Assessment of Financial Toxicity Among Patients With Advanced Lung Cancer in Western China.
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SUBMITTER: Xu T
PROVIDER: S-EPMC8790143 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ImportanceFinancial toxicity (FT), unintended and unanticipated financial burden experienced by cancer patients undergoing cancer care, is associated with negative consequences and increased risk of mortality. Older patients (≥70 years) with cancer are at risk for FT, yet data are limited on FT and whether oncologists discuss FT with their patients.ObjectiveTo examine the prevalence of FT in older adults with advanced cancer, its association with health-related quality of life (HRQoL), and cost conversations between oncologists and patients.Design, setting, and participantsThis cross-sectional secondary analysis was performed on baseline data from the Improving Communication in Older Cancer Patients and Their Caregivers study, a cluster randomized trial from 31 community oncology practices across the US that was conducted from October 29, 2014, to April 28, 2017. Participants included 536 patients with advanced cancer who answered 3 questions regarding financial toxicity. Data were analyzed from September 1, 2019, to May 1, 2020.ExposureOlder patients undergoing cancer care treatments.Main outcomes and measuresThe main outcome looked at FT and its association with HRQoL. Three questions were used to identify patients 70 years or older experiencing FT. Multivariable linear regression models were used to assess the independent associations of FT with HRQoL. A single audio-recorded clinic transcript was analyzed within 4 weeks of enrollment for patients with FT. The framework method was used to identify frequency and themes related to cost conversations.ResultsThis study evaluated 536 patients 70 years or older with advanced cancer. Ninety-eight patients (18.3%) reported FT; mean (SD) age was 76.4 (5.4) years; 59 (60.2%) were female, 14 (14.3%) were Black/African American, 91 (92.9%) were not employed, and 29 (29.6%) had Medicare as their sole insurance coverage. On multivariate regression analyses, FT was associated with higher levels of depression (β = 0.81; 95% CI, 0.15-1.48), anxiety (β = 1.67; 95% CI, 0.74-2.61), and distress (β = 0.73; 95% CI, 0.08-1.39) and lower HRQoL (β = -5.30; 95% CI, -8.92 to -1.69). Among those who reported FT, 49% had a conversation with their health care professional about costs. Most conversations (79%) were initiated by oncologists or patients. Four themes were generated from cost conversations: statements regarding cost of care, ability to afford medical prescriptions, indirect consequences associated with inability to work and provide for family, and cost burden in nontreatment domains.Conclusions and relevanceIn this study, among older adults with advanced cancer, FT is associated with worse HRQoL. Almost half of conversations among patients reporting FT demonstrated costs are being actively discussed. Resources and interventions are needed to manage FT.
| S-EPMC8184122 | biostudies-literature
Project description:Financial toxicity (FT) has been used to describe patients' whole economic experience that negatively impacts their well-being. FT's adverse effects on patients' health outcomes have been reported by reviews conducted in Western countries. However, these findings may not apply to patients in China. This review aimed to analyze existing data on the measures, prevalence, risk factors, and health-related consequences of FT in China. We searched 10 databases in May 2021 and again in January 2022 using Medical Subject Headings terms and free text. We also searched the reference lists of included articles. Two reviewers independently screened the studies, extracted the data, and assessed the quality of the included studies using the Joanna Briggs Institute Critical Appraisal Checklist. Thirty-one articles describing 30 studies were included in the analysis. Various FT measures were identified, but the number of validated measures was limited. The prevalence of material, psychological, and behavioral FT was 6%-78%, 61%-84%, and 10%-79%, respectively. We identified common risk factors and health-related consequences associated with FT similar to those reported in previous reviews. We also identified several potential risk factors (eg, increased length of hospital stay and larger household size) and consequences (patients' self-perceived burden) in a limited number of studies. Our findings show an urgent need for more data on the prevalence, risk factors, and health-related consequences associated with FT in Chinese cancer patients, and these data must be generated using validated measures.
