Impact of Physical and Functional Limitations on Health Care Utilization in Older Cancer Survivors: A Medicare Current Beneficiary Survey

Chavan, Prachi; Kedia, Satish; Yu, Xinhua

doi:10.1177/0898264319872309

Cited by 9 publications

(7 citation statements)

References 44 publications

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“…Our study makes several novel contributions to the literature. First, although previous studies used a variety of definitions for disability (eg, activities of daily living ( 36 , 37 ), Social Security Disability Insurance ( 13 , 38 )), we provided estimates of the prevalence of functional disability, collectively and by type, based on the standardized HHS definition ( 26 ). Second, prior research largely focused on the association of disability with use of a specific health service (eg, ED) ( 10 , 11 , 13 , 36 , 37 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of functional disability on health-care use and medical costs among cancer survivors

Tak

Horner

Lee

et al. 2023

JNCI Cancer Spectrum

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Background Cancer survivors with a disability are among the most vulnerable in health status and financial hardship, but no prior research has systematically examined how disability modifies healthcare use and costs. This study examines the association of functional disability among cancer survivors with their healthcare utilization and medical costs. Methods We generated nationally representative estimates using the 2015-2019 Medical Expenditure Panel Survey. Outcomes included utilization of six service types (inpatient, outpatient, office-based physician, office-based non-physician, ED, prescription) and medical costs of aggregate services and by each of six service types. Primary independent variable was a categorical variable of total number of functional disabilities. We employed multivariable generalized linear models and two-part models, adjusting for socio-demographics and health conditions and accounting for survey design. Results Among cancer survivors (n = 9,359; weighted n = 21,046,285), 38.8% reported at least one disability. Compared to those without disability, cancer survivors with ≥4 disabilities experienced longer hospital stays (adjusted average marginal effect [AME] 1.14 days; 95% confidence interval [CI] 0.55-1.73), more visits to office-based physician (AME 1.43 visits; 95% CI 0.51-2.35), and greater number of prescriptions (AME 12.1 prescriptions; 95% CI 9.27-15.0). Their total (AME $9,537; 95% CI $5,713-$13,361) and out-of-pocket (AME $639; 95% CI $79-$1,199) medical costs for aggregate services were significantly higher. By type, disability in independent living was most strongly associated with greater costs for aggregate services. Conclusions Cancer survivors with a disability experienced greater healthcare use and higher costs. Cancer survivorship planning for healthcare and financial stability should consider the patients’ disability profile.

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Section: Discussionmentioning

confidence: 99%

Impact of functional disability on health-care use and medical costs among cancer survivors

Tak

Horner

Lee

et al. 2023

JNCI Cancer Spectrum

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“…Measures of functional independence limitation measures were categorized into groups: global cognition (MMSE), frailty (IADL/ADL, FAI, Barthel Index, GFI), and mobility (SPPB, TUG, 6 MW). Thirty-five studies reported global cognition [ 11 , 39 , 41 , 47 , 51 , 55 , 59 , 62 , 63 , 65 , 66 , 69 , 70 , 75 , 76 , 78 , 80 , 85 , 86 , 88 , 89 , 91 , 92 , 94 , 96 , 98 , 101 , 104 , 106 – 108 , 110 , 115 – 117 , 121 , 123 ], 55 studies reported frailty characteristics [ 11 , 39 – 43 , 46 , 47 , 49 – 52 , 54 , 58 , 61 – 64 , 68 , 71 – 83 , 86 , 87 , 90 – 94 , 98 – 100 , 107 – 112 , 114 , 115 , 118 – 123 ], six reported mobility characteristics [ 54 , 55 , 63 , 97 , …”

