Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.

Download Full-text

Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study

BMJ Open ◽

10.1136/bmjopen-2019-030968 ◽

2019 ◽

Vol 9 (11) ◽

pp. e030968 ◽

Cited By ~ 5

Author(s):

Tom Bourne ◽

Harsha Shah ◽

Nora Falconieri ◽

Dirk Timmerman ◽

Christoph Lees ◽

...

Keyword(s):

Medical Practice ◽

Maslach Burnout Inventory ◽

Well Being ◽

Survey Study ◽

Secondary Outcome ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Obstetrics And Gynaecology ◽

Quality Of Patient Care ◽

The Uk

ObjectivesTo determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being.DesignNationwide online cross-sectional survey study; December 2017–March 2018.SettingHospitals in the UK.Participants5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists.Primary and secondary outcome measuresPrevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being.Results3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout.ConclusionsHigh levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.

Download Full-text

Understanding the Psychological Impact of COVID-19 Pandemic on Patients With Cancer, Their Caregivers, and Health Care Workers in Singapore

JCO Global Oncology ◽

10.1200/go.20.00374 ◽

2020 ◽

pp. 1494-1509

Author(s):

Kennedy Yao Yi Ng ◽

Siqin Zhou ◽

Sze Huey Tan ◽

Nur Diana Binte Ishak ◽

Zack Zhong Sheng Goh ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Psychological Impact ◽

Maslach Burnout Inventory ◽

Well Being ◽

Vulnerable Groups ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patients With Cancer ◽

Care Workers

PURPOSE The coronavirus disease 2019 (COVID-19) pandemic has had a global impact, and Singapore has seen 33,000 confirmed cases. Patients with cancer, their caregivers, and health care workers (HCWs) need to balance the challenges associated with COVID-19 while ensuring that cancer care is not compromised. This study aimed to evaluate the psychological effect of COVID-19 on these groups and the prevalence of burnout among HCWs. METHODS A cross-sectional survey of patients, caregivers, and HCWs at the National Cancer Centre Singapore was performed over 17 days during the lockdown. The Generalized Anxiety Disorder-7 and Maslach Burnout Inventory were used to assess for anxiety and burnout, respectively. Self-reported fears related to COVID-19 were collected. RESULTS A total of 624 patients, 408 caregivers, and 421 HCWs participated in the study, with a response rate of 84%, 88%, and 92% respectively. Sixty-six percent of patients, 72.8% of caregivers, and 41.6% of HCWs reported a high level of fear from COVID-19. The top concern of patients was the wide community spread of COVID-19. Caregivers were primarily worried about patients dying alone. HCWs were most worried about the relatively mild symptoms of COVID-19. The prevalence of anxiety was 19.1%, 22.5%, and 14.0% for patients, caregivers, and HCWs, respectively. Patients who were nongraduates and married, and caregivers who were married were more anxious. The prevalence of burnout in HCWs was 43.5%, with more anxious and fearful HCWs reporting higher burnout rates. CONCLUSION Fears and anxiety related to COVID-19 are high. Burnout among HCWs is similar to rates reported prepandemic. An individualized approach to target the specific fears of each group will be crucial to maintain the well-being of these vulnerable groups and prevent burnout of HCWs.

Download Full-text

Burnout of Healthcare Workers amid the COVID-19 Pandemic: A Japanese Cross-Sectional Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052434 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2434

Author(s):

Yoshito Nishimura ◽

Tomoko Miyoshi ◽

Hideharu Hagiya ◽

Yoshinori Kosaki ◽

Fumio Otsuka

Keyword(s):

