Insurance-based disparities and risk of financial toxicity among patients undergoing gynecologic cancer operations

Ng, Ayesha P.; Sanaiha, Yas; Verma, Arjun; Lee, Cory; Akhavan, Aaron; Cohen, Joshua G.; Benharash, Peyman

doi:10.1016/j.ygyno.2022.05.017

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…For insured patients with gynecological cancer, predictors of financial toxicity risk were Black race and Hispanic ethnicity, public (versus private) insurance, and open (versus minimally invasive) surgery [7]. While insurance quality and longer, more complicated surgeries may be associated with increased financial burden, non-White race implies racial healthcare disparities, consistent with other research.…”

supporting

confidence: 80%

“…Their findings revealed that the majority of uninsured patients undergoing cancer surgeries were at risk of financial toxicity (52.8%), compared to 15.4% of insured patients who were at risk. Among the uninsured, risk of financial toxicity worsened in the 12-year period while risk remained relatively stable among the insured [7]. Concurrent with the upward trend of cancer treatments costs, these results confirm the increasing vulnerability of uninsured patients with gynecological cancer receiving inpatient care to the material, physiological, and behavioral domains of financial toxicity.…”

mentioning

confidence: 53%

“…The risk of financial toxicity within the context of gynecological cancers is a growing area of investigation in clinical research [4][5][6], and has been specifically explored with respect to insurance status in a study by Ng et al 2022 in this issue of Gynecologic Oncology [7]. Their analysis of insurance-based disparities and risk for financial toxicity is important in further delineating high risk patients, especially as Medicaid expansion through the Affordable Care Act (ACA) may obscure public perception of healthcare access and affordability [8].…”

mentioning

confidence: 99%

“…Secondary outcomes of the Ng et al 2022 study demonstrated additional insurance-based disparities; while mortality rates were similar, uninsured patients had higher rates of postoperative complications (e.g., infection, thromboembolic event, blood transfusion), longer lengths of stay, and higher overall hospital costs. Uninsured patients were also disproportionately Black race or Hispanic ethnicity [7]. Given the lack of insurance, these patient populations likely suffer from poor access to primary health care and overall lower health status driven by social determinants of health (SDOH) factors; prior research has shown that health care accessibility, health outcomes, education level, and socio-economic status are all interconnected [9].…”

mentioning

confidence: 99%

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Financial toxicity of surgical treatment for gynecological cancer: A growing malignancy

Marion

Aviki²,

Chino

2022

Gynecologic Oncology

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supporting

confidence: 80%

mentioning

confidence: 53%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Financial toxicity of surgical treatment for gynecological cancer: A growing malignancy

Marion

Aviki²,

Chino

2022

Gynecologic Oncology

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“…Risk of FT was calculated by adapting previously used methods in the oncologic and trauma literature [ 11 , 13 ]. Gamma distribution probability density functions were first constructed to determine individual patient incomes [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Socioeconomic disparities in risk of financial toxicity following elective cardiac operations in the United States

