How Should We Intervene on the Financial Toxicity of Cancer Care? One Shot, Four Perspectives

2017 ◽  
pp. 35-39
Author(s):  
S. Yousuf Zafar ◽  
Lee N. Newcomer ◽  
Justin McCarthy ◽  
Shelley Fuld Nasso ◽  
Leonard B. Saltz
Keyword(s):  
Pharmaceutical Industry ◽  
Cancer Care ◽  
Cost Sharing ◽  
Financial Burden ◽  
Patient Advocacy ◽  
Financial Toxicity ◽  
The Past ◽  
Order Of Magnitude ◽  
Productive Discussion ◽  
Hypothetical Question

The median price of a month of chemotherapy has increased by an order of magnitude during the past 20 years, far exceeding inflation over the same period. Along with rising prices, increases in cost sharing have forced patients to directly shoulder a greater portion of those costs, resulting in undue financial burden and, in some cases, cost-related nonadherence to treatment. What can we do to intervene on treatment-related financial toxicity of patients? No one party can single-handedly solve the problem, and the solution must be multifaceted and creative. A productive discussion of the problem must avoid casting blame and, instead, must look inward for concrete starting points toward improvement in the affordability and value of cancer care. With these points in mind, the authors—representatives from the pharmaceutical industry, insurance providers, oncologists, and patient advocacy—have each been asked to respond with a practical answer to the provocative hypothetical question, “If you could propose one thing, and one thing only, in terms of an action or change by the constituency you represent in this discussion, what would that be?”

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.

Financial Toxicity of Cancer Care: An Analysis of Financial Burden in Three Distinct Health Care Systems

2021 ◽  
pp. OP.20.00890
Author(s):  
Divya A. Parikh ◽  
Meera Ragavan ◽  
Ritika Dutta ◽  
Jeffrey Garnet Edwards ◽  
James Dickerson ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Medical Center ◽  
Financial Burden ◽  
Financial Toxicity ◽  
Cross Sectional Survey ◽  
Factors Associated ◽  
Care Systems ◽  
Comprehensive Score

PURPOSE: The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. METHODS: We conducted a cross-sectional survey of patients in three care systems, Stanford Cancer Institute (SCI), VA Palo Alto Health Care System (VAPAHCS), and Santa Clara Valley Medical Center (SCVMC), from October 2017 to May 2019. We assessed demographic factors, employment status, and out-of-pocket costs (OOPCs) and administered the validated COmprehensive Score for financial Toxicity tool. We calculated descriptive statistics and conducted linear regression models to analyze factors associated with financial toxicity. RESULTS: Four hundred forty-four of 578 patients (77%) completed the entire COmprehensive Score for financial Toxicity tool and were included in the analysis. Most respondents at SCI were White, with annual household income (AHI) > $50,000 USD and Medicare insurance. At the VAPAHCS, most were White, with AHI ≤ $50,000 USD and insured by the Veterans Administration. At SCVMC, most were Asian and/or Pacific Islander, with AHI ≤ $25,000 USD and Medicaid insurance. Low AHI ( P < .0001), high OOPCs ( P = .003), and employment changes as a result of cancer diagnosis ( P < .0001) were associated with financial toxicity in the pooled analysis. There was variation in factors associated with financial toxicity by site, with employment changes significant at SCI, OOPCs at SCVMC, and no significant factors at the VAPAHCS. CONCLUSION: Low AHI, high OOPCs, and employment changes contribute to financial toxicity; however, there are variations based on site of care. Future studies should tailor financial toxicity interventions within care delivery systems.