Healthcare Workers ◽

Healthcare Professionals ◽

Healthcare Delivery ◽

General Medicine ◽

Maslach Burnout Inventory ◽

University Hospital ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Past

The coronavirus disease 2019 (COVID-19) global pandemic has drastically changed how we live and work. Amid the prolonged pandemic, burnout of the frontline healthcare professionals has become a significant concern. We conducted a cross-sectional survey study to provide data about the relationship between the COVID-19 pandemic and the prevalence of burnout in healthcare professionals in Japan. Healthcare workers in a single Japanese national university hospital participated in the survey, including basic demographics, whether a participant engaged in care of COVID-19 patients in the past 2 weeks and the Maslach Burnout Inventory. Of those, 25.4% fully answered the survey; 33.3% were doctors and 63.6% were nurses, and 36.3% engaged in care of COVID-19 patients in the past 2 weeks. Compared to those belonging to General Medicine, those in Emergency Intensive Care Unit were at higher risk of burnout (odds ratio (OR), 6.7; 95% CI, 1.1–42.1; p = 0.031). Of those who engaged in care of COVID-19 patients, 50% reported burnout while 6.1% did not (OR 8.5, 95% CI; 1.3–54.1; p = 0.014). The burnout of healthcare workers is a significant concern amid the pandemic, which needs to be addressed for sustainable healthcare delivery.

Download Full-text

Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD

Journal of Psychopharmacology ◽

10.1177/0269881120967878 ◽

2021 ◽

pp. 026988112096787

Author(s):

Alan K Davis ◽

Frederick S Barrett ◽

Sara So ◽

Natalie Gukasyan ◽

Thomas C Swift ◽

...

Keyword(s):

Life Satisfaction ◽

Longitudinal Research ◽

Psychological Flexibility ◽

Well Being ◽

Survey Study ◽

Strongly Correlated ◽

Strong Correlations ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Therapeutic Outcomes

Background: Several measures have been developed to examine acute psychedelic effects (e.g. mystical-type and challenging experiences), but no measure assesses acute psychologically insightful experiences that may occur during psychedelic experiences. Aim: The purpose of this study was to develop and examine the psychometric properties of the Psychological Insight Questionnaire. Method: A cross-sectional survey study among psilocybin and LSD users. Respondents ( n=1661; Mage=22.9, standard deviation=8.5; Caucasian/White=83%; non-Hispanic=91%; men=72%; United States resident=66%) completed an Internet-based survey. Results: The Psychological Insight Questionnaire consists of 23 items with two subscales: (a) Avoidance and Maladaptive Patterns Insights and (b) Goals and Adaptive Patterns Insights. Construct validity of the Psychological Insight Questionnaire was supported by strong correlations of the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores with the insight subscale of the Session Impacts Scale, and weak-to-moderate correlations with the Mystical Experiences and Challenging Experiences Questionnaires. Furthermore, Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores were moderately-to-strongly correlated with retrospectively reported increases in psychological flexibility, and well-being/life satisfaction that were attributed to a memorable psychedelic experience. Lastly, incremental validity was established showing that the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights subscale) scores predict unique variance in changes in psychological flexibility, and Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores predict changes in well-being and life satisfaction, beyond measures of acute mystical-type and challenging effects. Conclusions: The Psychological Insight Questionnaire has the potential to extend the understanding of the acute and enduring effects of psychedelics. Further longitudinal research is necessary to determine the long-term predictive validity of the Psychological Insight Questionnaire and to examine the role of psychological insight in predicting therapeutic outcomes.

Download Full-text

Doctors’ perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional survey of the UK physicians

BMJ Open ◽

10.1136/bmjopen-2017-017856 ◽

2017 ◽

Vol 7 (11) ◽

pp. e017856 ◽

Cited By ~ 7

Author(s):

Tom Bourne ◽

Bavo De Cock ◽

Laure Wynants ◽

Mike Peters ◽

Chantal Van Audenhove ◽

...

