Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors

Benedict, Catherine; Fisher, Sophie; Schapira, Lidia; Chao, Sabrina; Sackeyfio, Sarah; Sullivan, Tara M.; Pollom, Erqi L.; Berek, Jonathan S.; Kurian, Allison W.; Palesh, Oxana

doi:10.1002/pon.5763

Cited by 46 publications

(22 citation statements)

References 44 publications

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“…This study did not include other factors that affect patient healthcare costs such as travel or time off work. Financial toxicity is an emerging issue in cancer care, as patient financial burden has been associated with worse quality of life, lower patient satisfaction, and delaying or avoiding care 21–23. Telemedicine may offer a potential avenue to administer care while reducing patient burden and has previously been shown to be an accessible option for gynecologic oncology patients and for patients with advanced cancer in resource-limited settings 24 25…”

Section: Discussionmentioning

confidence: 99%

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

Janke

Santiago

Straubhar

et al. 2022

Int J Gynecol Cancer

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ObjectivesGiven the recent rapid increase in telemedicine in the setting of the COVID-19 pandemic, we sought to investigate the utility of symptom review, CA125, and physical examination in the detection of ovarian cancer recurrence to determine the role of virtual surveillance care in the COVID-19 era.MethodsThis retrospective cohort study included patients diagnosed with ovarian cancer between 2013 and 2020 who achieved remission after primary treatment and then had recurrence while in a routine surveillance program. Modalities that detected recurrence including symptoms, CA125, physical examination, or ‘other,’ which was denoted if imaging was obtained for reasons other than suspected recurrence and recurrence was incidentally identified, were recorded. Descriptive statistics were performed to summarize the cohort.ResultsOne hundred and nine patients met inclusion criteria. At time of recurrence, elevated CA125 was present in 97 (89.0%) patients, symptoms in 41 (37.6%), and abnormal physical exam findings in 27 (24.8%). Recurrence was incidentally found with imaging obtained for reasons other than suspicion of recurrence in six (5.5%) patients. Recurrence was suspected based on multiple modalities in 46 (42.2%) patients. Elevated CA125, symptoms, or both were present in 102 (93.6%) patients. Of patients with abnormal physical exam findings, 26 (96.3%) also had elevated CA125 or symptoms present. Recurrence was suspected based on physical exam findings alone in one (0.9%) patient.ConclusionsOver 90% of ovarian cancer recurrences were detected by rising CA125, symptoms, or both. Only one patient had recurrence detected by physical examination alone. Given that review of symptoms and CA125 can be conducted virtually, virtual visits may offer a reasonable alternative to in-person visits for ovarian cancer surveillance for patients who have pre-treatment elevated CA125.

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Section: Discussionmentioning

confidence: 99%

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

Janke

Santiago

Straubhar

et al. 2022

Int J Gynecol Cancer

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“…Recently, there has been an increasing awareness about long-term financial burden and distress among cancer survivors [13]. The COST has been used in several studies to assess financial toxicity of cancer survivors as well as insured patients [9,14,15].) Breast cancer is the most common cancer diagnosed in women.…”

Section: Introductionmentioning

confidence: 99%

Validation of Korean Version of the COmprehensive Score for financial Toxicity (COST) Among Breast Cancer Survivors

et al. 2022

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Little is known about the impact of financial toxicity in disease-free breast cancer survivors.We aim to validate the COST in Korean (COST-K) and evaluate financial toxicity among disease-free breast cancer survivors. Materials and MethodsWe conducted linguistic validation following a standardized methodology recommended by FACITtrans. For psychometric validation, we conducted a cross-sectional survey with 4,297 disease-free breast cancer survivors at a tertiary hospital in Seoul, Korea between November 2018 and April 2019. Survivors were asked to complete the COST-K and EORTC QLQ-C30 questionnaires. The test-retest reliability, internal consistency, and validity of the COST-K were assessed using standard scale construction techniques. ResultsThe COST-K demonstrated good internal consistency, with a Cronbach's α of 0.81. The testretest analysis revealed an intraclass correlation coefficient of 0.78. The COST-K had moderate correlation (r = -0.60) with the financial difficulty item of the EORTC QLQ-C30 and week correlation with the items on acute and chronic symptom burdens (nausea/vomiting = -0.18, constipation = -0.14, diarrhea = -0.14), showing good convergent and divergent validity. The median COST-K was 27 (range, 0-44; mean ± SD, 27.1 ± 7.5) and about 30% and 5% of cancer survivors experienced mild and severe financial toxicity, respectively. Younger age, lower education, lower household income was associated with higher financial toxicity.

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“…26 Some people may approach a cancer diagnosis and distress based on their socioeconomic status and whether or not they can pay for their cancer treatment. 48 Others may be distressed based on feeling a burden to their family. 49 As the recommendation for the cutoff score point for distress indicates further screening with the problem list, this strategy may ameliorate differences in the essential components that comprise distress.…”

Section: Discussionmentioning

confidence: 99%

“…suggested some women and very religious countries may have different sources of distressed than in those found in Western countries 26 . Some people may approach a cancer diagnosis and distress based on their socioeconomic status and whether or not they can pay for their cancer treatment 48 . Others may be distressed based on feeling a burden to their family 49 .…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non‐English speaking countries

et al. 2022

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Objective The National Comprehensive Cancer Network (NCCN) distress thermometer (DT) was developed as a brief screening tool for detecting distress in cancer patients. Conceptually, distress was considered a more acceptable and inclusive term than other psychological terms such as depression or anxiety. It is used extensively in the United States and other English‐speaking countries. We aim to describe the translation and validation methods of the DT and describe the recommended cutoff scores used to identify cancer patients experiencing clinically significant distress. Methods Nine bibliographic databases were searched using keywords to identify original research studies for non‐English speaking countries' cancer patients. Full articles were independently assessed for inclusion and data extraction by two authors. Results The review of 4442 articles yielded 39 articles that validated the DT. We identified 20 languages in 25 countries. In all but one country, investigators were able to agree upon a word or phrase that meant distress in their native language that was subsequently validated against standardized instruments. Asian, Middle Eastern and European counties recommended cutoff score of 4 or 5 to identify clinically significant distress; however, European Union countries had a range of 2 to 7. Conclusions Use of the translated DT with non‐English speaking cancer patients provides a simple and quick tool to identify high distress. Similar to NCCN, the cutoff score of 4 or 5 was suggested by 78% of the studies; however, more studies of different types of cancer and within and among more countries will strengthen a recommended global DT cutoff score.

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Greater financial toxicity relates to greater distress and worse quality of life among breast and gynecologic cancer survivors

Cited by 46 publications

References 44 publications

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

The utility of physical examination in ovarian cancer recurrence detection: a retrospective analysis informing virtual surveillance care

Validation of Korean Version of the COmprehensive Score for financial Toxicity (COST) Among Breast Cancer Survivors

A systematic review of the translation and validation methods used for the national comprehensive cancer network distress thermometer in non‐English speaking countries

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