scholarly journals Burden of Treatment Among Elderly Patients with Cancer: A Scoping Review

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 612
Author(s):  
Adem Sav ◽  
Sara S. McMillan ◽  
Adeola Akosile
Keyword(s):  
Elderly Patients ◽  
Cancer Treatment ◽  
Scoping Review ◽  
Financial Burden ◽  
Significant Proportion ◽  
Indirect Costs ◽  
The United States ◽  
Treatment Burden ◽  
Cross Sectional ◽  
Patients With Cancer

Background: The objective of this scoping review is to understand how treatment burden is experienced in elderly patients with cancer and what the most prevalent dimensions of treatment burden are among this population. According to one conceptual model, there are six dimensions of treatment burden, including financial, medication, administrative, time/travel, lifestyle, and healthcare. Methods: A scoping review methodology framework was used to collected data from EMBASE CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline/PubMed, Scopus, Web of Science, Embase, and Cochrane from 2000 to March 2020. Studies which focused on treatment burden among elderly patients with cancer (+65 years) were selected. Data were extracted using a standardized proforma. Results: The results identified 3319 total papers. Of these, 24 met the inclusion criteria and were included in the scoping review. A significant proportion of these studies was conducted in the United States (n = 10) using self-reported, cross-sectional data. Financial burden was the most prevalent dimension of treatment burden, with 11 studies focusing on the direct and indirect costs associated with cancer treatment. Other but less obvious aspects of treatment burden elderly patients experienced included the length of time taken to access and administer treatment and medication-related burdens. Conclusion: Emerging findings suggest that the financial aspects of cancer treatment are a significant burden for most elderly cancer patients. Personalized healthcare interventions targeting ways to reduce and screen for treatment burden, particularly those related to cost, are urgently needed.

Role of clinical pharmacist in the palliative care of adults and elderly patients with cancer: A scoping review

2022 ◽  
pp. 107815522110734
Author(s):  
Julia Franco ◽  
Rafael N de Souza ◽  
Tácio de M Lima ◽  
Patricia Moriel ◽  
Marília B Visacri
Keyword(s):  
Palliative Care ◽  
Elderly Patients ◽  
Scoping Review ◽  
The United States ◽  
Eligibility Criteria ◽  
Patient Counselling ◽  
Clinical Pharmacists ◽  
Patients With Cancer ◽  
Pharmacist Interventions

Objective: We conducted this scoping review to map and summarize scientific evidence on the role of clinical pharmacists in the palliative care of adults and elderly patients with cancer. Data Sources: A literature search was performed in MEDLINE, PubMed Central, Embase, Web of Science, Scopus, and BVS/BIREME for studies published until November 22nd, 2020. Studies that reported work experiences adopted by clinical pharmacists in the palliative care of adults and elderly patients with cancer were included. Two independent authors performed study selection and data extraction. Any disagreements were resolved by discussion with the third and fourth authors. The pharmacist interventions identified in the included studies were described based on key domains in the DEPICT v.2. Data Summary: A total of 586 records were identified, of which 14 studies fully met the eligibility criteria. Most of them were conducted in the United States of America (n  =  5) and Canada (n  =  5) and described the workplace of the pharmacist in clinic/ambulatory (n  =  10). Clinical pharmacists performed several activities and provided services, highlighting medication review (n  =  12), patient and caregivers education (n  =  12), medication histories and-or medication reconciliation (n  =  6). The pharmacist interventions were mostly conducted for patients/caregivers (n  =  13), by one-on-one contact (n  =  14), and by face-to-face (n  =  13). Pharmacists were responsible mainly for change or suggestion for change in therapy (n  =  12) and patient counselling (n  =  12). Pharmacist interventions were well accepted by the clinical team. Overall, studies showed that pharmacists, within an interdisciplinary team, had significant impacts on measured outcomes. Conclusions: In recent years, there have been advances in the role of the pharmacist in palliative care of patients with cancer and there are great opportunities in this field. They play an important role in managing cancer pain and other symptoms, as well as resolving drug related problems. We encourage more research to be carried out to strengthen this field and to benefit patients with advanced cancer with higher quality of life.

scholarly journals Patient and family financial burden associated with cancer treatment in Canada: a national study

2021 ◽  
Author(s):  
Christopher J. Longo ◽  
Margaret I. Fitch ◽  
Jonathan M. Loree ◽  
Linda E. Carlson ◽  
Donna Turner ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Financial Burden ◽  
Family Care ◽  
Indirect Costs ◽  
National Study ◽  
Patients With Cancer ◽  
Alternative Medicines ◽  
Patient Reported ◽  
Household Incomes ◽  
Self Administered Questionnaire

Abstract Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

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.

