Found Items

Financial Toxicity and Equitable Access to Clinical Trials

Financial barriers to clinical trial enrollment are an area of active investigation. Financial toxicity as a concept describes how high costs and financial burden can lead to compromised care and outcomes. Despite the potential to yield large survival benefits and improved access to cutting-edge therapies, less than 5% of adult patients with cancer are enrolled in a clinical trial. Disparities in trial enrollment exist along age, ethnic, and sociodemographic

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Poor emotional well-being is associated with rapid progression in amyotrophic lateral sclerosis

The study aimed to determine the impact of emotional well-being on disease aggressiveness and survival in amyotrophic lateral sclerosis (ALS). In 224 patients with ALS (without significant cognitive deficits) the revised ALS Functional Rating Scale (physical function), the ALS Assessment Questionnaire (ALSAQ-40) for health-related Quality of Life and survival data were collected. Data analysis comprised logistic regression, Kaplan-

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Emotional Well-Being Is Impaired in Hidradenitis Suppurativa Patients

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory condition. OBJECTIVE: To measure emotional well-being in HS patients and compare to other populations, assess if there is an effect of disease severity on emotional well-being, and determine if emotional well-being is correlated with quality of life and depression. METHODS: A total of 153 HS subjects were recruited, and 66 Positive and Negative Affect

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Association Between Subjective Well-being and Living Longer Without Disability or Illness

IMPORTANCE: Subjective well-being is associated with reduced mortality, but it is not clear whether additional time is spent in good health or with chronic disease and disability. OBJECTIVE: To evaluate the associations between affective well-being, total life expectancy, and life expectancy free of disability and chronic disease. DESIGN, SETTING, AND PARTICIPANTS: This survey study used data on 9761 participants from the English

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Annual Out-of-Pocket Expenditures and Financial Hardship Among Cancer Survivors Aged 18-64 Years – United States, 2011-2016

In the United States in 2019, an estimated 16.9 million persons are living after receiving a cancer diagnosis (1). These cancer survivors face many challenges, including functional limitations, serious psychological distress (2), and other lasting and late effects of cancer treatments. Because of the high cost of cancer therapy, many cancer survivors are more likely to face substantial out-of-pocket health care expenditures and financial

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Determinants and Consequences of Financial Hardship Among Adult Survivors of Childhood Cancer: A Report From the St. Jude Lifetime Cohort Study

BACKGROUND: Financial hardship among survivors of pediatric cancer has been understudied. We investigated determinants and consequences of financial hardship among adult survivors of childhood cancer. METHODS: Financial hardship, determinants, and consequences were examined in 2811 long-term survivors (mean age at evaluation = 31.8 years, years postdiagnosis = 23.6) through the baseline survey and clinical

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Gender differences in the association between modifiable risk factors and financial hardship among middle-aged and older adults

OBJECTIVE: To identify associations between modifiable risk factors (cigarette smoking, alcohol consumption, and obesity) and financial hardship (difficulty paying bills, food insecurity and medication need) among middle-aged and older Americans in a nationally representative sample. METHODS: This was a cross-sectional study of 8212 persons age 50 years and older who completed the core 2010 Health and Retirement Study

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Financial Support Models: A Case for Use of Financial Navigators in the Oncology Setting

BACKGROUND: Financial toxicity causes significant psychological and practical distress for patients and can affect their ability and willingness to undertake optimal treatment. Although different models of financial support are typically available to patients undergoing cancer treatments, not all models can offer equal amounts of support and effective solutions, particularly to those patients at the highest levels of risk for this

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Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey

Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement – The Effects of Cancer and Its

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Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients

PURPOSE: Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers’ emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. METHODS: We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race,

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Financial Vulnerability: A Case Study Involving a Patient With Head and Neck Cancer

BACKGROUND: Patients with head and neck cancer (HNC) face unique financial challenges. Even with stable income and health insurance, many patients become overwhelmed with direct and indirect treatment-associated costs. OBJECTIVES: This article discusses how prolonged financial burden in patients with cancer can result in compromised patient outcomes. METHODS: A case study is presented that highlights financial

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Patient recommendations for reducing long-lasting economic burden after breast cancer

