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.

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]

Inequalities in access to cross-border resources? An analysis based on spatio-temporal behaviours in the cross-border area of Greater Geneva

2021 ◽  
pp. 096977642110267
Author(s):  
Alexis Gumy ◽  
Guillaume Drevon ◽  
Vincent Kaufmann
Keyword(s):  
Labour Market ◽  
Border Area ◽  
Cross Border ◽  
The Social ◽  
Neighbouring Country ◽  
Logistic Regressions ◽  
The Cross ◽  
Spatio Temporal

With an activity-based approach, this article offers a new reading of cross-border integration by exploring the social and spatial conditions that predispose specific populations of Greater Geneva to cross its borders. Five different daily cross-border patterns were identified showing that travelling to the neighbouring country is still uncommon among the least qualified populations and women, and that this trend now extends beyond the mere cross-border labour market. Logistic regressions show that Greater Geneva is witnessing a functionalisation of its cross-border integration, revealing mechanisms where the increase of particular mobility may foster segregation and inequalities. This article argues for an approach where cross-border integration is not an objective but rather is a consequence of obligations and constraints that individuals face in their daily behaviours.

A Social Enterprise Company in EU Organisational Law?

2021 ◽  
pp. 1-35
Author(s):  
J S LIPTRAP
Keyword(s):  
European Integration ◽  
European Commission ◽  
Social Enterprise ◽  
Social Economy ◽  
Member States ◽  
Regulatory Issues ◽  
Cross Border ◽  
The Social ◽  
Proposal A

Abstract This article explores the European Parliament's July 2018 non-legislative resolution proposing to the European Commission a directive for facilitating social enterprise companies’ cross-border activities. The proposal is first situated within the context of the social economy and how the sector has grown in importance to European integration. The proposal and the European Commission's response are then examined. Although the European Commission was not convinced that Member States would be amenable to the proposal, a consensus may already exist that is sufficient to garner their support. Even if this prediction is wrong, however, it is argued that there are reasons to surmise that the proposal will likely be reassessed and ultimately successful at some future point. Finally, the proposal is viewed with a reflexive harmonisation lens. Through the analysis, regulatory issues are identified, and a solution is then suggested.

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.

Tobacco use, knowledge of harms, and cessation support among patients with non-tobacco related cancers.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24029-e24029
Author(s):  
Laura Vater ◽  
Anup Trikannad Ashwini Kumar ◽  
Neha Sehgal ◽  
Maria Khan ◽  
Kelsey Bullens ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Treatment ◽  
Medical Center ◽  
Safety Net ◽  
Cancer Center ◽  
Prescribe Medication ◽  
Patients With Cancer ◽  
Quit Smoking ◽  
Increased Risk ◽  
Quit Attempts

e24029 Background: Continued cigarette smoking among patients with cancer leads to numerous adverse health outcomes, even among patients with non-tobacco-related cancers such as breast, colon, and prostate cancer. Continued smoking is associated with poorer response to cancer treatment, increased risk for treatment-related toxicities, and shorter overall survival. While some patients with a smoking-related cancer make efforts to quit smoking at the time of diagnosis, patients with other forms of cancer might not understand the negative effects of continued smoking. In this study, we assessed patient knowledge of the harms of continued smoking, previous cessation attempts, and cessation support. Methods: We surveyed 102 adults with breast, colon, and prostate cancer at three locations: an NCI-designated cancer center, an urban safety-net medical center, and a rural cancer center. Patients were asked about current smoking behaviors, beliefs about the harms of continued smoking, quit attempts and resources used, and cessation support. We also surveyed seven oncologists to assess beliefs about harms of continued smoking, cessation support provided to patients, training and confidence in cessation counseling, and barriers to providing cessation support. Results: Most patients (82%) agreed or strongly agreed that continued smoking may shorten life expectancy, and 70% agreed or strongly agreed that continued smoking increased the risk of getting a different type of cancer. Only 41% of patients agreed or strongly agreed that continued smoking may cause more side effects from cancer treatment, and only 40% agreed or strongly agreed that ongoing smoking may affect treatment response. The majority of patients (86%) had tried to quit smoking for good, with an average 4.1 quit attempts per patient. Patients reported that physicians advised them to quit the majority of the time (92%), prescribed medication 33% of the time, and followed up on cessation attempts 43% of the time. Overall, oncologists had higher knowledge of the harms of continued smoking on treatment outcomes and survival. Those in practice for 20 years or more had higher confidence in cessation counseling than those in practice less than 4 years. Oncologists described lack of time and lack of confidence in cessation counseling as barriers to providing more cessation support. Conclusions: Among 102 patients with breast, colon, and prostate cancer who currently smoke, there was incomplete knowledge of the harms of continued smoking. Oncologists believe that tobacco cessation is important and frequently advise patients to quit, however they less frequently prescribe medication or follow up on cessation efforts. Interventions are needed to educate patients with cancer about the harms of continued smoking and to provide further cessation support.

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.

scholarly journals Clusters for Medical Tourism as a new Approach for Risk Management in Cross-border Healthcare

2017 ◽  
Vol 27 (suppl_3) ◽  
Author(s):  
L Georgieva ◽  
R Dimitrova ◽  
K Lazarova ◽  
R Gerl ◽  
M Georgiev
Keyword(s):  
Risk Management ◽  
Medical Tourism ◽  
New Approach ◽  
Cross Border

Research for Substantiation to Upscale Bio-Based Materials in the Construction Industry

2022 ◽  
Author(s):  
Fred van der Burgh ◽  
Sissy Verspeek
Keyword(s):  
The Netherlands ◽  
Construction Industry ◽  
Building Construction ◽  
Cross Border ◽  
The Social ◽  
Technical Issues

The building construction industry is slowly adopting bio-based materials. To accelerate this process, it is necessary to gain more proven data about technical issues. This should also fit in the social-economical and juridical context of the construction industry. In this paper we will highlight the main drivers and research that is going on in the Netherlands. Including a cross border project that works on this topic.

Cross-Border Funding and Microfinance Mission Drift: Evidence from Sub-Saharan Africa

2016 ◽  
Vol 17 (2) ◽  
pp. 20-40
Author(s):  
Akem Forkusam
Keyword(s):  
Sub Saharan Africa ◽  
Microfinance Institutions ◽  
Public And Private ◽  
Mission Drift ◽  
Cross Border ◽  
The Social ◽  
Sub Saharan ◽  
The Impact ◽  
Different Sources ◽  
Ssa Countries

Sub-Saharan Africa (SSA) has become the top priority for international funders and they are now increasing their cross-border funding to microfinance institutions (MFIs) in the region. This foreign funding is considered an additional source of capital for MFIs in the region who are facing difficulties in meeting the demand of the poor. However, these funds are provided by public and private funders who each have different motives. The paper examines the impact of these different sources of funding on microfinance performance and mission drift in SSA, which is the world’s poorest region. The study utilizes data from 212 MFIs in 30 SSA countries accessed over a three-year period (i.e. 2007, 2009, and 2011). The findings show that cross-border funding does not affect either the social or financial performance of MFIs when time and country effects are accounted for.

Sign in / Sign up

Export Citation Format

Share Document