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]

Financial Toxicity in Cancer Treatment

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

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

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

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

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

scholarly journals The prevalence of substance use in anaesthesia practitioners in South Africa

2019 ◽  
Vol 25 (6) ◽  
pp. 14-20
Author(s):  
JL Van Der Westhuizen ◽  
F Roodt ◽  
M Nejthardt ◽  
T Esterhuizen ◽  
M Flint ◽  
...  
Keyword(s):  
South Africa ◽  
Substance Use ◽  
South African ◽  
Significant Proportion ◽  
The United States ◽  
Opioid Use ◽  
Moderate Risk ◽  
Cross Sectional ◽  
Male And Female ◽  
South African Society

Background: In the United States the mortality associated with substance abuse among anaesthesia residents is twice that of non-anaesthesia residents. Since no data exist, the primary objective of this cross-sectional study was to establish the prevalence of substance use in South African anaesthesia practitioners. Secondary objectives were to compare the prevalence in male and female practitioners, and in private and state practice anaesthetists. Years of experience and level of training were explored as possible risk factors for hazardous or harmful use. Methods: Participants completed a self-administered, validated WHO questionnaire, over a ten-day period surrounding the 2018 South African Society of Anaesthesiologists (SASA) congress. All doctors practising anaesthesia in South Africa were eligible. Recruitment was via an email link sent to all SASA members, as well as a web-based link at the congress. Results: A total of 1 961 SASA members and 113 non-members (anaesthesiologists, registrars and non-specialists) were invited to participate (total 2 074). There were 434 responses (response rate 20.9%, margin of error 4.18%); 364 were suitable for analysis. The most commonly lifetime-used substances were alcohol (92.8%), tobacco (42.3%), cannabis (34.7%), and sedatives (34.4%). Questionnaire scores defined low-, medium- and high-risk categories according to substance use during the previous three months. Sedative (12.6%) and alcohol (12.1%) users were deemed to be at moderate risk. The prevalence of opioid use was 1.9% (n = 7). Prevalence of substance use was similar in male and female practitioners, as well as in those working in private practice or in state hospitals. Conclusion: The prevalence of current use of alcohol and sedatives is of major concern. A significant proportion of respondents were assessed to be at moderate risk of hazardous or harmful substance use. Gender and practice setting have little impact on substance use. Wellness efforts should be aimed at all anaesthesia practitioners in South Africa.

scholarly journals Catastrophic Healthcare Expenditure and Coping Strategies among Patients Attending Cancer Treatment Services in Addis Ababa, Ethiopia

2019 ◽  
Author(s):  
Gebremicheal Gebreslassie Kasahun ◽  
Gebremedhin Beedemariam Gebretekle ◽  
Yohannes Hailemichael Gecho ◽  
Aynalem Abraha Woldemariam ◽  
Teferi Gedif Fenta
Keyword(s):  
Cancer Treatment ◽  
Coping Strategies ◽  
Addis Ababa ◽  
Financial Burden ◽  
Public Hospitals ◽  
Medical Expenditure ◽  
Patients With Cancer ◽  
Treatment Services ◽  
Number Of Patients ◽  
And Coping

Abstract Background: With the rapid increase in magnitude and mortality of cancer, which is costly disease to manage, several patients particularly in developing countries are facing a huge financial burden. Objective: The purpose of the study was to examine the level of catastrophic health expenditure (CHE), identify associated factors and coping strategies among patients attending cancer treatment services in Addis Ababa, Ethiopia. Methods: A hospital based cross-sectional survey of patients with cancer was conducted in public and private hospitals between January and March 2018. Data was collected using a structured questionnaire. All direct medical and nonmedical expenditures were measured and reported as expenditure (US$) per patient (1US$ equivalent to 23.41 Ethiopian Birr). The CHE was estimated using a threshold of 10% of annual household income. Results: A total of 352 (response rate of 87.1%) participants were interviewed. Majority (73.3%) of the respondents were females; most (94%) from public hospitals and their mean (±SD) age was 48±13.2years. Breast (37%) and Cervical (16.5%) cancers accounted the largest proportion. Vast majority (74.4%) of patients experienced CHE with mean overall expenditure of $2366 per patient (median: $1708). Medical expenditure shared the highest overall expenditure (83.6%) with mean medical and nonmedical costs of $1978 (median: $1394) and $388 (median: $222), respectively. Patients who took greater than six cycles of chemotherapy (AOR: 3.64; 95%CI: 1.11-11.92), and age (AOR: 1.03; 95%CI: 1.01-1.06) were significantly associated with CHE. Household saving (85.5%) followed by financial support (43.0%) were the main coping strategies. Conclusion: A substantial number of patients with cancer are exposed to CHE with considerable medical expenditure. Hence, mobilizing the health insurance scheme is urgently needed to ensure financial risk protection and realize universal health coverage for patients with cancer.

