(s):  
T. Jonsdottir ◽  
S. Gunnarsdottir ◽  
H. Jonsdottir
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Daily Life ◽  
Demographic Variables ◽  
Provider Communication ◽  
Related Quality ◽  
Health Related ◽  
Patient Provider Communication ◽  
And Control

Abstract Aims To investigate patients’ perception of chronic pain related patient-provider communication in relation to socio-demographic and pain-related variables. Methods Apostal questionnaire measuring socio-demographic variables, pain characteristics, health-related quality of life (HRQoL), pain-related health care utilization and perceived patient provider communication, was sent to a sample of 4500 individuals randomly drawn from the national population of Iceland. Relationships between patient perceived patient-provider communication and perceived outcome, satisfaction with care as well as sociodemographic and pain-related variables were tested by using bivariate and multivariate statistical analysis. Results The prevalence of chronic pain (≥3months) among respondents was 47.5%. Among participants reporting chronic pain, 53.2% had consulted a health care provider for pain during the previous six months. Patients’ perception of providers’ behaviour and control in the communication was mostly related to pain impact on daily life and physical components of HRQoL as well as to patients’ satisfaction with health care providers. The more pain interfered with daily life and impaired patients’ physical health, the more they felt that the provider did not spend time to listen to their concerns and discuss symptoms and treatment options. Patients’ perception of own activity and control in the patient-provider communication and participation in care was related to socio-demographic variables but not with pain related variables. Conclusions To be understood as an individual and having their concerns legitimized by the health care provider is crucial for patients when consulting health care for chronic pain. The more pain interferes with daily life and impairs HRQoL, the more important this is. Patients’ perception of own control in patient-provider communication and participation in care is more related to socio-demographics than pain related variables.

scholarly journals Uncertainty and Quality of Life Among Men Undergoing Active Surveillance for Prostate Cancer in the United States and Ireland

2007 ◽  
Vol 2 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Josephine M. Hegarty ◽  
Meredith Wallace ◽  
Harry Comber
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
United States ◽  
Health Care ◽  
Active Surveillance ◽  
Psychological Health ◽  
Health Care Professionals ◽  
The United States ◽  
Management Option

Background. Prostate cancer continues to be the most common site of male cancers, particularly among older men in Europe and the United States, and the second most common male cancer worldwide. Active surveillance involves the use of no local or systemic therapy once prostate cancer has been diagnosed. A description of uncertainty and quality of life among men undergoing active surveillance in samples from both the United States and Ireland has the potential to enhance global health care delivery. Methods. The specific aim of this study is to enhance the understanding of the experience of active surveillance for prostate cancer among Irish and American men by measuring quality of life and levels of uncertainty among men over the age of 65 in receipt of the active surveillance management option for prostate cancer. A quantitative, descriptive survey design was used. Results. Twenty-nine men completed questionnaires. The results reveal that men undergoing active surveillance in the United States have slightly higher levels of uncertainty. Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries. Total affective and health-related quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences. Irish men had lower mean role and social function than U.S. men, and higher general health and energy. Irish men reported more urine bother and less sexual bother than U.S. men. Conclusion. To assist men with prostate cancer who are treated with the active surveillance management option, health care professionals must develop an awareness of how prostate cancer affects the man's physical and psychological health care outcomes.

scholarly journals Study of urinary incontinence affecting the quality of life and health seeking behavior in women of an urban slum in Mumbai

2018 ◽  
Vol 6 (1) ◽  
pp. 290
Author(s):  
Jyoti S. Mandge ◽  
Armaity Dehmubed
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Urinary Incontinence ◽  
Social Interactions ◽  
Financial Burden ◽  
Urban Slum ◽  
Sexual Life ◽  
Seeking Behavior ◽  
Emotional Upset

Background: Urinary incontinence (UI) defined by the International Continence Society as the complaint of any involuntary leakage of urine, is a social or hygiene problem. The purpose of this study was to determine how UI affected quality of life (QOL) of women in urban slum in Mumbai and also their health care seeking behavior for the same.Methods: A pre-formed, pre-tested, semi-structured questionnaire was designed for a centre based study, to collect information from 1200 eligible and willing women over a period of 6 months. Of these 361 had complaints of UI how had the UI affected their quality of life and whether they sought health care for treatment of same was studied. Data was entered in Microsoft Excel and analysis was done accordingly.Results: Of the 361 women who had UI, the QOL was affected as in avoiding social interactions 45.15%, avoiding religious functions 49.03%, feeling of emotional upset/distress 59.8% and hampering of domestic work 57.8%. The extra financial burden felt due to UI was only in 7.7% women and only 1.9% complained of sexual life getting affected. Health care services for treatment of UI were sought by only 24.1% of the affected women.Conclusions: That UI affected the QOL of women affected with it in terms of reduced social interactions and attendance at religious programs and the feeling of emotional upset and hampering of domestic works. Subjects felt their financial burden had increased due to UI.

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

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 874-874 ◽  
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.

Financial toxicity and cancer-related distress among melanoma survivors.

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.

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