BACKGROUND: In the United States, patients who have breast cancer experience significant economic burden compared with those who have other types of cancers. Cancer-related economic burden is exacerbated by adverse treatment effects. Strategies to resolve the economic burden caused by breast cancer and its adverse treatment effects have stemmed from the perspectives of health care providers, oncology navigators, and

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Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

PURPOSE: Estimate prevalence of types of cancer-related financial hardship by race and test whether they are associated with limiting care due to cost. METHODS: We used data from 994 participants (411 white, 583 African American) in a hospital-based cohort study of survivors diagnosed with breast, colorectal, lung, or prostate cancer since January 1, 2013. Financial hardship included decreased income, borrowing money,

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Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications

Patients experiencing financial distress as a side-effect of cancer are not only reported in the United States, but also in third-party payer healthcare systems in Europe. Since validated survey instruments are a prerequisite for robust and comparable results, we aimed to compile and classify available instruments to enable both a better understanding of the underlying construct of financial toxicity and to facilitate further

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Measuring catastrophic medical expenditures: Reflections on three issues

In the “basic” approach, medical expenses are catastrophic if they exceed a prespecified percentage of consumption or income; the approach tells us if expenses cause a large percentage reduction in living standards. The ability-to-pay (ATP) approach defines expenses as catastrophic if they exceed a prespecified percentage of consumption less expenses on nonmedical necessities or an allowance for them. The paper

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Material-Psychosocial-Behavioral Aspects of Financial Hardship: A Conceptual Model for Cancer Prevention

Risk of cancer increases with age; and socioeconomic factors have been shown to be relevant for (predictive of) cancer risk-related behaviors and cancer early detection and screening. Yet, much of this research has relied on traditional measures of socioeconomic status (SES) to assess socioeconomic circumstances, which limits our understanding of the various pathways through which the socioeconomic environment affects

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Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared

Patients with metastatic or advanced cancer are likely to be particularly susceptible to financial hardship for reasons related both to the characteristics of metastatic disease and to the characteristics of the population living with metastatic disease. First, metastatic cancer is a resource-intensive condition with expensive treatment and consistent, high-intensity monitoring. Second, patients diagnosed with metastatic disease are

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Financial toxicity risk among adult patients undergoing cancer surgery in the United States: An analysis of the National Inpatient Sample

BACKGROUND AND OBJECTIVE: Financial hardship occurring as a result of cancer treatment has been termed financial toxicity and is an established side effect of the cancer treatment. We investigated the risk of financial toxicity among patients undergoing surgery for gastrointestinal cancers. METHODS: All uninsured and privately insured patients who underwent surgery for a gastrointestinal cancer were identified from the

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It still affects our economic situation: long-term economic burden of breast cancer and lymphedema

PURPOSE: Financial toxicity after breast cancer may be exacerbated by adverse treatment effects, like breast cancer-related lymphedema. As the first study of long-term out-of-pocket costs for breast cancer survivors in the USA with lymphedema, this mixed methods study compares out-of-pocket costs for breast cancer survivors with and without lymphedema. METHODS: In 2015, 129 breast cancer survivors from Pennsylvania

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Economic Burden Associated with Cancer Caregiving

OBJECTIVE: The societal value of unpaid caregiving is estimated to exceed $470 billion annually. In spite of the high value care they provide, caregivers experience significant financial burden. This paper examines the sources and impact of financial burden on cancer caregivers. DATA SOURCES: Survey of the published peer-reviewed literature complemented by Web-based sources. CONCLUSION: Caregivers for cancer patients may

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Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action

BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577]

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The social and economic toll of cancer survivorship: a complex web of financial sacrifice

PURPOSE: To assess the financial outcomes and associated social and economic effects on cancer survivors and their families. METHODS: We assessed the responses of 1656 cancer survivors to a survey with both closed- and open-ended questions about cancer-related financial sacrifices they and their family experienced and evaluated differences in financial sacrifice by reported levels of cancer-related debt. RESULTS: The most

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Prevalence and Correlates of Medical Financial Hardship in the USA

