The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults.
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ABSTRACT:
SUBMITTER: Landwehr MS
PROVIDER: S-EPMC4864815 | biostudies-other | 2016 May
REPOSITORIES: biostudies-other
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Project description:BackgroundFor adolescents and young adults (AYAs), the diagnosis of cancer can impede social development, especially with respect to education, employment, and financial independence. However, there are limited quantitative data on the extent and trajectory of life disruptions during cancer treatment for AYA patients.MethodsThis was a longitudinal, prospective, questionnaire-based cohort study of 145 AYA patients with cancer aged 15 to 29 years who were treated at a large academic cancer center. Questionnaires were administered shortly after diagnosis and 4 and 12 months after diagnosis.ResultsAlthough half of the participants lived with their parents 6 months before diagnosis, 61% lived with their parents after diagnosis (P = .0002 vs 6 months before diagnosis), with a similar proportion reported to be living with their parents 4 months after diagnosis (61%; P = .001) and 55% doing so 12 months after diagnosis (P = .07). Before diagnosis, 38% of the patients were not attending school. After diagnosis, that proportion rose to 61% (P < .0001), with a similar proportion 4 months after diagnosis (61%; P < .0001); 54% were not in school at 12 months (P = .001). Patients experienced similar decrements in employment (30% not working before diagnosis vs 49% not working after diagnosis; P < .0001) and financial independence (37% with complete financial independence before diagnosis vs 31% after diagnosis; P = .02). Overall, 65% of the patients (94 of 145) had not returned to their precancer baseline in at least 1 of these 4 social domains by 12 months after diagnosis.ConclusionsFor many AYA patients, cancer leads to less engagement with school and work activities and decreased financial independence from parents. Clinicians should engage in early and ongoing discussions with patients about the potential impact of cancer on their lives.
| S-EPMC7719071 | biostudies-literature
Project description:Background:Financial capability is an essential feature of the organisation of one's personal life and engagement with society. Very little is known of how adequately individuals with developmental language disorder handle financial matters. It is known that language difficulties place them at a disadvantage in many aspects of their development and during their transition into adulthood, leading to the possibility that financial issues may prove burdensome for them. This study examines the financial capability and functional financial literacy of young adults with developmental language disorder and compares them to those of age matched peers. We tested the expectation that those with developmental language disorder would find financial management more challenging than would their peers, and that they would need to seek greater support from family members or other people. Methods:Participants completed a detailed individual interview, which included items drawn from the British Household Panel Survey and additional measures of financial capability, functional financial literacy and of perceived support. Nonverbal IQ, language, reading and numeracy measures were also collected. Results:Compared to typically developing age matched peers, young people with developmental language disorder report less extensive engagement with financial products and lower competence in functional financial literacy. A considerably higher proportion of those with developmental language disorder (48% vs. 16% of age matched peers) report that they draw on support, primarily from parents, in various financial tasks, including paying bills, choosing financial products, and taking loans from family or friends. Conclusions:This is the first study to consider the financial capability skills and functional financial literacy of young adults with developmental language disorder. We provide novel evidence that some young adults with developmental language disorder lack functional financial skills and require support to successfully manage their finances. This has policy implications that relate not only to engaging affected individuals in discussions about financial management but also to wider familial support.
| S-EPMC6188087 | biostudies-literature
Project description:BackgroundThe cost of cancer treatment has increased significantly in recent decades, but it is unclear whether these costs have been associated with commensurate improvement in clinical value. This study aimed to assess the association between the cost of cancer treatment and 4 of the 5 NCCN Evidence Blocks (EB) measures of clinical value: efficacy of regimen/agent, safety of regimen/agent, quality of evidence, and consistency of evidence.MethodsThis is a cross-sectional, observational study. We obtained NCCN EB ratings for all recommended, first-line, and/or maintenance treatments for the 30 most prevalent cancers in the United States and calculated direct pharmacologic treatment costs (drug acquisition, administration fees, guideline-concordant supportive care medications) using Medicare reimbursement rates in January 2019. We used generalized estimating equations to estimate the association between NCCN EB measures and treatment cost with clustering at the level of the treatment indication.ResultsA total of 1,386 treatments were included. Among time-unlimited treatments (those administered on an ongoing basis without a predetermined stopping point), monthly cost was positively associated with efficacy ($3,036; 95% CI, $1,782 to $4,289) and quality of evidence ($1,509; 95% CI, $171 to $2,847) but negatively associated with safety (-$1,470; 95% CI, -$2,790 to -$151) and consistency of evidence (-$2,003; 95% CI, -$3,420 to -$586). Among time-limited treatments (those administered for a predetermined interval or number of cycles), no NCCN EB measure was significantly associated with treatment cost.ConclusionsAn association between NCCN EB measures and treatment cost was inconsistent, and the magnitude of the association was small compared with the degree of cost variation among treatments with the same EB scores. The clinical value of cancer treatments does not seem to be a primary determinant of treatment cost.
