Drug Recovery and Copay Assistance Program in a Community Cancer Center: Charity and Challenges

PURPOSE: The cost of cancer care is escalating dramatically, in part because of the rising expense of systemic cancer therapy. This creates financial dilemmas for patients and insurers and potential economic disruption for institutions attempting to provide cancer care to the underserved. Our institution initiated a drug recovery and copay assistance program (DRCAP) to mitigate the impact of the rising cost of parenteral medications. METHODS: We performed a 3-year review of our strategies to mitigate financial burden of parenteral therapeutics and supportive care medicines. Financial metrics were established and analyzed before and after implementing DRCAP. Medication encounters and associated costs were stratified by adolescents and young adults (15 to 39 years of age), and adults 40 years of age and older and were annualized from 2016 to 2018. RESULTS: The DRCAP resulted in a total of nearly $3.5 million worth of drugs replaced or copay assistance yearly in 2017 and 2018. This accounted for approximately 10% of our pharmacy budget for parenteral medications in each of these years. The vast majority was received in the form of drug replacement. The DRCAP resulted in assistance to 173 and 256 patients in 2017 and 2018, respectively. CONCLUSION: A DRCAP increased availability of otherwise unaffordable parenteral oncolytics and resulted in cost savings for our institution. Adolescents and young adults were disproportionately represented because of inadequate or no insurance. Despite the salutary benefits, such programs likely inflate the overall cost of cancer care. Cancer care providers participating in a DRCAP will remain in this conundrum until market forces can affect the cost of oncology therapeutics.

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A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

Current Oncology ◽

10.3390/curroncol28040278 ◽

2021 ◽

Vol 28 (4) ◽

pp. 3201-3213

Author(s):

Kaitlyn Howden ◽

Camille Glidden ◽

Razvan G. Romanescu ◽

Andrew Hatala ◽

Ian Scott ◽

...

Keyword(s):

Young Adults ◽

Cancer Treatment ◽

Cancer Care ◽

Negative Impact ◽

Positive Impact ◽

Care Delivery ◽

Adolescents And Young Adults ◽

P Value ◽

Cross Sectional Survey ◽

The Impact

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.

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Fear of receiving less effective care: A barrier to effective cancer care cost communication.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18339 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18339-e18339

Author(s):

Sokbom Kang ◽

Yelee Yu

Keyword(s):

Effective Treatment ◽

Cancer Patients ◽

Cancer Care ◽

Financial Burden ◽

Considerable Proportion ◽

Care Providers ◽

Financial Status ◽

Cost Effective Treatment ◽

The Cost ◽

To Receive

e18339 Background: Increasing financial burden in cancer care promoted cost communication as an intervention to the problem. We explored patients’ attitudes and concerns for the physician-patient communication of the costs of cancer care. Methods: From an oncology outpatient clinic, patients were recruited and interviewed using a 29-item questionnaire. The questionnaire includes basic and financial characteristics, attitudes toward cost-communication, and experience of cost-communication with oncologists. Results: Among 292 patients with gynecologic cancer, 68% were found to have an income below the nation’s average households income. Although the majority (81%) of patients have a positive attitude toward patient-physician cancer care cost-communication, however, only 19% of them wanted to discuss the cost with their physicians - 33% of them did not want to disclose their financial status to health care providers and 48% wanted to discuss the cost with other providers than their physicians. In addition, while 87% preferred to be informed about costs for various treatment options, 86% of them did not want to receive cost-effective treatment and preferred to receive the most effective treatment regardless of their financial status. Compared with non-cancer patients (n = 83), significantly more patients had a negative attitude to disclosing their financial status especially to their physician (22% vs. 11%, P = 0.024). Conclusions: A considerable proportion of cancer patients had concerns that cost communication with their physician may interfere with their opportunity to access the best care options. To facilitate cost communication, oncologists should understand such concerns and making a thoughtful effort to relieve the concern during cost communication.

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The impact of COVID‐19 on the cancer care of adolescents and young adults and their well‐being: Results from an online survey conducted in the early stages of the pandemic

Cancer ◽

10.1002/cncr.33098 ◽

2020 ◽

Vol 126 (19) ◽

pp. 4414-4422 ◽

Cited By ~ 5

Author(s):

Urška Košir ◽

Maria Loades ◽

Jennifer Wild ◽

Milan Wiedemann ◽

Alen Krajnc ◽

...