Presentation and Outcomes of Elderly Patients Undergoing Head and Neck Surgeries: A National Perspective

2020 ◽  
Vol 163 (2) ◽  
pp. 335-343 ◽  
Author(s):  
Zaid Al-Qurayshi ◽  
Christopher Blake Sullivan ◽  
Adam Schwalje ◽  
Jarrett Walsh ◽  
Rodrigo Bayon ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Elderly Patients ◽  
Head And Neck ◽  
Neck Surgery ◽  
The United States ◽  
Cross Sectional ◽  
Logistic Analysis ◽  
Cancer Types ◽  
National Perspective ◽  
Sectional Analysis

Objectives To examine clinical profile and outcomes of elderly patients (65-90 years) undergoing head and neck surgeries in the United States. Study Design A retrospective cross-sectional analysis. Setting The Nationwide Readmissions Database, 2010 to 2015. Subjects and Methods Adult (≥18 years) patients who underwent head and neck surgeries. Analysis included χ2 test and logistic analysis. Results A total of 113,602 and 32,580 patients <65 and ≥65 years old, respectively, were included. Patients ≥65 years old were more likely to have multiple comorbidities (62.8% vs 32.6%, P < .001) and to present with head and neck cancer (19.8% vs 11.4%, P < .001). The most common comorbidity was diabetes (21.0%). The most common cancer types by site were mouth (29.12%), thyroid (28.08%), and nonmelanoma skin cancer (13.22%). The percentage of geriatric patients who underwent head and neck surgeries increased from 21.8% in 2010 to 25.0% in 2015 ( P < .001). A total of 5450 (16.85%) patients developed postoperative complications, and the most common complications were pulmonary related (10.55%), bleeding (6.96%), acute renal failure (6.01%), and infection (3.97%). Blood transfusion was required in 3.53% of the patients. Readmission prevalence was 0.32%, and mortality risk was twice as likely (odds ratio, 2.05; 95% confidence interval, 1.77-2.38; P < .001). Independent risk factors of mortality were older age, multiple comorbidities, type of surgery, blood transfusion, and tracheostomy ( P < .05, each). Conclusion Elderly patients currently represent 25% of patients admitted for head and neck surgery. This population should be provided with a different level of care due to a higher risk of complications and mortality.

scholarly journals High-Cost Hospitalizations Among Elderly Patients With Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. e447-e457 ◽  
Author(s):  
Jaqueline Avila ◽  
Daniel Jupiter ◽  
Mariana Chavez-MacGregor ◽  
Claire de Oliveira ◽  
Sapna Kaul
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Lower Cost ◽  
Metastatic Cancer ◽  
The United States ◽  
National Sample ◽  
Interquartile Range ◽  
Care Needs ◽  
Patients With Cancer

PURPOSE: Health care costs are driven by a small proportion of patients, and it is important to identify their characteristics to effectively manage their health care needs. We examined characteristics associated with high-cost inpatient visits of elderly patients with cancer using a national sample. METHODS: We identified 574,367 inpatient visits of individuals age 65 years or older with a cancer diagnosis using the 2014 National Inpatient Sample data, an all-payer sample of inpatient stays in the United States. High-cost visits were defined as those with a total cost at or above the 90th percentile. The remaining visits were defined as the lower-cost group. We examined patients’ clinical characteristics and hospital characteristics for both groups. Logistic regression was used to identify characteristics associated with being in the high-cost group. RESULTS: The median visit cost in the high-cost group was $38,194 (interquartile range, $31,405 to $51,802), which was nearly five times the cost of the lower-cost group (median, $8,257; interquartile range, $5,032 to $13,335). Hematologic malignancies were the most common cancer in the high-cost group. Those in the high-cost group were more likely to have metastatic cancer. Compared with patients with no comorbidities, those with five or more comorbidities were four times more likely to be in the high-cost group (odds ratio, 4.08; 95% CI, 3.74 to 4.46). Patients with a greater number of procedures were also more likely to be in the high-cost group (odds ratio, 1.57; 95% CI, 1.52 to 1.61). CONCLUSION: High-cost cancer visits were five times more expensive than the remaining visits. Identification of high-cost visits and the associated factors may help provide tailored strategies to effectively manage costly inpatient admissions.

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