Financial toxicity of cancer treatment at a diverse county hospital.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 76-76
Author(s):  
Divya Ahuja Parikh ◽  
Meera Vimala Ragavan ◽  
Debeshi Maitra ◽  
Sangeeta Aggarwal ◽  
Manali I. Patel
Keyword(s):  
Sex Education ◽  
Low Income ◽  
Cancer Care ◽  
Financial Burden ◽  
Education Level ◽  
Financial Toxicity ◽  
Demographic Information ◽  
Significant Difference ◽  
The Cost ◽  
Out Of Pocket Costs

76 Background: The rising costs of cancer care increasingly results in financial distress for patients and their families. Low-income patients face a greater burden of financial toxicity, but few studies have characterized what factors contribute to this, and what interventions can relieve toxicity. Methods: From October 2017 to December 2017, we used a validated COST survey tool to understand the extent of financial burden that patients with cancer experience. We surveyed patients who receive their oncology care in a medical system that serves predominantly minority and low-income patients in Santa Clara County. We collected demographic information including sex, education level, ethnicity, income, insurance status, monthly out of pocket costs (OOPC) and employment status prior to diagnosis. We used a multivariable linear regression to study the association between the patient factors and financial burden as demonstrated by the COST score. All data were analyzed using Stata 14. Results: Demographic information is presented in Table 1. A total of 152 patients completed all 11 items of the COST survey. In the multivariate model, there was no significant difference in COST score by sex, education level, or ethnicity. However, income ≤$25,000 was associated with higher COST scores (p = 0.019), as was higher monthly OOPC (p = 0.003). Medicare patients and patients who were employed prior to diagnosis tended to have higher COST scores although not quite statistically significant (p = 0.057, p = 0.083). Conclusions: Patient-reported financial toxicity is an unmet concern among patients in this single institution study with a high proportion of underinsured patients. Higher OOPC and low income was associated with a higher financial burden. These findings suggest that patients would benefit from targeted interventions to mediate out of pocket costs of cancer care.[Table: see text]

Patient-reported benefit from proposed interventions to reduce financial hardship during cancer treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7080-7080
Author(s):  
Emeline Aviki ◽  
Fumiko Chino ◽  
Julia Ramirez ◽  
Victoria Susana Blinder ◽  
Jennifer Jean Mueller ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Financial Burden ◽  
Gynecologic Cancer ◽  
Financial Hardship ◽  
Care Providers ◽  
Financial Toxicity ◽  
The Past ◽  
Patient Reported ◽  
The Impact

7080 Background: Awareness of cancer patients’ financial toxicity (FT) has increased substantially over the past decade; however, interventions to minimize financial burden remain underdeveloped and understudied. This survey-based study explores patient beliefs on which potential mitigating strategies could improve their financial hardship during cancer treatment. Methods: Interviewer-administered surveys were conducted with consecutive patients in an outpatient, urban, private academic Gynecologic Cancer clinic waiting room for 2 weeks in August 2019. The survey items included patient demographics, disease characteristics, the Comprehensive Score for Financial Toxicity (COST) tool (validated measure of FT with score 0-44; lower scores indicate worse FT), assessment of cost-coping strategies, and patient-reported anticipated benefit from described potential interventions (items that were feasible and relevant to implement in clinic). Results: Of 101 patients who initiated the survey, 87 (86%) completed it and were included in this analysis. The median age was 66 (range, 32-87). Thirty-eight patients (44%) had ovarian, 29 (33%) uterine, 5 (6%) cervical, and 15 (17%) an “other” gynecologic cancer. The median COST score was 32 (range, 6-44). Twenty-nine patients (33%) had COST scores ≤25 and 16 (18%) had COST scores ≤18. The most frequent cost-coping strategy reported was reducing leisure activities (n = 36, 41%) and using savings to pay for medical bills (n = 34, 39%). Six patients (7%) reported not taking a prescribed medication in the past 12 months due to the inability to pay and 0 reported skipping a recommended imaging study. When it came to interventions patients anticipated would improve their current financial hardships, 34 (39%) indicated access to transportation assistance to and from appointments, 31 (36%) said “knowing up front how much I’m going to have to pay for my healthcare”, 29 (33%) indicated “minimizing wait time associated with appointments, which keeps me away from work”, and 22 (25%) indicated “access to free food during/around appointments and treatments”. Only 26 (30%) noted they were not experiencing financial hardship. Conclusions: For an outpatient population of gynecologic cancer patients, several focused, feasible interventions could be implemented to potentially decrease patient FT. Our study can help health care providers in the design of interventions to create meaningful improvements in patient financial burden. Next steps should assess the impact of targeted interventions on patient outcomes.