Keyword(s):

Young Adults ◽

Cancer Care ◽

Online Survey ◽

Well Being ◽

Adolescents And Young Adults ◽

Early Stages ◽

The Impact

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Fear of receiving less effective care: A barrier to effective cancer care cost communication.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.8 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 8-8

Author(s):

Sokbom Kang ◽

Ye Lee Yu

Keyword(s):

Effective Treatment ◽

Cancer Patients ◽

Cancer Care ◽

Financial Burden ◽

Considerable Proportion ◽

Care Providers ◽

Financial Status ◽

Cost Effective Treatment ◽

The Cost ◽

To Receive

8 Background: Increasing financial burden in cancer care promoted cost communication as an intervention to the problem. We explored patients’ attitudes and concerns for the physician-patient communication of the costs of cancer care. Methods: From an oncology outpatient clinic, patients were recruited and interviewed using a 29-item questionnaire. The questionnaire includes basic and financial characteristics, attitudes toward cost-communication, and experience of cost-communication with oncologists. Results: Among 292 patients with gynecologic cancer, 68% were found to have an income below the nation’s average households income. Although the majority (81%) of patients have a positive attitude toward patient-physician cancer care cost-communication, however, only 19% of them wanted to discuss the cost with their physicians - 33% of them did not want to disclose their financial status to health care providers and 48% wanted to discuss the cost with other providers than their physicians. In addition, while 87% preferred to be informed about costs for various treatment options, 86% of them did not want to receive cost-effective treatment and preferred to receive the most effective treatment regardless of their financial status. Compared with non-cancer patients (n = 83), significantly more patients had a negative attitude to disclosing their financial status especially to their physician (22% vs. 11%, P = 0.024). Conclusions: A considerable proportion of cancer patients had concerns that cost communication with their physician may interfere with their opportunity to access the best care options. To facilitate cost communication, oncologists should understand such concerns and making a thoughtful effort to relieve the concern during cost communication.

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A Reflection on the Work of Gianni Bonadonna from the Viewpoint of the Global Challenge of Adolescents and Young Adults with Cancer

Tumori Journal ◽

10.5301/tj.5000682 ◽

2017 ◽

Vol 103 (6) ◽

pp. 489-494 ◽

Cited By ~ 1

Author(s):

Ronald D. Barr ◽

W. Archie Bleyer

Keyword(s):

Young Adults ◽

Survival Rates ◽

Great Majority ◽

Adolescents And Young Adults ◽

Care Providers ◽

Middle Income ◽

Late Professor ◽

Global Challenge ◽

Middle Income Countries ◽

The Impact

Adolescents and young adults (AYAs – ages 15 to 39) constitute approximately 40% of the world's population and contribute an estimated one million new cases of cancer annually, the great majority in low- and middle-income countries (LMICs). In high-income countries (HICs) cancer is the commonest cause of disease-related death in AYAs, though overall 5-year survival rates now exceed 80%. A very different circumstance likely holds in LMICs, but accurate assessments are not readily available. Breast cancer accounts for 40% of tumours in female AYAs and this age group includes the peak incidence of Hodgkin lymphoma. The late Professor Gianni Bonadonna contributed importantly to improved survival in patients with these two diseases. Accordingly, he would be justifiably proud of the advances in AYA oncology that are being made in Italy, especially the impact of his colleagues at the Istituto Nazionale dei Tumori (INT). The initiatives of the Associazione Italiana Ematologia Pediatrica and the Società Italiana Adolescenti con Malattie Onco-ematologiche are particularly noteworthy, with the accomplishment of productive collaboration between paediatric and adult cancer care providers serving as a model for other countries to emulate. Exporting these advances can be successful through the vehicle of “twinning”: establishing sustainable cooperation between institutions in HICs and partners in LMICs. Colleagues in Monza and at INT have been leaders in such programmes for decades. Cancer in AYAs remains a global challenge to which Gianni Bonadonna surely would have risen with enthusiasm and leadership while securing measurable achievements.