Romo Valenzuela,

Chervu,

Roca

et al. 2024

PLoS ONE

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Background While insurance reimbursements allay a portion of costs associated with cardiac operations, uncovered and additional fees are absorbed by patients. An examination of financial toxicity (FT), defined as the burden of patient medical expenses on quality of life, is warranted. Therefore, the present study used a nationally representative database to demonstrate the association between insurance status and risk of financial toxicity (FT) among patients undergoing major cardiac operations. Methods Adults admitted for elective coronary artery bypass grafting (CABG) and isolated or concomitant valve operations were assessed using the 2016–2019 National Inpatient Sample. FT risk was defined as out-of-pocket expenditure >40% of post-subsistence income. Regression models were developed to determine factors associated with FT risk in insured and uninsured populations. To demonstrate the association between insurance status and risk of FT among patients undergoing major cardiac operations. Results Of an estimated 567,865 patients, 15.6% were at risk of FT. A greater proportion of uninsured patients were at risk of FT (81.3 vs. 14.8%, p<0.001), compared to insured. After adjustment, FT risk among insured patients was not affected by non-income factors. However, Hispanic race (Adjusted Odds Ratio [AOR] 1.60), length of stay (AOR 1.17/day), and combined CABG-valve operations (AOR 2.31, all p<0.05) were associated with increased risk of FT in the uninsured. Conclusion Uninsured patients demonstrated higher FT risk after undergoing major cardiac operation. Hispanic race, longer lengths of stay, and combined CABG-valve operations were independently associated with increased risk of FT amongst the uninsured. Conversely, non-income factors did not impact FT risk in the insured cohort. Culturally-informed reimbursement strategies are necessary to reduce disparities in already financially disadvantaged populations.

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Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

Rauh-Hain,

Melamed,

Pareja

et al. 2024

JAMA Netw Open

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ImportanceDespite the absence of high-quality evidence of its safety and effectiveness, minimally invasive surgery (MIS) is increasingly used to treat advanced epithelial ovarian cancer (EOC).ObjectiveTo assess the feasibility of conducting a full-scale randomized clinical trial (RCT) designed to compare the efficacy of MIS vs laparotomy in patients with advanced-stage EOC and a complete or partial response to neoadjuvant chemotherapy (NACT).Design, Setting, and ParticipantsThis lead-in pilot phase of LANCE (Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy), an international, open-label, noninferiority RCT, opened to enrollment in September 2020 and enrolled the 100th eligible patient in February 2023. It was conducted at 11 academic cancer centers in North America and Europe. Participants were adults with stage IIIC or IV epithelial ovarian, fallopian, or primary peritoneal carcinoma who had normal cancer antigen 125 levels and at least a partial radiologic response after 3 to 4 cycles of NACT. Patients were randomly assigned to receive either interval cytoreductive surgery performed using MIS or laparotomy. Data analysis was based on the evaluable population.InterventionsThe MIS arm underwent laparoscopic or robotic surgery, vs laparotomy for the control arm. Resection of all visible tumor was attempted, and conversion from MIS to laparotomy was performed when necessary to attain complete resection.Main Outcomes and MeasuresTrial feasibility was defined by 3 primary end points: patient accrual rate of at least 5.6 patients per month by the last month of the lead-in pilot phase, conversion from MIS to laparotomy in less than 25% of patients, and a difference in complete gross resection rates of fewer than 20 percentage points between study arms.ResultsOne hundred women (median [IQR] age, 63 [39-82] years) were included, of whom 49 were randomly assigned to MIS and 51 to laparotomy; 95 were evaluable for surgical outcomes. Most patients (34 [67%] in the laparotomy arm, and 33 [67%] in the MIS arm) had stage IIIC cancer. The monthly accrual rate reached 5.9 patients per month in the final month of the study. Six of 48 evaluable patients (12.5%; 95% CI, 4.7%-25.2%) assigned to MIS underwent conversion to laparotomy. Surgeons achieved a complete gross resection rate in 42 of 48 evaluable patients (88%) assigned to MIS and in 39 of 47 patients (83%) assigned to laparotomy (difference, 4.5 [95% CI, −9.7 to 18.8] percentage points).Conclusions and RelevanceResults of this lead-in pilot study indicated the feasibility of the LANCE RCT to compare the oncological outcomes of MIS vs laparotomy.Trial RegistrationClinicalTrials.gov Identifier: NCT04575935

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Insurance-based disparities and risk of financial toxicity among patients undergoing gynecologic cancer operations

Cited by 10 publications

References 27 publications

Financial toxicity of surgical treatment for gynecological cancer: A growing malignancy

Financial toxicity of surgical treatment for gynecological cancer: A growing malignancy

Socioeconomic disparities in risk of financial toxicity following elective cardiac operations in the United States

Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

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