| S-EPMC9184292 | biostudies-literature
Project description:IntroductionLung cancer has the second-ranked morbidity rate and the first-ranked mortality rate worldwide. With the progression of the cancer condition and the advancement of new treatments, the corresponding medical expenses have risen sharply. Nowadays, financial toxicity has become one of the most common concerns in patients with cancer. However, by far, the full landscape of studies on financial toxicity is unclear in patients with lung cancer. Thus, this scoping review aims to summarise the degree, affecting factors, outcomes and intervention strategies of financial toxicity in patients with lung cancer.Methods and analysisThis scoping review will be developed following the methodology described in the Joanna Briggs Institute Manual for Evidence Synthesis on scoping review protocol, which was based on Arksey and O'Malley's methodological framework, Levac et al's recommendations for applying this framework and Peters et al's enhancements of the framework. From the day of database building to 31 December 2021, 10 English databases will be searched in the 'Abstract' field with three key search terms: "Lung", "Cancer" and "Financial toxicity". The studies' screening and data extraction will be independently performed by two reviewers (MZ and RZ). Any disagreements between the two reviewers (MZ and RZ) will be resolved by consensus, and a third reviewer (BW) will be invited if necessary. The results will be analysed and presented using tables and figures. This scoping review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.Ethics and disseminationAn ethical approval is not required for this scoping review protocol, nor for the scoping review. The results of this scoping review will be disseminated through publication in a peer-reviewed journal or presentation at conferences.RegistrationThis scoping review protocol has been registered in the Open Science Framework (https://osf.io/ub45n/?view_only=bb93eb94e1434a0f8196b3b61cffcec2).
| S-EPMC9131061 | biostudies-literature
Project description:PurposeWe examined the frequency and severity of financial distress (FD) and its association with quality of life (QOL) and symptoms among patients with advanced cancer in France.DesignIn this cross-sectional study, 143 patients with advanced cancer were enrolled. QOL was assessed using the Functional Assessment of Cancer General (FACT-G) and symptoms assessed using Edmonton Assessment System (ESAS) and Hospital Anxiety and Depression Scale (HADS). FD was assessed using a self-rated numeric scale from 0 to 10.ResultsSeventy-three (51%) patients reported having FD. Patients reported having FD were most likely to be younger (53.8 (16,7SD) versus 62 (10.5SD), p<0.001), single (33 (62%) versus 40(44%), p = 0.03) and had a breast cancer (26 (36%), p = 0.024). Patients with FD had a lower FACT-G score (59 versus 70, p = 0.005). FD decreased physical (14 versus 18, p = 0.008), emotional (14 versus 16, p = 0.008), social wellbeing (17 versus 19, p = 0.04). Patients with FD had higher HADS-D (8 versus 6 p = 0.007) and HADS-A (9 versus 7, p = 0.009) scores. FD was linked to increased ESAS score (59 (18SD) versus 67 (18SD), p = 0.005) and spiritual suffering (22(29SD) versus 13(23SD), p = 0.045).ConclusionThe high rate of patient-reported FD was unexpected in our studied population, as the French National Health Insurance covers specific cancer treatments. The FD was associated with a poorer quality of life. Having a systematic assessment, with a simple tool, should lead to future research on interventions that will increase patients' QOL.
| S-EPMC5436643 | biostudies-literature
Project description:IntroductionFinancial toxicity (FT) is a growing concern among cancer survivors that adversely affects the quality of life and survival. Individuals diagnosed with aggressive cancers are often at a greater risk of experiencing FT. The objectives of this study were to estimate FT among prostate cancer (PCa) survivors after 10-15 years of diagnosis, assess the relationship between PCa aggressiveness at diagnosis and FT, and examine whether current cancer treatment status mediates the relationship between PCa aggressiveness and FT.MethodsPCa patients enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP) were recontacted for long-term follow-up. The prevalence of FT in the PCaP cohort was estimated. FT was estimated using the COmprehensive Score for Financial Toxicity, a validated measure of FT. The direct effect of PCa aggressiveness and an indirect effect through current cancer treatment on FT was examined using causal mediation analysis.ResultsMore than one-third of PCa patients reported experiencing FT. PCa aggressiveness was significantly independently associated with high FT; high aggressive PCa at diagnosis had more than twice the risk of experiencing FT than those with low or intermediate aggressive PCa (adjusted odds ratio [aOR] = 2.13, 95% CI = 1.14-3.96). The proportion of the effect of PCa aggressiveness on FT, mediated by treatment status, was 10%, however, the adjusted odds ratio did not indicate significant evidence of mediation by treatment status (aOR = 1.05, 95% CI = 0.95-1.20).ConclusionsAggressive PCa was associated with high FT. Future studies should collect more information about the characteristics of men with high FT and identify additional risk factors of FT.