BACKGROUND: High patient out-of-pocket (OOP) spending for medical care is associated with medical debt, distress about household finances, and forgoing medical care because of cost in the USA. OBJECTIVE: To examine the national prevalence of medical financial hardship domains: (1) material conditions from increased OOP expenses (e.g., medical debt), (2) psychological responses (e.g., distress), and (3) coping behaviors

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Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

Financial toxicity is the adverse impact of a cancer diagnosis on a patient’s financial well-being resulting from direct or indirect costs. Potential consequences of financial toxicity include material loss, psychological distress, and/or maladaptive coping strategies. This review will summarize the prevalence, causes, and consequences of financial toxicity, with an emphasis on strategies to anticipate and reduce its burden.

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Financial hardship among individuals with serious mental illness

This study explored financial hardship, defined as difficulty in obtaining food, shelter, or medicine in the past 12 months and its personal and clinical correlates in individuals with serious mental illness (SMI) in a sample of 271 adults with SMI newly admitted to two inner city community mental health centers. The study found that 59 percent (n = 161) reported experiencing financial hardship in the past 12 months. Patients with financial

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The Personal Financial Burden Associated with Musculoskeletal Trauma

BACKGROUND: Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. METHODS: We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American

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Within-Person Associations Between Financial Hardship and Cognitive Performance in the PATH Through Life Study

The aim of this study was to investigate the within-person associations between the experience of financial hardship and cognitive performance throughout adulthood. Three waves of data provided by 6,343 participants (49% men) were analyzed from a representative community-based sample from Canberra, Australia (2003-2015). The outcome was a composite measure reflecting fluid cognitive abilities. Financial

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Relationship between paid leave, financial burden, and patient-reported outcomes among employed patients who have undergone bone marrow transplantation

PURPOSE: The US does not have universal paid family and medical leave. We examine the direct effects of access to paid leave on patient-reported health, quality of life (QOL), and perceived stress of employed patients who underwent bone marrow transplantation (BMT) to treat advanced blood cancer as well as the indirect effects through reductions in the financial burden (FB) that patients face. METHODS: Our cross-

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Economic instability and household chaos relate to cortisol for children in poverty

The present study investigated relations among various aspects of economic adversity and cortisol levels for young children facing economic hardship. Specifically, the study examined relations to cortisol for variables representing family income, material hardship, financial strain, economic instability, and household chaos. Participants were 374 children, ages 3-5 years, who attended a Head Start preschool, as well as their primary

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Cancer-related financial hardship among head and neck cancer survivors: Risk factors and associations with health-related quality of life

OBJECTIVE: Cancer survivors are susceptible to financial hardship. In head and neck cancer (HNC) survivors, we investigated (a) predictors for cancer-related financial hardship and (b) associations between financial hardship and health-related quality of life (HRQoL). METHODS: We conducted a cross-sectional study in HNC survivors identified from the National Cancer Registry Ireland. HRQoL was based on the Functional

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The association of financial difficulties and out-of-pocket payments with health-related quality of life among breast, prostate and colorectal cancer patients

Objectives: Financial difficulties experienced by cancer patients may affect their health-related quality of life (HRQoL). This study assessed the direct economic burden that out-of-pocket (OOP) payments cause and explored how they and financial difficulties are associated with HRQoL. Methods: This is a cross-sectional registry and survey study of 1978 cancer patients having either prostate (630), breast (840) or colorectal

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Financial Costs and Burden Related to Decisions for Breast Cancer Surgery

PURPOSE: Financial toxicity is a well-recognized adverse effect of cancer care, yet little is known about how women consider treatment costs when facing preference-sensitive decisions for breast cancer surgery or how surgical treatment choice affects financial harm. We sought to determine how financial costs and burden relate to decisions for breast cancer surgery. METHODS: Women (≥ 18 years old) with a history of breast

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Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

BACKGROUND: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer. METHODS: We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously

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Material hardship and sleep: results from the Michigan Recession and Recovery Study

OBJECTIVE: Sleep is unequally distributed in the US population. People with low socioeconomic status report worse quality and shorter sleep than people with high socioeconomic status. Past research hypothesized that a potential reason for this link could be exposure to material hardship. This study examines the associations between several material hardships and sleep outcomes. METHODS: We use population-representative cross-

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Financial Hardship and Quality of Life among African American and White Cancer Survivors: The Role of Limiting Care Due to Cost

BACKGROUND: Financial hardship is common among cancer survivors and is associated with both limiting care due to cost and with poor health-related quality of life (HRQOL). This study estimates the association between limiting care due to cost and HRQOL in a diverse population of cancer survivors and tests whether limiting care mediates the association between financial hardship and HRQOL. METHODS: We used data from

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High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use?