| S-EPMC8354655 | biostudies-literature
Project description:We estimate the price sensitivity in health care among adolescents and young adults, and assess how it varies across income groups and gender, using a regression discontinuity design. We use the age differential cost-sharing in Swedish primary care as our identification strategy. At the 20th birthday, the copayment increases from €0 to approx. €10 per primary care physician visit and close to this threshold the copayment faced by each person is distributed almost as good as if randomized. The analysis is performed using high-quality health care and economic register data of 73,000 individuals aged 18-22. Our results show that the copayment decreases the average number of visits by 7%. Among women visits are reduced by 9%, for low-income individuals by 11%, and for low-income women by 14%. In conclusion, modest copayments have significant utilization effects, and even in a policy context with relatively low income inequalities, the effect is substantially larger in low-income groups and among women.
| S-EPMC6803576 | biostudies-literature
Project description:BackgroundThough financial hardship is a well-documented adverse effect of standard-of-care cancer treatment, little is known about out-of-pocket costs and their impact on patients participating in cancer clinical trials. This study explored the financial effects of cancer clinical trial participation.MethodsThis cross-sectional analysis used survey data collected in December 2022 and May 2023 from individuals with cancer previously served by Patient Advocate Foundation, a nonprofit organization providing social needs navigation and financial assistance to US adults with a chronic illness. Surveys included questions on cancer clinical trial participation, trial-related financial hardship, and sociodemographic data. Descriptive and bivariate analyses were conducted using Cramer's V to estimate the in-sample magnitude of association. Associations between trial-related financial hardship and sociodemographics were estimated using adjusted relative risks (aRR) and corresponding 95% confidence intervals (CI) from modified Poisson regression models with robust standard errors.ResultsOf 650 survey respondents, 18% (N = 118) reported ever participating in a cancer clinical trial. Of those, 47% (n = 55) reported financial hardship as a result of their trial participation. Respondents reporting trial-related financial hardship were more often unemployed or disabled (58% vs. 43%; V = 0.15), Medicare enrolled (53% vs. 40%; V = 0.15), and traveled >1 h to their cancer provider (45% vs. 17%; V = 0.33) compared to respondents reporting no hardship. Respondents who experienced trial-related financial hardship most often reported expenses from travel (reported by 71% of respondents), medical bills (58%), dining out (40%), or housing needs (40%). Modeling results indicated that respondents traveling >1 h vs. ≤30 min to their cancer provider had a 2.2× higher risk of financial hardship, even after adjusting for respondent race, income, employment, and insurance status (aRR = 2.2, 95% CI 1.3-3.8). Most respondents (53%) reported needing $200-$1000 per month to compensate for trial-related expenses. Over half (51%) of respondents reported less willingness to participate in future clinical trials due to incurred financial hardship. Notably, of patients who did not participate in a cancer clinical trial (n = 532), 13% declined participation due to cost.ConclusionCancer clinical trial-related financial hardship, most often stemming from travel expenses, affected almost half of trial-enrolled patients. Interventions are needed to reduce adverse financial participation effects and potentially improve cancer clinical trial participation.
| S-EPMC11022148 | biostudies-literature
Project description:OBJECTIVE:In traditional behavioral weight loss (BWL) programs, young adults fare worse than older adults with respect to engagement, retention, and weight loss, but money and use of technology have been cited as program factors that might improve outcomes for this population. This study evaluated young adult performance in internet-based BWL (IBWL) offering financial incentives for self-monitoring and weight loss. METHODS:Participants (N = 180; BMI = 33.2 ± 6.0 kg/m2 ) were randomly assigned to a 12-week IBWL or IBWL + incentives (IBWL + $) group. This secondary data analysis compared young adults (ages 18-35) in IBWL (n = 16) with young adults in IBWL + $ (n = 12) on percent weight loss, engagement, and retention. Young adults (n = 28) were also compared with older adults (ages 36-70; n = 152) on these outcomes. RESULTS:Young adult weight loss was -2.8% ± 5.2% in IBWL and -5.4% ± 5.7% in IBWL + $ (P = 0.23, partial η2 = 0.06). A greater proportion of young adults in IBWL + $ achieved a 10% weight loss compared with IBWL (42% vs. 6%, P = 0.02). Compared with older adults, young adults were less engaged, but there were no differences for retention or weight loss (P values > 0.05). CONCLUSIONS:Findings suggest that technology-based BWL has the potential to eliminate weight loss disparities observed between young adults and older adults in in-person BWL trials. Moreover, adding financial incentives holds promise for promoting clinically meaningful weight loss for young adults.
