Patient-Oncologist Cost Communication, Financial Distress, and Medication Adherence

Bestvina, Christine M.; Zullig, Leah L.; Rushing, Christel; Chino, Fumiko; Samsa, Gregory P.; Altomare, Ivy; Tulsky, James A.; Ubel, Peter A.; Schrag, Deborah; Nicolla, Jon; Abernethy, Amy P.; Peppercorn, Jeffrey; Zafar, S. Yousuf

doi:10.1200/jop.2014.001406

Cited by 213 publications

(159 citation statements)

References 20 publications

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“…Importantly, emerging evidence has demonstrated an inverse association between financial toxicity and quality of life, treatment adherence, and mortality. 17 Certain populations are more vulnerable to financial impact of cancer treatment. Older individuals with multiple medical problems that require frequent hospitalizations may face higher out of pocket cost burden due to the need for more services, though some of it may be buffered because of Medicare coverage.…”

Section: Discussionmentioning

confidence: 99%

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients

Farnia¹,

Ganetsky

Silver

et al. 2017

Biology of Blood and Marrow Transplantation

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Hematopoietic cell transplantation (HCT) is an expensive, medically complicated, and potentially life-threatening therapy for multiple hematologic and nonhematologic disorders with a prolonged trajectory of recovery. Similar to financial issues in other cancer treatments, adverse financial consequences of HCT are emerging as an important issue and may be associated with poor quality of life and increased distress in HCT survivors. Prescription medicine coverage for HCT for Medicare and some Medicaid beneficiaries, especially in the long-term, remains suboptimal because of inadequate payer formularies or prohibitive copays. With an increasing number of older patients undergoing HCT and improvement in the overall survival after HCT, the problem of financial burden faced by Medicare beneficiaries with fixed incomes is going to worsen. In this article, we describe the typical financial burden borne by HCT recipients based on estimated copayment amounts attached to the categories of key medications as elucidated through 2 case studies. We also suggest some possible solutions for consideration to help these patients and families get through the HCT by minimizing the financial burden from essential medications needed during the post-HCT period.

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Section: Discussionmentioning

confidence: 99%

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients

Farnia¹,

Ganetsky

Silver

et al. 2017

Biology of Blood and Marrow Transplantation

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“…In another survey on 134 breast cancer patients conducted by Irwin et al, 32 most of the patients (94%) believed that physicians should discuss costs of care with patients, while only 14% of them discussed costs with their doctor. Likewise, the results of Bestvina et al 33 study on 300 cancer patients showed that only …”

Section: Discussionmentioning

confidence: 96%

Attitude of Iranian Medical Oncologists Toward Economic Aspects, and Policy-making in Relation to New Cancer Drugs

Daroudi¹,

Mirzania²,

Zendehdel³

2015

Int J Health Policy Manag

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Background: Although medical oncologists can have an important role in controlling the cost of cancer treatment, there is little information about their attitudes toward the cost of cancer treatment and the impact of cost on their treatment recommendations, especially in low-and middle-income countries (LMICs). In this study, we assessed the attitude of Iranian medical oncologists toward some economic aspects of new cancer drugs. Methods: We translated a questionnaire that was used in similar studies in the United States and Canada into Persian and modified it according to the local setting in Iran. The face and content validity of the questionnaire were assessed by oncologists before being used in the survey. We distributed the questionnaire and collected the data from 80 oncologists who participated in the 13th Annual Congress of the Iranian Society of Medical Oncology and Hematology (ISMOH). Results: Fifty-two oncologists participated in our study (a response rate of 65%). The majority of oncologists stated that drug costs and patient out-of-pocket (OOP) costs influence their treatment recommendations (92% and 94%, respectively). Most oncologists (70%) felt that they are ready enough to use cost-effectiveness information in their treatment decisions, and 74% believed that patients should only have access to cancer treatments that are cost-effective. Most oncologists agree that the government should have control over drug prices, and more use of cost-effectiveness data is required for decision-making about cancer drug coverage. Ninety-one percent of oncologists said that they always or frequently discuss cancer treatment costs with their patients. Oncologists believed that academic groups (research centers and scientific societies) (81%) and the Ministry of Health (MoH) (43%) are the most eligible groups for determining whether a drug provides good value. Conclusion: Iranian medical oncologists are ready to participate in the health technology assessment and prioritysetting process. This situation creates a unique opportunity for the government to rely on scientific societies and find an appropriate solution for the improvement of patients' access to high-quality care. Keywords: Medical Oncologists, Attitude, New Cancer Drugs, Cost, Policy-making, Iran. Implications for policy makers• The high prices of new cancer drugs affect oncologists' treatment recommendations and their patients' access to effective treatments.• Iranian medical oncologists agree that government should have control over drug prices.• It seems that Iranian medical oncologists are ready to participate in the health technology assessment and priority-setting process. Implications for publicSome of the new cancer drugs impose high financial costs on cancer patients, their families and society. Patient-physician communication about the clinical benefits and costs of chemotherapy drugs seems to be necessary during the decision-making process for treatment planning in cancer patients. Patients and their caregivers should take this oppor...