PURPOSE: To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization. MATERIALS AND METHODS: The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the

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Economic burden of stroke: a systematic review on post-stroke care

OBJECTIVES: Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS: A systematic literature review on economic studies reporting PSC-associated data was performed

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Financial burden of cancer care under the Affordable Care Act: Analysis of MEPS-Experiences with Cancer Survivorship 2011 and 2016

PURPOSE: To examine whether the implementation of Affordable Care Act (ACA) reduced the financial burden associated with cancer care among non-elderly cancer survivors. METHODS: Using data from the MEPS-Experiences with Cancer Survivorship Survey, we examined whether there was a difference in financial burden associated with cancer care between 2011 (pre-ACA) and 2016 (post-ACA). Two aspects of financial burden

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Financial Hardship, Motivation to Quit and Post-Quit Spending Plans Among Low-Income Smokers Enrolled in a Smoking Cessation Trial

BACKGROUND: Tobacco spending may exacerbate financial hardship in low-income populations by using funds that could go toward essentials. This study examined post-quit spending plans among low-income smokers and whether financial hardship was positively associated with motivation to quit in the sample. METHODS: We analyzed data from the baseline survey of a randomized controlled trial testing novel a smoking

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The Contribution of Social Support, Professional Support, and Financial Hardship to Family Caregiver Life Satisfaction After Traumatic Brain Injury

OBJECTIVES: (a) To assess whether 3 changeable environmental variables (social support, professional support, and financial hardship) contribute to explaining differences in well-being of family caregivers after traumatic brain injury (TBI), above and beyond the influence of neurobehavioral functioning. (b) To assess the unique and relative contribution of social support, professional support, and financial hardship to life

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Cancer History, Health Insurance Coverage, and Cost-Related Medication Nonadherence and Medication Cost-Coping Strategies in the United States

OBJECTIVES: To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. METHODS: We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking

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Trajectories of poverty and economic hardship among American families supporting a child with a neurodisability

BACKGROUND: Caring for a child with a neurodisability (ND) impacts the financial decisions, relationships and well-being of family members, but evidence on the economic trajectories of families throughout the life course is missing. METHODS: Using data from the Panel Study of Income Dynamics, we tracked the families of 3317 children starting 5 years before childbirth until the child reached 20 years of age. We used regression and

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Financial Stress Interacts With CLOCK Gene to Affect Migraine

Previous studies suggested that both maladaptive stress response and circadian dysregulation might have a role in the background of migraine. However, effects of circadian genes on migraine have not been tested yet. In the present study, we investigated the main effect of rs10462028 of the circadian locomotor output cycles kaput (CLOCK) gene and its interaction with different stress factors on migraine. In our cross-sectional study

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You Have to Keep a Roof Over Your Head: A Qualitative Study of Housing Needs Among Patients With Cancer in New York City

PURPOSE: Housing status can become compromised in the wake of financial hardship for some patients with cancer and become a source of disparity. This qualitative study describes the types of housing issues experienced by patients with cancer and survivors of cancer in New York City. METHODS: Semistructured interviews were conducted with a volunteer sample of 21 patients with cancer or survivors of cancer treated in

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Colorectal cancer survivors’ challenges to returning to work: A qualitative study

OBJECTIVE: To assess the challenges and needs of colorectal cancer (CRC) survivors in maintaining employment and returning to work (RTW) from the perspectives of both CRC survivors and employers in the United States. METHODS: Semi-structured interviews with CRC survivors (n = 10) and employers (n = 4) were transcribed, coded and thematically analysed using NVivo 12 software. RESULTS: Workplace challenges for

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