Financial toxicity of cancer treatment at a large academic cancer center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18323-e18323
Author(s):  
Divya Ahuja Parikh ◽  
Krunal Amin ◽  
Evan Thomas Hall ◽  
Manali I. Patel
Keyword(s):  
Sex Education ◽  
Cancer Care ◽  
Household Income ◽  
Financial Burden ◽  
Education Level ◽  
Cancer Center ◽  
Financial Toxicity ◽  
Annual Household Income ◽  
Significant Difference ◽  
Patient Reported

e18323 Background: Many studies have shown that patients with cancer are at higher risk of financial difficulty than those without cancer. Given the rising cost of cancer therapy it is important to study the financial distress associated with cancer care. Therefore, we assessed patient reported financial toxicity at a large tertiary academic cancer institute. Methods: From July 2014 to August 2014, we asked 300 patients at the Stanford Cancer Center to participate in an 11-item questionnaire about costs incurred with cancer care. We calculated patient-reported financial toxicity using the COST score, validated at the University of Chicago (scores range from 0-44 with higher values indicating higher financial burden). We obtained demographic information including sex (male or female), education level (high school or less, associates/bachelors degree, or masters/professional degree), race (white or non-white) and annual household income ( < $49,999, $50,000-$99,999, or > $100,000) and used multivariable logistic regression to analyze the association between demographic factors and COST score. Results: Out of the 300 patients approached 254 patients (84.7%) participated in the survey. Nearly half (46%) responded that they “worry about the financial problems in the future as a result of illness or treatment“ quite a bit (4) or very much (5). More than half (52%) reported “I feel I have no choice about the amount of money I spend on care” quite a bit (4) or very much (5). Of patients without missing data (n = 184, 61.3%), the mean COST score was 21 (range 2-41). There were no significant differences in COST score by sex, education level, or race. However, there was a significant difference in COST score by annual household income with a higher degree of financial burden in the lowest income group (OR = 1.04, CI = 0.69-1.38, p < 0.001). Conclusions: Financial toxicity is an unmet concern among patients in our single institution study, with increased burden expressed by those in lower income groups. Our results demonstrate that financial toxicity is a critical concern despite our limited sample. Multicenter studies should be conducted to better characterize the risk factors and serve as a basis for interventions for patients at risk for financial toxicity.

Navigating the high costs of cancer care: opportunities for patient engagement

2021 ◽  
Author(s):  
Alexander H Gunn ◽  
Corinna Sorenson ◽  
Rachel A Greenup
Keyword(s):  
Digital Technology ◽  
Cancer Care ◽  
Financial Burden ◽  
System Level ◽  
Patient Level ◽  
The Past ◽  
Drug Prices ◽  
Economic Experience ◽  
Care Costs ◽  
Financial Burden Of Cancer

Over the past decade, the financial burden of cancer care on patients and their families has garnered increased attention. Many of the potential solutions have focused on system-level interventions such as adopting value-based payment models and negotiating drug prices; less consideration has been given to actions at the patient level to address cancer care costs. We argue that it is imperative to develop and support patient-level strategies that engage patients and consider their preferences, values and individual circumstances. Opportunities to meet these aims and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.

scholarly journals Financial toxicity in sarcoma patients and survivors in Germany: results from the multicenter PROSa study

2021 ◽  
Author(s):  
Matthias Büttner ◽  
Susanne Singer ◽  
Leopold Hentschel ◽  
Stephan Richter ◽  
Peter Hohenberger ◽  
...  
Keyword(s):  
Financial Burden ◽  
Clinical Importance ◽  
Financial Toxicity ◽  
Financial Difficulties ◽  
Education Status ◽  
Eortc Qlq C30 ◽  
Multicenter Prospective Cohort Study ◽  
Associated Risk Factors ◽  
Eortc Qlq ◽  
Age And Sex