| S-EPMC7380503 | biostudies-literature
Project description: Not available
| S-EPMC10590929 | biostudies-literature
Project description:The Metabolic Cost of Walking (MCoW) is an important variable of daily life that has been studied extensively. Several studies suggest that MCoW is higher in Older Adults (OA) than in Young Adults (YA). However, it is difficult to compare values across studies due to differences in the way MCoW was expressed, the units in which it was reported and the walking speed at which it was measured. To provide an overview of MCoW in OA and YA and to investigate the quantitative effect of age on MCoW, we have conducted a literature review and performed two meta-analyses. We extracted data on MCoW in healthy YA (18-41 years old) and healthy OA (≥59 years old) and calculated, if not already reported, the Gross (GCoW) and Net MCoW (NCoW) in J/kg/m. If studies reported MCoW measured at multiple speeds, we selected those values for YA and OA at which MCoW was minimal. All studies directly comparing YA and OA were selected for meta-analyses. From all studies reviewed, the average GCoW in YA was 3.4 ± 0.4 J/kg/m and 3.8 ± 0.4 J/kg/m in OA (~12% more in OA), and the average NCoW in YA was 2.4 ± 0.4 J/kg/m and 2.8 ± 0.5 J/kg/m in OA (~17% more in OA). Our meta-analyses indicated a statistically significant elevation of both GCoW and NCoW (p < 0.001) for OA. In terms of GCoW, OA expended about 0.3 J/kg/m more metabolic energy than YA and about 0.4 J/kg/m more metabolic energy than YA in terms of NCoW. Our study showed a statistically significant elevation in MCoW of OA over YA. However, from the literature it is unclear if this elevation is directly caused by age or due to an interaction between age and methodology. We recommend further research comparing MCoW in healthy OA and YA during "natural" over-ground walking and treadmill walking, after sufficient familiarization time.
| S-EPMC6620279 | biostudies-other
Project description:BackgroundYoung adults and other working-age adults with cancer are at risk for cancer-related financial toxicity (FT), including material hardships, depletion of coping resources, and psychological burden. This study compares FT domains in young adults (18-39 years old) (YAs), other working-age adults (40-64 years old), and older adults (≥65 years old) receiving cancer care.MethodsA total of 311 adults were surveyed using the multi-domain Economic Strain and Resilience in Cancer instrument measuring FT (0-10 score indicating least to greatest FT; score ≥5 severe FT). Participants were receiving ambulatory care from March-September 2019. Associations of age with overall FT and material hardship, coping resource depletion, and psychological burden FT domains were tested using Kruskal-Wallis and χ2 tests and multivariable generalized linear models with gamma distribution.ResultsYAs (median age, 31.5 years) comprised 9.6% of the sample; other working-age adults comprised 56.9%. Overall, material, coping, and psychological FT scores were worse in younger age adults versus older adults (P < .001 in all multivariable models). Compared with older adults, younger age adults demonstrated worse material hardship (median scores, 3.70 vs 4.80 vs 1.30 for YAs, other working-age, and older adults, respectively; P < .001), coping resource depletion (4.50 vs 3.40 vs 0.80; P < .001), and psychological burden (6.50 vs 7.00 vs 1.00; P < .001). Fifty percent of YAs had severe overall FT versus 40.7% of other working-age adults and 9.6% of older adults (P < .001).ConclusionsYounger age adults with cancer bore disproportionate FT. Interventions to address unmet needs are critical components for addressing FT in this population.
| S-EPMC9177670 | biostudies-literature
Project description:ObjectiveTo evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress.MethodsThis was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress.ResultsSignificant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P = 0.032) and psychological distress (P < 0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50-59 years (P = 0.035), 60-69 years (P = 0.007), and 70 years or older (P = 0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P < 0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P = 0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P = 0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P = 0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P = 0.009), the surgery group (P < 0.001) and adjuvant therapy group (P < 0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups.ConclusionsThe research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.
| S-EPMC9166374 | biostudies-literature