Purpose: This study aims to describe the characteristics of cancer survivors who are at heightened risk of adopting cost-saving behaviors as a means to cope with financial hardship. Methods: Study data were derived from the 2018 National Health Interview Survey. Weighted multivariable logistic regressions were used to assess the relationship between cost-related medication rationing and non-adherence and the sociodemographic and behavioral characteristics of US cancer survivors. Results: A total of 2594 cancer survivors were respondents. As income increased, the odds of medication rationing and non-adherence decreased. Cancer survivors aged 65 years and older were less likely to skip or take less medication to save costs than those aged < 45 years. Compared to respondents with health insurance coverage, those without health insurance coverage were over two folds (aOR: 2.38, 95% CI: 1.07-5.29) more likely to skip medications (aOR: 2.38, 95% CI: 1.07-5.29) and take less medication (aOR: 3.53, 95% CI: 1.62-7.72) to save cost. Current smokers were more likely to skip medications (aOR: 1.98, 95% CI: 1.13-3.48) or take less medication (aOR: 1.99, 95% CI: 1.16-3.42) to save money compared to never-smokers. Conclusions: Cancer survivors who skip or ration medications are more likely to be younger, low-income, current smokers, with no health insurance coverage. Results call for multi-pronged interventions targeting at-risk groups identified in this study. Implications for Cancer Survivors: Smoking cessation, expanding insurance coverage for cancer survivors, and furthering ongoing governmental-level efforts aimed at reducing drug prices can help tackle financial hardship and improve outcomes for cancer survivors
e18814 Background: The cost burden associated with cancer care is substantial event. Studies have shown that this burden has continued to increase over time, even for longer term survivors. However, there is a paucity if studies that have described the characteristics of cancer patients who are at greater risk of adopting cost saving behaviors as a means to cope with cancer-related financial burden. Methods: Study data were derived from the 2018 National Health Interview Survey, which is administered annually by the National Center for Health Statistics. Outcomes of interest were reports of medication rationing and nonadherence among cancer survivors who had received a prescription medication from a doctor/health professional in the past 12 months. Survey questions used to assess this were: This was derived via “yes” responses to the survey questions: “DURING THE PAST 12 MONTHS, were any of the following true for you? ...You skipped medication doses to save money” and “DURING THE PAST 12 MONTHS, were any of the following true for you?....you took less medicine to save money”. Survey logistic regressions were used to identify sociodemographic and behavioral factors associated with cost saving behaviors among cancer patients. All analysis were carried using STATA version 14.2'. Results: A total of 2594 cancer survivors were included in our study. Among those who reported skipping medications to save money, 75.5% were females, 29.1% were aged > 65 years, and 50.7% had an annual income < $34,999. Also, 92% had health insurance coverage, 47.5% were never smokers, and 27.3% were current smokers. As income increased, the odds of medication rationing and non-adherence decreased. For example, cancer survivors earning $50,000 - $74,999 were less likely (aOR: 0.49, 95% CI: 0.24-1.00) to skip medications compared to those with income less than $34,999; while those earning $100,000 and over had 83% (aOR: 0.17, 95% CI: 0.07-0.44) lower odds of skipping medications compared to those with income less than $34,999. Compared to cancer survivors with health insurance coverage, those without health insurance coverage were over two folds (aOR: 2.38, 95% CI: 1.07-5.29) more likely to skip medications to save cost. Current smokers were about twice (aOR: 1.98, 95% CI: 1.13-3.48) as likely to skip medications to save money compared to never smokers. Findings with health insurance and cigarette use were constant for medication rationing. Conclusions: From our study, cancer survivors who skip or ration medications are likely to be younger, low-income and have no health insurance coverage. We also found an association between cancer-related cancer saving behaviors and ongoing tobacco use among cancer survivors. These findings align with previous studies and hint at the need for a multipronged approach to minimize the huge cost of treatment incurred by cancer survivors, their families, and the government.
Platypnea-Orthodeoxia syndrome (POS) is a rare and poorly understood syndrome characterized by platypnea and oxygen desaturation in the upright position that is relieved by recumbency. Here, we report a case of an 84-year-old woman who had chronic hypoxia in an upright position despite using home oxygen. The patient presented for hypoxia evaluation and was noted to have a restrictive pattern on pulmonary function tests (PFT). An echocardiogram showed a prominent eustachian valve extending from inferior to superior vena cava with contrast approaching the interatrial septum. The patient had a complete resolution of her platypnea following the closure of the patent foramen ovale.
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