Financial toxicity and implications for cancer care in the era of molecular and immune therapies

Tran, George; Zafar, S. Yousuf

doi:10.21037/atm.2018.03.28

Cited by 142 publications

(114 citation statements)

References 83 publications

(76 reference statements)

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“…10 A systematic review of work-related issues among young cancer survivors found that those who returned to work struggled with reduced work productivity that ultimately impacted their income. 11 A cancer diagnosis results in high financial burden, [12][13][14][15][16] and there is an increase in the risk of bankruptcy following a cancer diagnosis. 16 For cancer patients who are <50 years old, the risk of bankruptcy following their cancer diagnosis is particularly high.…”

Section: Introduction/purp Os Ementioning

confidence: 99%

Financial burden and quality of life among early‐onset colorectal cancer survivors: A qualitative analysis

Blum‐Barnett

Madrid

Burnett‐Hartman

et al. 2019

Health Expectations

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BackgroundColorectal cancer (CRC) diagnosed at ages <50 years old (early‐onset CRC) has been increasing in the United States, resulting in a growing number of early‐onset CRC survivors who may face significant financial and quality of life (QOL) challenges.ObjectiveIdentify themes from a patient advocate discussion about the impact of CRC on financial burden and QOL among early‐onset CRC survivors.MethodsWe conducted a semi‐structured, stakeholder discussion among 14 early‐onset CRC survivors and one caregiver who were members of an advocacy group. The discussion focused on the financial and overall QOL impacts of CRC. The meeting was recorded, transcribed and coded in ATLAS.ti, using a thematic analysis approach.ResultsCancer stage at diagnosis among advocates with CRC ranged from 2 to 4; about half of the attendees had no evidence of disease, and about half were undergoing treatment. Employment (career trajectory, lost wages, health insurance/benefits, performance) emerged as the dominant theme of the financial impacts discussion. Lifestyle impacts of disease and survivorship included both emotional and physical side‐effects. Diagnosis experience, missing information about CRC treatment and side‐effects, financial stress and strain on relationships were the primary themes for the overall QOL impacts.ConclusionGiven the growing incidence of CRC in those under 50, it is particularly important for providers to be aware of these patients' financial, emotional and QOL needs, and to develop care plans that specifically address these areas of concern for early‐onset CRC survivors.

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Section: Introduction/purp Os Ementioning

confidence: 99%

Financial burden and quality of life among early‐onset colorectal cancer survivors: A qualitative analysis

Blum‐Barnett

Madrid

Burnett‐Hartman

et al. 2019

Health Expectations

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“…However, increased efforts to address FT are widely believed to be difficult without providing money directly . Trans and Zafar noted that interventions addressing FT could include reducing drug costs, altering reimbursement models, assessing the value of therapies, designing value‐based insurance, and implementing other survivor‐ and provider‐level interventions . In our study, we found that cancer survivors had unmet needs for supportive information, including treatment costs, cancer's potential effects on finances, insurance coverage, and supportive agencies or programs.…”

Section: Discussionmentioning

confidence: 68%

Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies

Zhu

Xing

et al. 2020

Psycho-Oncology

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Objective The aim of this study was to synthesize qualitative research evidence on cancer survivors' experiences with financial toxicity (FT). Methods We carried out a systematic review of qualitative studies using a meta‐aggregation approach. Papers published prior to 31 August 2019, were collected from electronic databases, including PubMed/MEDLINE, MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), Web of Science, ProQuest Dissertations and Theses, and Cochrane Library (Wiley). Results Six synthesized findings were derived from 14 studies covering cancer patients' awareness of FT, cancer‐related expenditures, and the risk factors, impacts, coping strategies, and unmet needs related to FT. Conclusions Cancer survivors incur FT; however, their awareness of FT is limited. Cancer‐related FT has multiple impacts on survivors' lives. Although cancer survivors try to cope with FT through adjustments, they still have unmet needs for the management of FT. Nurses and social workers can play a critical role in helping survivors manage FT by increasing pre‐awareness of FT, strengthening emotional empowerment, and providing personalized informative support.

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“…The high acquisition cost of CAR-T therapy has been subject to intense discussion. 5,6,39 On the one hand, this therapy seems to offer high added value, given its innovative nature, 1,2 and its potential for cure. 2,40 Moreover, it has been designated as an orphan drug, which often tend to have a high price tag.…”

Section: Acquisition Costsmentioning

confidence: 99%

“…7 Also, patients in different countries may encounter restricted access or refused coverage by payers, 4 or suffer financial toxicity in the US. 6,8 Moreover, many have expressed that this therapy with the current high price would become unaffordable in the future, 5,[9][10][11] because of its potential to treat more cancer types. 1,10,12 Unsurprisingly, immediately upon its first marketing authorization, a question was raised about the production cost of this therapy.…”

mentioning

confidence: 99%

Cost of decentralized CAR T‐cell production in an academic nonprofit setting

Tao

Eichmüller

Schmidt

et al. 2020

Intl Journal of Cancer

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Chimeric antigen receptor (CAR) T-cell therapy is a promising immunotherapy with high acquisition costs, and it has raised concerns about affordability and sustainability in many countries. Furthermore, the current centralized production paradigm for the T cells is less than satisfactory. Therefore, several countries are exploring alternative Tcell production modes. Our study is based on the T-cell production experience in a nonprofit setting in Germany. We first identified the work steps and main activities in the production process. Then we determined the fixed costs and variable costs. Main cost components included personnel and technician salaries, expenditure on equipment, a clean room, as well as production materials. All costs were calculated in 2018 euros and converted into U.S. dollars. For a clean room with one machine for closed and automated manufacturing installed, annual fixed costs summed up to approximately €438 098 ($584 131). The variable cost per production was roughly €34 798 ($46 397). At the maximum capacity of one machine, total cost per product would be close to €60 000 ($78 849). As shown in the scenario analysis, if three machines were to be installed in the clean room, per production cost could be as low as €45 000 (roughly $59905). If a cheaper alternative to lentivirus was used, per production total cost could be further reduced to approximately €33 000 (roughly $44309). Decentralized T-cell production might be a less costly and more efficient alternative to the current centralized production mode that requires a high acquisition cost.

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Financial toxicity and implications for cancer care in the era of molecular and immune therapies

Cited by 142 publications

References 83 publications

Financial burden and quality of life among early‐onset colorectal cancer survivors: A qualitative analysis

Financial burden and quality of life among early‐onset colorectal cancer survivors: A qualitative analysis

Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies

Cost of decentralized CAR T‐cell production in an academic nonprofit setting

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