Section: Resultsmentioning

confidence: 99%

International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study

et al. 2022

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Background Functional independence limitations restrict older adult self-sufficiency and can reduce quality of life. This systematic review and cost of impairment study examined the costs of functional independence limitations among community dwelling older adults to society, the health care system, and the person. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines this systematic review included community dwelling older adults aged 60 years and older with functional independence limitations. Databases (Cochrane Database of Systematic Reviews, EconLit, NHS EED, Embase, CINAHL, AgeLine, and MEDLINE) were searched between 1990 and June 2020. Two reviewers extracted information on study characteristics and cost outcomes including mean annual costs of functional independence limitations per person for each cost perspective (2020 US prices). Quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Results 85 studies were included. The mean annual total costs per person (2020 US prices) were: $27,380.74 (95% CI: [$4075.53, $50,685.96]) for societal, $24,195.52 (95% CI: [$9679.77, $38,711.27]) for health care system, and $7455.49 (95% CI: [$2271.45, $12,639.53]) for personal. Individuals with cognitive markers of functional independence limitations accounts for the largest mean costs per person across all perspectives. Variations across studies included: cost perspective, measures quantifying functional independence limitations, cost items reported, and time horizon. Conclusions This study sheds light on the importance of targeting cognitive markers of functional independence limitations as they accounted for the greatest costs across all economic perspectives.

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Section: Introductionmentioning

confidence: 99%

“…1 Individuals with cancer experience declines in physical function and subsequently may have decreased treatment tolerance, higher health service utilization, and shorter survival. [2][3][4] Despite interdisciplinary agreement on physical activity guidelines for cancer patients, 5 approximately only 30-47% of patients meet these guidelines. [6][7][8] Existing interventions focused on improving physical functioning in cancer survivors have limitations including generalizability, alignment with patient goals, and cost.…”

Section: Introductionmentioning

confidence: 99%

Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer

et al. 2023

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Background Cancer supportive care interventions often have limited generalizability, goal misalignment, and high costs. We developed and piloted a health coaching intervention, UNC HealthScore, in patients undergoing cancer treatment (http://clinicaltrials.gov identifier NCT04923997). We present feasibility, acceptability, and preliminary outcome data. Methods HealthScore is a six‐month, theory‐based, multicomponent intervention delivered through participant‐driven coaching sessions. For the pilot study, participants were provided a Fitbit, responded to weekly symptom and physical function digital surveys, and met with a health coach weekly to develop and monitor goals. Coaching notes were discussed in weekly interdisciplinary team meetings and provided back to the treating oncology team. Symptom alerts were monitored and triaged through a study resource nurse to relevant supportive care services. Feasibility was determined based on intervention enrollment and completion. Acceptability was based on satisfaction with coaching and Fitbit‐wearing and was informed by semistructured exit interviews. Outcomes evaluated for signs of improvement included several PROMIS (Patient‐Reported Outcomes Measurement Information System) measures, including the primary intervention target, physical function. Results From May 2020 to March 2022, 50 participants completed the single‐arm pilot. Feasibility was high: 66% enrolled and 71% completed the full intervention. Participants reported an average of 4.8 and 4.7 (out of 5) on the acceptability of coaching calls and using the Fitbit, respectively. Physical function scores rose 3.1 points (SE = 1.1) from baseline to 3 months, and 4.3 (SE = 1.0) from baseline to 6 months, above established minimal clinically important difference (MCID). Improvements above MCID were also evident in anxiety and depression, and smaller improvements were demonstrated for emotional support, social isolation, cognitive function, symptom burden, and self‐efficacy. Discussion HealthScore shows feasibility, acceptability, and promising preliminary outcomes. Randomized studies are underway to determine the efficacy of preserving physical function in patients with advanced cancer.

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Impact of Physical and Functional Limitations on Health Care Utilization in Older Cancer Survivors: A Medicare Current Beneficiary Survey

Cited by 9 publications

References 44 publications

Impact of functional disability on health-care use and medical costs among cancer survivors

Impact of functional disability on health-care use and medical costs among cancer survivors

International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study

Piloting HealthScore: Feasibility and acceptability of a clinically integrated health coaching program for people living with cancer

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