Keyword(s):

Online Survey ◽

Well Being ◽

Adverse Outcomes ◽

Perceived Support ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Final Sample ◽

Perception Of Support ◽

The Uk

ObjectiveHow adverse outcomes and complaints are managed may significantly impact on physician well-being and practice. We aimed to investigate how depression, anxiety and defensive medical practice are associated with doctors actual and perceived support, behaviour of colleagues and process issues regarding how complaints investigations are carried out.DesignA survey study. Respondents were classified into three groups: no complaint, recent/current complaint (within 6 months) or past complaint. Each group completed specific surveys.SettingBritish Medical Association (BMA) members were invited to complete an online survey.Participants95 636 members of the BMA were asked to participate. 7926 (8.3%) completed the survey, of whom 1780 (22.5%) had no complaint, 3889 (49.1%) had a past complaint and 2257 (28.5%) had a recent/current complaint. We excluded those with no complaints leaving 6144 in the final sample.Primary outcomes measuresWe measured anxiety and depression using the Generalised Anxiety Disorder Scale 7 and Physical Health Questionnaire 9. Defensive practice was assessed using a new measure for avoidance and hedging.ResultsMost felt supported by colleagues (61%), only 31% felt supported by management. Not following process (56%), protracted timescales (78%), vexatious complaints (49%), feeling bullied (39%) or victimised for whistleblowing (20%), and using complaints to undermine (31%) were reported. Perceived support by management (relative risk (RR) depression: 0.77, 95% CI 0.71 to 0.83; RR anxiety: 0.80, 95% CI 0.74 to 0.87), speaking to colleagues (RR depression: 0.64, 95% CI 0.48 to 0.84 and RR anxiety: 0.69, 95% CI 0.51 to 0.94, respectively), fair/accurate documentation (RR depression: 0.80, 95% CI 0.75 to 0.86; RR anxiety: 0.81, 95% CI 0.75 to 0.87), and being informed about rights (RR depression 0.96 (0.89 to 1.03) and anxiety 0.94 (0.87 to 1.02), correlated positively with well-being and reduced defensive practice. Doctors worried most about professional humiliation following a complaint investigation (80%).ConclusionPoor process, prolonged timescales and vexatious use of complaints systems are associated with decreased psychological welfare and increased defensive practice. In contrast, perceived support from colleagues and management is associated with a reduction in these effects.

Download Full-text

Exploring Safety Aspects in Dental School Clinics Including Droplet Infection Prevention

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4941 ◽

2020 ◽

Vol 8 (E) ◽

pp. 509-515

Author(s):

Asmaa Abdelnaby ◽

Laila Mahmoud Kamel ◽

Jylan Elguindy ◽

Reham Yousri Elamir ◽

Eman Elfar

Keyword(s):

Health Care ◽

Patient Safety ◽

Infection Control ◽

Dental Health ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Safety Practices ◽

Preparedness Plan ◽

Dental Schools

BACKGROUND: Health-care safety focuses on improving patient’s and worker’s safety in a safe working clinics’ environment and prevent infection transmission including droplet infections as seasonal influenza and novel coronavirus (COVID-19). Dental health-care personnel (DHCP) are the target of safety measures and are themselves responsible for elimination of preventable harm. Dental schools are expected to demonstrate the model for quality safe care. AIM: This study aims to achieve high-quality safe dental care at dental clinics, Faculty of Dentistry, Cairo University. METHODS: A cross-sectional survey study was conducted at two Dental Outpatient Clinics, Cairo University. Disk review of policies, observation checklists for practices and awareness questionnaires of DHCP were used. RESULTS: DHCP showed good awareness for most of infection control (IC) and X-ray safety items. However, there are no policies or procedures to control droplet infections in the clinics. The clinics were closed in the current COVID-19 pandemic. There were poor patient safety practices, hand hygiene compliance, and personal protective equipment (PPE) use except for protecting clothes and disposable gloves. Students showed better compliance for patient safety guidelines. Other safety policies were poorly communicated. CONCLUSION: There should be preparedness plan to deal with any droplet infection outbreak, epidemic or pandemic as COVID-19 in all dental settings. There is a need to initiate dental safety unit in dental schools to implement, communicate, train, and supervise all dental safety practices including infection control.