| S-EPMC10087487 | biostudies-literature
Project description:BackgroundThe number of cervical cancer cases is reported to increase among women of reproductive age in the recent past with patients facing challenges with care and management of the illness. However, little is known about the financial challenges these patients undergo in contexts such as western Kenya. This study assessed financial challenges and sources of financial assistance for cervical cancer patients in western Kenya.MethodsA cross-sectional study involving 334 cervical cancer patients was conducted in Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu from September 2014 to February 2015. Structured questionnaire, in-depth interview guide and key informant interview guide were used to collect data. Quantitative data was analyzed using Statistical Package for Social Scientists (SPSS) Version 20 at a statistical significance of P ≤ 0.05, descriptive statistics and crosstabulations were performed. For qualitative data, the responses were transcribed verbatim and the content was then analyzed by searching for emerging themes on the financial challenges faced by cervical cancer patients. Qualitative data was presented in textual form with verbatim reports for illustrations.ResultsThe key financial challenges from the study were costs of medication 291 (87%), cost of travel 281 (84%) and cost of diagnostic tests 250 (75%). Other costs incurred by the patients were cost of cloths and wigs 91 (27%), and cost of home and child care 80 (24%). Most 304 (91%) of the cervical cancer patients admitted and referred to JOOTRH did not have insurance cover and only 30 (9%) had National Hospital Insurance Fund cover which catered for only bed component of inpatient costs. Results showed that no patient received any assistance from well-wishers. Only a few received assistance from charity organizations 43 (13%), friends 91 (27%) and colleagues 31 (9%). Some patients received some assistance from relatives 32 (10%) and church 32 (10%).ConclusionCervical cancer patients experience several financial challenges yet only few of them had insurance cover which catered for only bed component of inpatient costs. There is a need for the Kenyan health care system to develop mechanisms for provision of financial support for cervical cancer patients.
| S-EPMC5891984 | biostudies-literature
Project description:Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy-dimensions of "financial toxicity"-need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.
| S-EPMC8270089 | biostudies-literature
Project description:BackgroundFinancial toxicity is commonly reported by cancer patients, but few studies have assessed caregiver perceptions. We aimed to validate the modified Comprehensive Score for Financial Toxicity (COST) in cancer caregivers, identify factors associated with financial toxicity in both patients and caregivers, and assess the association of caregiver financial toxicity with patient and caregiver outcomes.MethodsUsing a convenience sampling method, 100 dyads of adult cancer patients and a primary caregiver visiting outpatient oncology clinics (Jan-Sep 2019) were recruited. We assessed the internal consistency and convergent and divergent validity of the modified COST. Multivariable analyses identified correlates of financial toxicity. Association of financial toxicity with care non-adherence, lifestyle-altering behaviors (e.g., home refinance/sale, retirement/saving account withdrawal), and quality of life (QOL) was investigated.ResultsRecruited patient vs. caregiver characteristics were as follows: mean age: 60.6 vs. 56.5; 34% vs. 46.4% female; 79% vs. 81.4% white. The caregiver COST measure demonstrated high internal consistency (Cronbach α = 0.91). In patients, older age (B, 0.3 [95% CI, 0.1-0.4]) and higher annual household income (B, 14.3 [95% CI, 9.3-19.4]) correlated with lower financial toxicity (P < 0.05). In caregivers, lower patient financial toxicity (B, 0.4 [95% CI, 0.2-0.6]) and cancer stages 1-3 (compared to stage 4) (B, 4.6 [95% CI, 0.4-8.8]) correlated with lower financial toxicity (P < 0.05). Increased caregiver financial toxicity correlated with higher care non-adherence in patients, increased lifestyle-altering behaviors, and lower QOL in patients and caregivers (P < 0.05).ConclusionThe COST measure can also be used to assess caregiver financial toxicity. Caregivers' financial toxicity was associated with negative outcomes for both dyad members.
| S-EPMC8639637 | biostudies-literature
Project description:BackgroundColorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients.MethodsMedline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study.ResultsOut of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management- annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795.ConclusionsThere is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.
| S-EPMC10770883 | biostudies-literature
Project description: Not available
| S-EPMC11365698 | biostudies-literature