Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System

Ezeife, Doreen Anuli; Morganstein, Brandon Josh; Lau, Sally; Law, Jennifer; Le, Lisa W.; Bredle, Jason; Cella, David; Doherty, Mark; Bradbury, Penelope Ann; Liu, Geoffrey; Sacher, Adrian G.; Shepherd, Frances A.; Leighl, Natasha B.

doi:10.1016/j.cllc.2018.12.010

Cited by 45 publications

(46 citation statements)

References 14 publications

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“…Pearson correlation coefficient: 0.41, P < 0.001. financial toxicity. 5,15 However, our results have demonstrated that assessing household savings and screening for access to basic necessities are more objective measures of low financial reserve, which better identify those at the highest risks for cancer-related financial toxicity (P < 0.001). We also identified that transient changes in employment status due to cancer treatment (being employed but on sick leave) might also identify those at a higher risk for cancerrelated financial distress (P ¼ 0.06).…”

Section: Discussionmentioning

confidence: 80%

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Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

Hazell

et al. 2020

Annals of Oncology

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Background: Advances in lung cancer therapy have resulted in improved clinical outcomes. Unfortunately, advances can come at a financial cost to patients and their families that poses a significant risk to overall quality of life (QoL). Financial distress has been shown to be associated with increased symptom burden and decreased treatment compliance but the magnitude of financial distress is not well characterized in lung cancer populations. Patients and methods: Patients with stage IIeIV newly diagnosed lung cancer and starting first-line therapy were recruited at a tertiary academic institution between July 2018 and April 2019. The comprehensive score for financial toxicity (COST) was used to assess financial toxicity and the Functional Assessment of Cancer Therapy-Lung (FACT-L) was used to assess QoL. Associations between financial toxicity and baseline variables were assessed using multivariable linear regression and correlations were assessed using the Pearson correlation. Results: In this study, 143 consecutive patients were approached and 91.6% agreed to participate (N ¼ 131). The median age was 65 years (35e90); 52.7% were male (n ¼ 69), and 75.6% were white (n ¼ 99). The inability to afford basic necessities and having <1 month of savings was associated with increased financial toxicity (P < 0.001) after adjusting for other factors such as age, race, insurance, and income. There was also a trend toward increased financial toxicity among those who were employed but on sick leave (P ¼ 0.06). Increased financial toxicity was correlated with a decrease in QoL (correlation coefficient 0.41, P < 0.001). Patients' anticipated out-of-pocket (OOP) expenses for the upcoming 6 months ranged from $0 to $50 000 (median $2150). However, there was no correlation between anticipated OOP expenses and either financial toxicity or QoL. Conclusions: These data identify key factors for identifying at-risk patients and builds a framework for exploring the benefit of financial counseling interventions, which may improve QoL and oncologic outcomes.

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Section: Discussionmentioning

confidence: 80%

“…While past studies have shown an association between high OOP costs and financial toxicity, 9,15 there may be a difference between what patients expect to pay and what they do pay. Among our cohort, there was no correlation between estimated OOP costs and financial toxicity.…”

Section: Discussionmentioning

confidence: 97%

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

Hazell

et al. 2020

Annals of Oncology

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“…COST has already been translated and adapted for different cultures and applied in different health systems, in different countries. A study [13] in Canada, which has a public health system, used COST to define factors associated with financial toxicity in patients with lung cancer. In another study [8] in the United States, in which most populations have a private health system, it was used to investigate the financial impact of cancer among newly diagnosed individuals.…”

Section: Introductionmentioning

confidence: 99%

Validation of the comprehensive score for financial toxicity for Brazilian culture

