scholarly journals Financial Burdens of Cancer Treatment: A Systematic Review of Risk Factors and Outcomes

2019 ◽  
Vol 17 (10) ◽  
pp. 1184-1192 ◽  
Author(s):  
Grace L. Smith ◽  
Maria A. Lopez-Olivo ◽  
Pragati G. Advani ◽  
Matthew S. Ning ◽  
Yimin Geng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Cancer Treatment ◽  
Financial Burden ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Patients With Cancer ◽  
Related Quality ◽  
Financial Burdens ◽  
Cancer Experience

Background: Patients with cancer experience financial toxicity from the costs of treatment, as well as material and psychologic stress related to this burden. A synthesized understanding of predictors and outcomes of the financial burdens associated with cancer care is needed to underpin strategic responses in oncology care. This study systematically reviewed risk factors and outcomes associated with financial burdens related to cancer treatment. Methods: MEDLINE, Embase, PubMed, PsychINFO, and the Cochrane Library were searched from study inception through June 2018, and reference lists were scanned from studies of patient-level predictors and outcomes of financial burdens in US patients with cancer (aged ≥18 years). Two reviewers conducted screening, abstraction, and quality assessment. Variables associated with financial burdens were synthesized. When possible, pooled estimates of associations were calculated using random-effects models. Results: A total of 74 observational studies of financial burdens in 598,751 patients with cancer were identified, among which 49% of patients reported material or psychologic financial burdens (95% CI, 41%–56%). Socioeconomic predictors of worse financial burdens with treatment were lack of health insurance, lower income, unemployment, and younger age at cancer diagnosis. Compared with patients with health insurance, those who were uninsured demonstrated twice the odds of financial burdens (pooled odds ratio [OR], 2.09; 95% CI, 1.33–3.30). Financial burdens were most severe early in cancer treatment, did not differ by disease site, and were associated with worse health-related quality of life (HRQoL) and nearly twice the odds of cancer medication nonadherence (pooled OR, 1.70; 95% CI, 1.13–2.56). Only a single study demonstrated an association with increased mortality. Studies assessing the comparative effectiveness of interventions to mitigate financial burdens in patients with cancer were lacking. Conclusions: Evidence showed that financial burdens are common, disproportionately impacting younger and socioeconomically disadvantaged patients with cancer, across disease sites, and are associated with worse treatment adherence and HRQoL. Available evidence helped identify vulnerable patients needing oncology provider engagement and response, but evidence is critically needed on the effectiveness of interventions designed to mitigate financial burden and impact.

scholarly journals Impact of the Cost of Cancer Treatment: An Internet-Based Survey

2010 ◽  
Vol 6 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Maurie Markman ◽  
Ryan Luce
Keyword(s):  
Cancer Treatment ◽  
Cost Of Care ◽  
Patients With Cancer ◽  
Recommended Treatment ◽  
Cancer Experience ◽  
The Cost ◽  
To Receive

Survey suggests many patients with cancer experience distress associated with cost of care. A serious issue for those with modest annual incomes, these costs affect whether patients decide to receive recommended treatment.

scholarly journals Identification and Management of Lymphedema in Patients With Breast Cancer

2019 ◽  
Vol 15 (5) ◽  
pp. 255-262 ◽  
Author(s):  
Pavankumar Tandra ◽  
Avyakta Kallam ◽  
Jairam Krishnamurthy
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Treatment ◽  
Early Stage ◽  
Financial Burden ◽  
Breast Cancer Treatment ◽  
Initial Diagnosis ◽  
Axillary Surgery ◽  
Incidence Risk ◽  
End Stage

