Understanding Financial Hardship Among Cancer Survivors in the United States: Strategies for Prevention and Mitigation

Yabroff, K. Robin; Bradley, Cathy J.; Shih, Ya Chen Tina

doi:10.1200/jco.19.01564

Cited by 103 publications

(100 citation statements)

References 54 publications

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“…These measures may not only limit exposure but also decrease potentially unnecessary treatment‐related financial toxicity at this critical time. Additionally, there is a critical need—now more than ever before—to promote financial planning among patients and improve the frequency and content of patient‐provider communication concerning expected OOP expenses 65 . It is essential to adopt an approach of shared decision making, involving patients not only in conversations regarding goals of care, but also discussions involving access to care, availability of caregiver support, and exposures to financial toxicity.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

et al. 2020

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Background: In the context of COVID-19, cancer survivors represent a particularly vulnerable population that may be "doubly hit" by both costs of cancer treatment and financial strain imposed by the pandemic. Methods: We performed a review of the literature pertaining to cancer, financial toxicity, and economic challenges. Results: Multiple societies have put forth recommendations to modify delivery of cancer care in order to minimize patient exposure to the virus. Cancer survivors, especially patients with head and neck cancer, have been disproportionately affected by rising unemployment levels and economic recessions in the past, both of which are linked to higher cancer mortality. Patients who rely on employer-provided insurance and do not qualify for Medicaid may lose access to life-saving treatments.Conclusions: It is essential to implement interventions and policy changes in order to mitigate the effects of this pandemic but also to ensure this becomes a nonissue during the next one.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

et al. 2020

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“…Disease progression is one of several patient factors associated with financial distress [ 29 ], and patients with metastatic breast cancer may wish to address costs at the time of treatment decisions [ 30 ]. The American Society of Clinical Oncology encourages cost discussions between patients and providers [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Using a Twitter Chat to Rapidly Identify Barriers and Policy Solutions for Metastatic Breast Cancer Care: Qualitative Study

Shimkhada¹,

Attai²,

Scheitler³

et al. 2021

JMIR Public Health Surveill

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Background Real-time, rapid assessment of barriers to care experienced by patients can be used to inform relevant health care legislation. In recent years, online communities have become a source of support for patients as well as a vehicle for discussion and collaboration among patients, clinicians, advocates, and researchers. The Breast Cancer Social Media (#BCSM) community has hosted weekly Twitter chats since 2011. Topics vary each week, and chats draw a diverse group of participants. Partnering with the #BCSM community, we used Twitter to gather data on barriers to care for patients with metastatic breast cancer and potential policy solutions. Metastatic breast cancer survival rates are low and in large part conditioned by time-sensitive access to care factors that might be improved through policy changes. Objective This study was part of an assessment of the barriers to care for metastatic breast cancer with the goal of offering policy solutions for the legislative session in California. Methods We provided 5 questions for a chat specific to metastatic breast cancer care barriers and potential policy solutions. These were discussed during the course of a #BCSM chat on November 18, 2019. We used Symplur (Symplur LLC) analytics to generate a transcript of tweets and a profile of participants. Responses to the questions are presented in this paper. Results There were 288 tweets from 42 users, generating 2.1 million impressions during the 1-hour chat. Participants included 23 patient advocates (most of whom were patients themselves), 7 doctors, 6 researchers or academics, 3 health care providers (2 nurses, 1 clinical psychologist), and 2 advocacy organizations. Participants noted communication gaps between patient and provider especially as related to the need for individualized medication dosing to minimize side effects and maximize quality of life. Timeliness of insurance company response, for example, to authorize treatments, was also a concern. Chat participants noted that palliative care is not well integrated into metastatic breast cancer care and that insurance company denials of coverage for these services were common. Regarding financial challenges, chat participants mentioned unexpected copays, changes in insurance drug formularies that made it difficult to anticipate drug costs, and limits on the number of physical therapy visits covered by insurance. Last, on the topic of disability benefits, participants expressed frustration about how to access disability benefits. When prompted for input regarding what health system and policy changes are necessary, participants suggested a number of ideas, including expanding the availability of nurse navigation for metastatic breast cancer, developing and offering a guide for the range of treatment and support resources patients with metastatic breast cancer, and improving access to clinical trials. Conclusions Rapid assessments drawing from online community insights may be a critical source of data that can be used to ensure more responsive policy action to improve patient care.

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“…We highlight the untenable circumstances patients face when confronted with the high cost of cancer care, which is well documented. 1 We also discuss the effect quality metrics have had on oncology practices and why we believe quality metrics are a way to incorporate financial concerns into routine practice. The approach we propose is patient-centered, which is what most patients want when balancing treatment and financial concerns.…”

Section: Discussionmentioning

confidence: 99%

“…Financial hardship after a cancer diagnosis is well documented in the United States. 1 In addition to financial stressors that can leave patients and their families with debt and possible bankruptcy, financial hardship has negative emotional and physical effects. The pervasiveness of financial distress for cancer patients led to the creation of the term financial toxicity, a term that is consistent with other adverse events associated with treatment.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Time to add screening for financial hardship as a quality measure?

Yabroff

Zafar

Shih

2020

CA A Cancer J Clinicians

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Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.

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Understanding Financial Hardship Among Cancer Survivors in the United States: Strategies for Prevention and Mitigation

Abstract: Author affiliations and support information (if applicable) appear at the end of this article.

Cited by 103 publications

References 54 publications

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

Potential impact of the COVID‐19 pandemic on financial toxicity in cancer survivors

Using a Twitter Chat to Rapidly Identify Barriers and Policy Solutions for Metastatic Breast Cancer Care: Qualitative Study

Time to add screening for financial hardship as a quality measure?

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