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Cancer care through the fire and flames: Three-year experience in utilizing of oncologic electronic consultation and referral system in the red zone of Thailand.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.14 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 14-14

Author(s):

Nanthiya Rattanakhot ◽

Arunee Dechaphunkul ◽

Patrapim Sunpaweravong ◽

Chirawadee Sathitruangsak ◽

Maliwan Songserm ◽

...

Keyword(s):

Cancer Patients ◽

Waiting Time ◽

Cancer Care ◽

Financial Burden ◽

Referral System ◽

Cancer Center ◽

Potential Cost ◽

Electronic Consultation ◽

Consultation And Referral ◽

The Impact

14 Background: “The South Thailand Insurgency” is burning violence in the deep south of Thailand. The insurgency which has been ongoing since 2004 has played out in the three southernmost districts of the country Pattani, Yala and Narathiwat and some area of Songkhla, so-called the “Red Zone”. The chronic terrorism had major affected on cancer service. Many cancer patients gave up on their lives due to struggle with the disease itself, financial constraints due to longstanding economic downturn and security concerns during travelling led to high loss to follow-up rate and treatment delay. We, an oncology service team working at Songklanagarind hospital, the only one cancer center served this area together with primary doctors and nurses in the Red Zone created a network and utilized an oncology-specific electronic consultation and referral system to make more efficient care. We reported its performance in 3 years period. Methods: Electronic consultation system (E-consult) was a web-based program developed to provide advice and facilitate the referral process in cancer care. Since October 2015, we prospectively surveyed the impact of this pilot project on the quality of service by counting waiting time, number of center visit until treatment, unnecessary referral avoidance, patient and potential cost saving compared to normal referral system. Results: E-consult reached out to 7 hospitals and 589 cancer patients successfully referred through E-consult. Among patients from the Red Zone, without E-consult, their average waiting time was 56.4 days, number of visit was 6.5 visits. The estimated financial burden was $758.8 per patient. After implementation of E-consult in 259 patients, average time to treatment was 41.5 days (p = 0.006) and a number of the counter visit was 2.3 visits (p < 0.001). Estimated financial burden could be reduced to $358.7(p < 0.001). Ultimately, we prevented 28 patients from unnecessary referral. Conclusions: In this special context the electronic referral system was helpful to improve medical access, timeliness to specialist care, saving the patients’ family time and resources. This model is widely applicable to oncology referral chain.

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Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1220 ◽

2011 ◽

Vol 14 (2) ◽

Author(s):

Thomas G Koch

Keyword(s):

Weight Loss ◽

Cost Savings ◽

Cost Effective ◽

Economic Consequences ◽

Health Care Spending ◽

Order Of Magnitude ◽

Dynamic Measures ◽

The Cost ◽

The Impact ◽

The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

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Generalized Joint Hypermobility and Anxiety in Adolescents and Young Adults, the Impact on Physical and Psychosocial Functioning

Healthcare ◽

10.3390/healthcare9050525 ◽

2021 ◽

Vol 9 (5) ◽

pp. 525

Author(s):

Janneke de Vries ◽

Jeanine Verbunt ◽

Janine Stubbe ◽

Bart Visser ◽

Stephan Ramaekers ◽

...

Keyword(s):

Young Adults ◽

Psychosocial Functioning ◽

Negative Impact ◽

Pain Catastrophizing ◽

Joint Hypermobility ◽

Adolescents And Young Adults ◽

P Value ◽

High Performing ◽

Generalized Joint Hypermobility ◽

The Impact

The purpose of this study was to study the association between the presence of generalized joint hypermobility (GJH) and anxiety within a non-clinical high performing group of adolescents and young adults. Second, to study the impact of GJH and/or anxiety on physical and psychosocial functioning, 168 adolescents and young adults (mean (SD) age 20 (2.9)) were screened. Joint (hyper)mobility, anxiety, and physical and psychosocial functioning were measured. In 48.8% of all high performing adolescents and young adults, GJH was present, whereas 60% had symptoms of anxiety. Linear models controlled for confounders showed that adolescents and young adults with GJH and anxiety had decreased workload (ß (95%CI) −0.43 (−0.8 to −0.08), p-value 0.02), increased fatigue (ß (95%CI) 12.97 (6.3–19.5), p-value < 0.01), and a higher level of pain catastrophizing (ß (95%CI) 4.5 (0.5–8.6), p-value 0.03). Adolescents and young adults with only anxiety had increased fatigue (ß (95%CI) 11 (4.9–19.5). In adolescents and young adults with GJH alone, no impact on physical and psychosocial functioning was found. Adolescents and young adults with the combination of GJH and anxiety were significantly more impaired, showing decreased physical and psychosocial functioning with decreased workload, increased fatigue, and pain catastrophizing. Presence of GJH alone had no negative impact on physical and psychosocial functioning. This study confirms the association between GJH and anxiety, but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in adolescents and young adults with GJH and might influence tailored interventions.