Breast cancer–related lymphedema (BCRL) is a potentially debilitating and often irreversible complication of breast cancer treatment. Risk of BCRL is proportional to the extent of axillary surgery and radiation. Other risk factors include obesity and infections. Given the 5-year survival rate of 90% and its potential impact on the quality of life of survivors of breast cancer, BCRL has become a significant financial burden on the health care system. Minimizing axillary surgery and radiation has been proven to reduce the risk of BCRL. Comprehensive multidisciplinary assessment at the time of initial diagnosis; early referral to physical therapy after surgery; and patient education regarding weight loss, skin, and nail care are cornerstones of the management of early-stage lymphedema. End-stage lymphedema may benefit from referral to a plastic surgeon specializing in lymphedema surgery. In this review, we attempt to review the incidence, risk factors, staging, prevention, and management of this complication of breast cancer treatment. We also describe our multidisciplinary approach for the prevention of this complication at the time of initial diagnosis.

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.

scholarly journals The use of non-pharmacological adjuvant therapies for cancer pain: a narrative review in the context of dance

2022 ◽  
Vol 11 (1) ◽  
pp. e30411124771
Author(s):  
Elaine Izabel da Silva Cruz ◽  
Aline Helena da Silva Cruz ◽  
Rômulo Alberto Silva Marques ◽  
Rodrigo da Silva Santos ◽  
Angela Adamski da Silva Reis
Keyword(s):  
Cancer Pain ◽  
Cancer Treatment ◽  
Life Quality ◽  
Pharmacological Therapy ◽  
Cochrane Library ◽  
Patients With Cancer ◽  
Number Of Publications ◽  
The Cochrane Library ◽  
The Relationship

Cancer is one of the leading causes of morbidity in the globe, with more than half of patients reporting pain as a result of the disease. By reducing cancer-related pain, dance has the potential to redefine the life of patients independently of their cure prognosis. This review investigated the benefits of dance as adjuvant, non-pharmacological therapy for cancer treatment. To identify studies related to this topic, we searched the Cochrane Library, PUBMED, Scielo, BVS, Embase, CINAHL, and PsycINFO databases. However, we found few published systematic reports investigating the effects of dance in cancer treatment. The numbers are even smaller when we considered the relationship between dance and cancer pain. Although there is a small number of publications on this theme, we reviewed studies that indicate that there is a positive relationship between dance practice and cancer pain management. Moreover, we found that the decline of pain contributed to the better life quality of patients with cancer. We concluded that dance is a physical practice that may improve patients’ quality of life. Regarding the estimations of cancer diagnosis and pain during disease development and therapy, it is fundamental new studies and clinical trials that integrate dance as adjuvant therapy for improving cancer pain and patient’s life quality.

scholarly journals Financial toxicity in cancer care: origins, impact, and solutions

2021 ◽  
Vol 11 (11) ◽  
pp. 2043-2054 ◽  
Author(s):  
Hannah R Abrams ◽  
Sienna Durbin ◽  
Cher X Huang ◽  
Shawn F Johnson ◽  
Rahul K Nayak ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Financial Burden ◽  
Indirect Costs ◽  
Future Research ◽  
Financial Toxicity ◽  
Patients With Cancer ◽  
The Past ◽  
Financial Burdens ◽  
The Impact

Abstract Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term “financial toxicity” has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.

scholarly journals Optimizing Cardiovascular Health in Patients With Cancer: A Practical Review of Risk Assessment, Monitoring, and Prevention of Cancer Treatment–Related Cardiovascular Toxicity

2020 ◽  
pp. 501-515
Author(s):  
Susan F. Dent ◽  
Robin Kikuchi ◽  
Lavanya Kondapalli ◽  
Roohi Ismail-Khan ◽  
Christine Brezden-Masley ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
Cardiovascular Risk Factors ◽  
Health Care Providers ◽  
Cardiovascular Health ◽  
Care Providers ◽  
Cardiovascular Toxicity ◽  
Patients With Cancer

