An interactive mobile application versus an educational booklet to promote job retention in women undergoing adjuvant chemotherapy for breast cancer: a randomized controlled trial

Abstract

Background Job loss after a cancer diagnosis can lead to long-term financial toxicity and its attendant adverse clinical consequences, including decreased treatment adherence. Among women undergoing (neo)adjuvant chemotherapy for breast cancer, access to work accommodations (e.g., sick leave) is associated with higher job retention after treatment completion. However, low-income and/or minority women are less likely to have access to work accommodations and, therefore, are at higher risk of job loss. Given the time and transportation barriers that low-income working patients commonly face, it is crucial to develop an intervention that is convenient and easy to use. Methods We designed an intervention to promote job retention during and after (neo)adjuvant chemotherapy for breast cancer by improving access to relevant accommodations. Talking to Employers And Medical staff about Work (TEAMWork) is an English/Spanish mobile application (app) that provides (1) suggestions for work accommodations tailored to specific job demands, (2) coaching/strategies for negotiating with an employer, (3) advice for symptom self-management, and (4) tools to improve communication with the medical oncology team. This study is a randomized controlled trial to evaluate the app as a job-retention tool compared to a control condition that provides the app content in an informational paper booklet. The primary outcome of the study is work status after treatment completion. Secondary outcomes include work status 1 and 2 years later, participant self-efficacy to ask an employer for accommodations, receipt of workplace accommodations during and following adjuvant therapy, patient self-efficacy to communicate with the oncology provider, self-reported symptom burden during and following adjuvant therapy, and cancer treatment adherence. Discussion This study will assess the use of mobile technology to improve vulnerable breast cancer patients’ ability to communicate with their employers and oncology providers, work during treatment and retain their jobs in the long term, thereby diminishing the potential consequences of job loss, including decreased treatment adherence, debt, and bankruptcy. Trial registration ClincalTrials.gov NCT03572374. Registered on 08 June 2018.

Financial burden and recommended multilevel solutions among caregivers of pediatric hematopoietic stem cell transplant recipients

“…However, unlike most cancer patients and their caregivers, caregivers in our sample were required to meet with social work at least once to discuss the financial impact of cancer—however, financial assistance resources are sometimes simply not available 47 . This finding suggests that caregivers’ recommendations, which parallel the growing literature surrounding the development and testing of financial navigation, employment, and health insurance literacy interventions may not mitigate long‐term financial toxicity among caregivers of HSCT recipients after treatment 48–52 . However, most interventions are tailored to adult patients on treatment and often do not explicitly include caregivers in the intervention design.…”

“…47 This finding suggests that caregivers' recommendations, which parallel the growing literature surrounding the development and testing of financial navigation, employment, and health insurance literacy interventions may not mitigate long-term financial toxicity among caregivers of HSCT recipients after treatment. [48][49][50][51][52] However, most interventions are tailored to adult patients on treatment and often do not explicitly include caregivers in the intervention design. At the same time, it is crucial that clinical providers not be completely removed from the financial burden concerns of patients as cost-conversations with providers have the potential to result in lower costs (e.g., prescription of generic medication).…”

“…Currently, there are ongoing interventions focused on reducing financial burden and improving resources through financial navigation and health insurance literacy only among adult and adolescent and young adult cancer patients. [48][49][50][51][52] These interventions may provide evidence and direction for the types of interventions that should be conducted among pediatric HSCT recipients and their caregivers. At the same time, however, these interventions will need to be adapted and integrated into existing social work workflows already embedded in HSCT programs.…”

“…Considering the substantial, long‐term financial burden among pediatric HSCT patients and their caregivers, this population could greatly benefit from financial burden interventions. Currently, there are ongoing interventions focused on reducing financial burden and improving resources through financial navigation and health insurance literacy only among adult and adolescent and young adult cancer patients 48–52 . These interventions may provide evidence and direction for the types of interventions that should be conducted among pediatric HSCT recipients and their caregivers.…”

Job lock among survivors of childhood cancer and their spouses post Affordable Care Act implementation: A Childhood Cancer Survivor Study brief report

“…In more recent years (2017-2019), one in five (21.8%) childhood cancer survivors or their spouses experienced job lock, which suggests that the ACA alone has not eliminated job lock among childhood cancer survivors, and that health system-, policy-, employer-, and individuallevel interventions are needed to address employment and health insurance challenges. [12][13][14] Future inquiry should investigate the longterm economic and health-related consequences of job lock among childhood cancer survivors and their families.…”