Abstract Purpose Cancer patients have been shown to frequently suffer from financial burden before, during, and after treatment. However, the financial toxicity of patients with sarcoma has seldom been assessed. Therefore, the aim of this study was to evaluate whether financial toxicity is a problem for sarcoma patients in Germany and identify associated risk factors. Methods Patients for this analysis were obtained from a multicenter prospective cohort study conducted in Germany. Using the financial difficulties scale of the EORTC QLQ-C30, financial toxicity was considered to be present if the score exceeded a pre-defined threshold for clinical importance. Comparisons to an age- and sex-matched norm population were performed. A multivariate logistic regression using stepwise backward selection was used to identify factors associated with financial toxicity. Results We included 1103 sarcoma patients treated in 39 centers and clinics; 498 (44.7%) patients reported financial toxicity. Sarcoma patients had 2.5 times the odds of reporting financial difficulties compared to an age- and sex-matched norm population. Patient age < 40 and > 52.5 years, higher education status, higher income, and disease progression (compared to patients with complete remission) were associated with lower odds of reporting financial toxicity. Receiving a disability pension, being currently on sick leave, and having a disability pass were statistically significantly associated with higher odds of reporting financial toxicity. Conclusion Financial toxicity is present in about half of German sarcoma patients, making it a relevant quality of life topic for patients and decision-makers.

Financial Toxicity During Breast Cancer Treatment: A Qualitative Analysis to Inform Strategies for Mitigation

2021 ◽  
pp. OP.21.00182
Author(s):  
Laila A. Gharzai ◽  
Kerry A. Ryan ◽  
Lauren Szczygiel ◽  
Susan Goold ◽  
Grace Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Financial Distress ◽  
Ductal Carcinoma ◽  
Financial Burden ◽  
Unmet Need ◽  
Metastatic Breast ◽  
Financial Toxicity ◽  
Knowledge Gaps ◽  
Treatment Expectations

PURPOSE: Financial toxicity from cancer treatment is a growing concern. Its impact on patients requires refining our understanding of this phenomenon. We sought to characterize patients' experiences of financial toxicity in the context of an established framework to identify knowledge gaps and strategies for mitigation. METHODS: Semistructured interviews with patients with breast cancer who received financial aid from a philanthropic organization during treatment were conducted from February to May 2020. Interviews were transcribed and coded until thematic saturation was reached, and findings were contextualized within an existing financial toxicity framework. RESULTS: Thirty-two patients were interviewed, of whom 58% were non-Hispanic White. The mean age was 46 years. Diagnoses ranged from ductal carcinoma in situ to metastatic breast cancer. Concordant with an established framework, we found that direct and indirect costs determined objective financial burden and subjective financial distress stemmed from psychosocial, behavioral, and material impact of diagnosis and treatment. We identified expectations as a novel theme affecting financial toxicity. We identified knowledge gaps in treatment expectations, provider conversations, identification of resources, and support-finding and offer strategies for mitigating financial toxicity on the basis of participant responses, such as leveraging support from decision aids and allied providers. CONCLUSION: This qualitative study confirms an existing framework for understanding financial toxicity and identifies treatment expectations as a novel theme affecting both objective financial burden and subjective financial distress. Four knowledge gaps are identified, and strategies for mitigating financial toxicity are offered. Mitigating patients' financial toxicity is an important unmet need in optimizing cancer treatment.

Pharmaceutical Innovation in the United States: Factors Affecting Future Performance

1993 ◽  
Vol 9 (2) ◽  
pp. 167-173 ◽  
Author(s):  
Michael R. Pollard
Keyword(s):  
United States ◽  
Pharmaceutical Industry ◽  
Research And Development ◽  
Cost Containment ◽  
The United States ◽  
Private Companies ◽  
Factors Affecting ◽  
The Past ◽  
Future Performance ◽  
Regulatory Strategy

AbstractFueled by high returns on its investments, the pharmaceutical industry in the United States has flourished for the past 50 years. The regulatory strategy of demanding stringent testing then allowing market-based pricing has allowed private companies to fund ambitious research and development activities with the assurance that these investments will be recovered. However, aggressive managed-care cost-containment strategies threaten the companies' ability to recoup research and development expenses and may affect their willingness to invest in future innovative research.

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