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“…Responsibility for self-management and adherence is transferred to patients prescribed OAs, who have less direct contact with health care professionals (Bestvina et al 2014). This innovative intervention involves combining three proven methods, PE, CBT, and MI, to target a difficult clinical problem, using APRNs in clinical settings where they already interact with patients on a regular basis (DiIorio et al 2009, Given et al 2010.…”

Section: Discussionmentioning

confidence: 99%

“…Over 25% of cancer treatment is now delivered using oral anti-cancer agent (OAs) (Bestvina et al 2014). This shift in treatment delivery places more responsibility for managing cancer treatment on patients.…”

Section: Introductionmentioning

confidence: 99%

A trial examining an advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients prescribed oral anti‐cancer agents: study protocol

Spoelstra

Burhenn

DeKoekkoek

et al. 2015

Journal of Advanced Nursing

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AimTo report a study protocol that refines then examines feasibility, preliminary efficacy, and satisfaction of ADHERE, an intervention using motivational interviewing and brief cognitive behavioral therapy as a mechanism for goal-oriented systematic patient education to promote symptom management and adherence among cancer patients prescribed oral anti-cancer agents. Background Cancer treatment with oral anti-cancer agents shifts responsibility for managing treatment from clinicians in supervised cancer centers to patients and their caregivers. Thus, a need exists to standardize start-of-care for support patient self-management of care at home. Design A two-phase quasi-experimental sequential design with repeated measures. Methods Sixty five adult patients newly prescribed an oral anti-cancer agent will be recruited from three community cancer centers. Phase one will enroll 5 patients to refine the ADHERE intervention prior to testing, using an iterative process. After completion, Phase two will enroll 30 patients who receive usual care to examine symptoms and ahderence. Advanced practice nurses will then be trained. Then 30 patients will be enrolled in the intervention group and provided ADHERE, a 4-week intervention using semi-structured interactions (initial face-to-face session and once a week phone sessions over 3-weeks) and a Toolkit to promote selfmanagement of care. Outcome measures include: oral anti-cancer agents adherence rate, symptom presence and severity, feasibility, and satisfaction with ADHERE. This protocol was approved January 2014 and is registered at ClinicalTrials.gov (Identifier NCT02337296). Discussion This nurse-led intervention has the potential to standardize the start-of-care trainingfor the patients to self-manage when prescribed oral anti-cancer agents for treatment. Summary Statement Why this study is needed? No standard of care exists for patients newly prescribed oral anti-cancer agents.  Many cancer patients treated with oral anti-cancer agents have difficulty managing symptoms, which may lead to adverse events and difficulty adhering to the medication regimen.  Sub-optimal adherence rates for cancer patients prescribed oral anti-cancer agents exist, which may impact cancer treatment effectiveness.

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Patient-Oncologist Cost Communication, Financial Distress, and Medication Adherence

Cited by 213 publications

References 20 publications

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients

Challenges around Access to and Cost of Life-Saving Medications after Allogeneic Hematopoietic Cell Transplantation for Medicare Patients

Attitude of Iranian Medical Oncologists Toward Economic Aspects, and Policy-making in Relation to New Cancer Drugs

A trial examining an advanced practice nurse intervention to promote medication adherence and symptom management in adult cancer patients prescribed oral anti‐cancer agents: study protocol

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