Nogueira¹,

Koller²,

Marcondes³

et al. 2020

ecancer

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Financial toxicity is a side effect of cancer treatment showing the financial burden experienced by cancer patients for funding their treatment. An instrument for its evaluation can contribute towards the creation of coping strategies. In Brazil, a developing country, cancer patients certainly feel the effects of this serious adverse event, however, the discussion on the theme and research concerning these issues is scarce and an instrument for evaluation can help in the promotion of coping strategies. Thus, the study objective was to: 1) translate and adapt the COmprehensive Score for financial Toxicity (COST) questionnaire to Brazilian culture and 2) evaluate the COST psychometric properties in Brazil. Thus, a methodological study was developed in two stages. In the first stage, the translation and cross-cultural adaptation were performed, and in the second stage, two groups of participants were recruited to evaluate the psychometric properties. In the first stage, 21 individuals participated, including translators and cancer patients, and in the second stage, 126 patients participated who were undergoing cancer treatment. For validation, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and Cronbach’s alpha coefficient were performed to verify internal consistency. For the first stage’s outcome, the pre-test Cronbach’s alpha was 0.83. The EFA and CFA carried out in the second stage of the study revealed that the COST Brazilian version measures a single construct with a value of—χ2/gl = 179.78, comparative fit index = 0.00, Parsimony goodness of fit index = 0.302, root mean square error of approximation = 1.196 and p-value of close fit = 0.000. When comparing the average of the COST score and the standard deviation of the two samples, the significance value was p = 0.001. Therefore, it is possible to confirm that the COST is a valid and reliable questionnaire to measure the financial toxicity of cancer patients in Brazil.

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“…In conclusion, certain teams, including ours, limit the use of NGS at baseline for certain patients and integrate the practice of a large sequencing approach using a specific algorithm for predictive biomarker testing [33]. The algorithm proposed to physicians for patient care could be modified and should be adapted to the circuit of the samples, the different therapeutic strategies available, the requests of the physicians, and the financial model of the molecular pathology laboratory.…”

Section: Discussionmentioning

confidence: 99%

Targeted Assessment of the EGFR Status as Reflex Testing in Treatment-Naive Non-Squamous Cell Lung Carcinoma Patients: A Single Laboratory Experience (LPCE, Nice, France)

Lassalle

Hofman

Heeke

et al. 2020

Cancers

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Background: Assessment of actionable EGFR mutations is mandatory for treatment-naïve advanced or metastatic non-squamous lung carcinoma (NSLC), but the results need to be obtained in less than 10 working days. For rapid EGFR testing, an EGFR-specific polymerase chain reaction (PCR) assay is an alternative and simple approach compared to next generation sequencing (NGS). Here, we describe how a rapid EGFR-specific PCR assay can be implemented in a single laboratory center (LPCE, Nice, France) as reflex testing in treatment-naïve NSLC. Methods: A total of 901 biopsies from NSLC with more than 10% of tumor cells were prospectively and consecutively evaluated for EGFR mutation status between November 2017 and December 2019 using the Idylla system (Biocartis NV, Mechelen, Belgium). NGS was performed for nonsmokers with NSLC wild type for EGFR, ALK, ROS1, and BRAF and with less than 50% PD-L1 positive cells using the Hotspot panel (Thermo Fisher Scientific, Waltham, MA, USA). Results: Results were obtained from 889/901 (97%) biopsies with detection of EGFR mutations in 114/889 (13%) cases using the Idylla system. Among the 562 EGFR wild type tumors identified with Idylla, NGS detected one actionable and one nonactionable EGFR mutation. Conclusions: Rapid and targeted assessment of EGFR mutations in treatment-naïve NSLC can be implemented in routine clinical practice. However, it is mandatory to integrate this approach into a molecular algorithm that allows evaluation of potentially actionable genomic alterations other than EGFR mutations.

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Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System

Cited by 45 publications

References 14 publications

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

Financial toxicity in lung cancer: an assessment of magnitude, perception, and impact on quality of life

Validation of the comprehensive score for financial toxicity for Brazilian culture

Targeted Assessment of the EGFR Status as Reflex Testing in Treatment-Naive Non-Squamous Cell Lung Carcinoma Patients: A Single Laboratory Experience (LPCE, Nice, France)

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