Download Full-text

Areas of Work Life as Predictors of Occupational Burnout of Nurses and Doctors in Operating Theaters in Poland—Multicenter Studies

Healthcare ◽

10.3390/healthcare10010026 ◽

2021 ◽

Vol 10 (1) ◽

pp. 26

Author(s):

Piotr Jarzynkowski ◽

Renata Piotrkowska ◽

Wioletta Mędrzycka-Dąbrowska ◽

Janina Książek

Keyword(s):

Emotional Exhaustion ◽

Maslach Burnout Inventory ◽

Work Life ◽

Personal Accomplishment ◽

Survey Study ◽

Cross Sectional Survey ◽

Occupational Burnout ◽

Multicenter Studies ◽

Cross Sectional ◽

Mean Values

Introduction: Researchers’ interest in occupational burnout results primarily from the dangerous and extensive consequences of this phenomenon. The aim of the study was to analyze the level of occupational burnout among nurses and doctors in operating theaters. Materials and Methods: A cross-sectional survey study conducted on 325 nurses and doctors of seven hospitals in Poland. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) by Michael Leiter and Christina Maslach. Results: The mean values for the level of occupational burnout for the entire sample according to the scale from the Maslach Burnout Inventory by C. Maslach amounted to 14.35 for emotional exhaustion, 8.56 for depersonalization, and 11.90 for personal accomplishment; when compared to reference levels, they classified emotional exhaustion at a low level, depersonalization at an average level, and personal accomplishment at a high level of burnout. Areas of work life are predictors of occupational burnout. The analysis showed a relationship between three of the six variables. As the workload increased, so did the level of burnout among participants, and the categories of honesty and values. Conclusions: The conducted research has shown that occupational burnout among nurses and doctors in operating theaters occurs in all dimensions of this phenomenon (emotional exhaustion, depersonalization, job satisfaction). It was also shown that the areas of work life (workload, control, community, rewards, fairness, values) are predictors of occupational burnout among the respondents. This article shows how important the problem of burnout among operating theater medical staff is. Perhaps it will allow nurses and doctors to recognize this syndrome and encourage them make changes to their work to prevent burnout.

Download Full-text

Improving community health networks for people with severe mental illness: a case study investigation

Health Services and Delivery Research ◽

10.3310/hsdr03050 ◽

2015 ◽

Vol 3 (5) ◽

pp. 1-234 ◽

Cited By ~ 11

Author(s):

Vanessa Pinfold ◽

Daryl Sweet ◽

Ian Porter ◽

Cath Quinn ◽

Richard Byng ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Illness ◽

Severe Mental Illness ◽

Community Health ◽

Well Being ◽

Personal Networks ◽

System Level ◽

Network Type ◽

Care System

IntroductionPolicy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.MethodsA five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.ResultsThree personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.ConclusionWhile our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Download Full-text

The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study (Preprint)

10.2196/preprints.22142 ◽

2020 ◽

Author(s):

Jean C J Liu ◽

Eddie M W Tong

Keyword(s):

Protective Factor ◽

Psychological Symptoms ◽

Well Being ◽

Primary Outcome Measure ◽

World Health ◽

Survey Study ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Global Pandemic ◽

Health Organization

BACKGROUND In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. OBJECTIVE In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. METHODS Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government’s WhatsApp channel; and (3) their demographics. RESULTS Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=–0.07, t[863]=–2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government’s WhatsApp messages (b=–0.05, t[863]=–2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. CONCLUSIONS Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an “infodemic.” CLINICALTRIAL ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574

Download Full-text

Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems

JCO Oncology Practice ◽

10.1200/op.20.00890 ◽

2021 ◽

pp. OP.20.00890

Author(s):

Divya A. Parikh ◽

Meera Ragavan ◽

Ritika Dutta ◽

Jeffrey Garnet Edwards ◽

James Dickerson ◽

...

Keyword(s):

Health Care ◽

Cancer Care ◽

Care Delivery ◽

Medical Center ◽

Financial Burden ◽

Financial Toxicity ◽

Cross Sectional Survey ◽

Factors Associated ◽

Care Systems ◽

Comprehensive Score

PURPOSE: The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. METHODS: We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity. RESULTS: Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI ( P < .0001), high OOPCs ( P = .003), and employment changes as a result of cancer diagnosis ( P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS. CONCLUSION: Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.

Download Full-text