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The Australian Youth Cancer Service: Developing and Monitoring the Activity of Nationally Coordinated Adolescent and Young Adult Cancer Care

Cancers ◽

10.3390/cancers13112675 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2675

Author(s):

Pandora Patterson ◽

Kimberley R. Allison ◽

Helen Bibby ◽

Kate Thompson ◽

Jeremy Lewin ◽

...

Keyword(s):

Clinical Trial ◽

Young Adults ◽

Cancer Care ◽

Young Patients ◽

Adolescents And Young Adults ◽

Adolescent And Young Adult ◽

Trial Participation ◽

Clinical Trial Participation ◽

Activity Data ◽

Cancer Services

Adolescents and young adults (aged 15–25 years) diagnosed with cancer have unique medical and psychosocial experiences and care needs, distinct from those of paediatric and older adult patients. Since 2011, the Australian Youth Cancer Services have provided developmentally appropriate, multidisciplinary and comprehensive care to these young patients, facilitated by national service coordination and activity data collection and monitoring. This paper reports on how the Youth Cancer Services have conceptualised and delivered quality youth cancer care in four priority areas: clinical trial participation, oncofertility, psychosocial care and survivorship. National activity data collected by the Youth Cancer Services between 2016–17 and 2019–20 are used to illustrate how service monitoring processes have facilitated improvements in coordination and accountability across multiple indicators of quality youth cancer care, including clinical trial participation, access to fertility information and preservation, psychosocial screening and care and the transition from active treatment to survivorship. Accounts of both service delivery and monitoring and evaluation processes within the Australian Youth Cancer Services provide an exemplar of how coordinated initiatives may be employed to deliver, monitor and improve quality cancer care for adolescents and young adults.

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Obesity in Children and Adolescents during COVID-19 Pandemic

Children ◽

10.3390/children8020135 ◽

2021 ◽

Vol 8 (2) ◽

pp. 135

Author(s):

Androniki Stavridou ◽

Evangelia Kapsali ◽

Eleni Panagouli ◽

Athanasios Thirios ◽

Konstantinos Polychronis ◽

...

Keyword(s):

Physical Activity ◽

Young Adults ◽

Health Care Providers ◽

Eating Behaviors ◽

Adolescents And Young Adults ◽

Care Providers ◽

Weight Changes ◽

Sugary Drinks ◽

Precautionary Measures ◽

Obesity In Children

Background: The COVID-19 pandemic has led to special circumstances and changes to everyday life due to the worldwide measures that were imposed such as lockdowns. This review aims to evaluate obesity in children, adolescents and young adults during the COVID-19 pandemic. Methods: A literature search was conducted to evaluate pertinent studies up to 10 November 2020. Results: A total of 15 articles were eligible; 9 identified 17,028,111 children, adolescents and young adults from 5–25 years old, 5 pertained to studies with an age admixture (n = 20,521) and one study included parents with children 5–18 years old (n = 584). During the COVID-19 era, children, adolescents and young adults gained weight. Changes in dietary behaviors, increased food intake and unhealthy food choices including potatoes, meat and sugary drinks were noted during the ongoing COVID-19 pandemic. Food insecurity associated with financial reasons represents another concern. Moreover, as the restrictions imposed reduced movements out of the house, physical activity was limited, representing another risk factor for weight gain. Conclusions: COVID-19 restrictions disrupted the everyday routine of children, adolescents and young adults and elicited changes in their eating behaviors and physical activity. To protect them, health care providers should highlight the risk of obesity and provide prevention strategies, ensuring also parental participation. Worldwide policies, guidelines and precautionary measures should ideally be established.

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