Advances in cancer screening and improved treatment approaches have led to an increase in survivorship and, consequently, recognition of an association between cancer treatments and the development of cardiovascular complications. In addition, as the population becomes proportionally older, comorbid cardiovascular risk factors are more prevalent in the population and compound the risk of developing cancer treatment–related cardiovascular toxicity. Cardio-oncology has emerged as a new subspecialty of medicine that provides a multidisciplinary approach, bringing together oncologists, cardiologists, and allied health care providers who are tasked with optimizing the cardiovascular health of patients exposed to potentially cardiotoxic cancer therapy. Using a case-based approach, practical advice on how to identify, monitor, and treat patients with cancer who are at risk for developing cancer treatment–related cardiovascular dysfunction is discussed. Cardiovascular risk factors (e.g., age, hypertension, diabetes) and cancer therapies (chemotherapy, targeted therapy, radiation) associated with cardiovascular toxicity are presented. Current cardiac monitoring strategies such as two- and three-dimensional echocardiography, cardiac MRI, and biomarkers (troponin and brain natriuretic peptide [BNP]) are discussed. Last, the current literature on pharmacologic (e.g., angiotensin-converting enzyme inhibitors, β-blockers, statins) and lifestyle (diet and exercise) strategies to mitigate cardiovascular toxicity during and following completion of cancer therapy are reviewed.

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 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.

scholarly journals Systemic Anti-Cancer Therapy and Metastatic Cancer Are Independent Mortality Risk Factors during Two UK Waves of the COVID-19 Pandemic at University College London Hospital

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6085
Author(s):  
Yien Ning Sophia Wong ◽  
Christopher C. T. Sng ◽  
Diego Ottaviani ◽  
Grisma Patel ◽  
Amani Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Treatment ◽  
Mortality Risk ◽  
Metastatic Cancer ◽  
Hospitalized Patients ◽  
Solid Cancer ◽  
Patients With Cancer ◽  
Anti Cancer ◽  
History Of ◽  
University College London

An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March–May 2020; December 2020–February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30–0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.

Longitudinal Trends of Financial Toxicity in Patients With Lung Cancer: A Prospective Cohort Study

2021 ◽  
pp. OP.20.00721
Author(s):  
Cole Friedes ◽  
Sarah Z. Hazell ◽  
Wei Fu ◽  
Chen Hu ◽  
Ranh K. Voong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cancer Treatment ◽  
Medical Care ◽  
Financial Burden ◽  
Financial Toxicity ◽  
Prospective Longitudinal Study ◽  
The Cost ◽  
Prospective Longitudinal

BACKGROUND: Cancer therapy is associated with severe financial burden. However, the magnitude and longitudinal patient relationship with financial toxicity (FT) in the initial course of therapy is unclear. METHODS: Patients with stage II-IV lung cancer were recruited in a prospective longitudinal study between July 2018 and March 2020. FT was measured via the validated COmprehensive Score for financial Toxicity (COST) at the time of cancer diagnosis and at 6-month follow-up (6MFU). 6MFU data were compared with corresponding baseline data. A lower COST score indicates increased financial hardship. RESULTS: At the time of analysis, 215 agreed to participate. Subsequently, 112 patients completed 6MFU. On average, slightly more FT was observed at diagnosis compared with 6MFU (median COSTbase 25 v COST6M 27; P < .001); however, individual patients experienced large changes in FT. At 6MFU, 27.7% of patients had made financial sacrifices to pay for treatment but only 4.5% refused medical care based on cost. Median reported out-of-pocket (OOP) costs for the initial 6 months of cancer treatment was $2,496 (range, $0-25,900). Risk factors for FT at diagnosis were unique from risk factors at 6MFU. Actual OOP expenses were not correlated with FT; however, inability to predict upcoming treatment expenses resulted in higher FT at 6MFU. DISCUSSION: FT is a pervasive challenge during the initiation of lung cancer treatment. Few patients are willing to sacrifice medical care regardless of the cost. Risk factors for FT evolve, resulting in unique interventional targets throughout therapy.

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