Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study

Palmer, Joshua D.; Patel, Tejash; Eldredge-Hindy, Harriet; Keith, Scott W.; Patel, Tapas Kumar; Malatesta, Theresa M.; DiNome, Jessie; Lowther, A.; Ferguson, Linda; Wagenborg, Sally; Smyles, John; Babaria, Usha; Stabile, Richard J.; Gressen, Eric; Rudoler, Shari; Fisher, SK

doi:10.1016/j.ijrobp.2018.03.014

Cited by 63 publications

(55 citation statements)

References 17 publications

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“…However, results might not be generalizable beyond our sample. For example, our sample reported less financial distress compared with other studies evaluating financial toxicity among cancer patients (de Souza et al, 2017; Palmer et al, 2018), perhaps because we interviewed survivors who were beyond active treatment. Our sample was slightly higher educated and reported average higher income levels than those in the U.S. population.…”

Section: Discussionmentioning

confidence: 92%

Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors

et al. 2018

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This qualitative study explored cancer survivors’ experiences selecting and using health insurance and anticipating out-of-pocket care costs. Thirty individuals participated in semistructured interviews. On average, participants were 54 years ( SD ± 8.85, range 34-80) and diagnosed with cancer about 5 years prior (range 0.5-10 years). About 57% were female, 77% were non-Hispanic White, and 53% had less than a college education. Participants struggled to access information about health insurance and costs. Lack of cost transparency made it difficult to anticipate expenses and increased anxiety. Many participants were surprised that after cancer, care that was once preventive with no out-of-pocket costs became diagnostic with associated fees. They discussed the cognitive burden of managing finances on top of treatment and overseeing communication between doctors and insurance. Interventions are needed to clearly communicate information about insurance coverage and care costs to improve cancer survivors’ confidence in selecting health insurance and anticipating out-of-pocket expenses.

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Section: Discussionmentioning

confidence: 92%

Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors

et al. 2018

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“…The impact of radiation therapy is also poorly studied, yet about half of patients with cancer receive it . One study showed that 22% of patients who received radiation therapy developed financial toxicity, specifically via loss of employment or income, and difficulty paying for housing, transportation, and meals …”

Section: Causes Of Financial Toxicitymentioning

confidence: 99%

“…Physician apprehension may be due to time constraints, lack of knowledge, and an ethical desire to provide the most ideal treatment regardless of cost. While the last point is important, the patient will ultimately suffer the consequences of financial toxicity in addition to the disease, and most patients don’t believe that discussing cost will affect care …”

Section: Strategies To Reduce Financial Toxicitymentioning

confidence: 99%

Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

Lentz

Benson

Kircher

2019

Journal of Surgical Oncology

238

229

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Financial toxicity is the adverse impact of a cancer diagnosis on a patient’s financial well‐being resulting from direct or indirect costs. Potential consequences of financial toxicity include material loss, psychological distress, and/or maladaptive coping strategies. This review will summarize the prevalence, causes, and consequences of financial toxicity, with an emphasis on strategies to anticipate and reduce its burden. Improvement will require multilevel, coordinated efforts between stakeholders including patients, providers, health systems, payers, manufacturers, and policymakers.

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“…Furthermore, newer tools developed to identify patients at increased risk of toxicity after RT will need to be governed with the priority of optimizing access to care rather than optimizing profit. 65 , 66 Otherwise, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.…”

Section: Discussionmentioning

confidence: 99%

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States—Part 4: Appalachian patients

McClelland

Kaleem

Bernard

et al. 2018

Advances in Radiation Oncology

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PurposeCompared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined.Methods and materialsThe National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical).ResultsAlthough the literature investigating RT access disparities in Appalachia is relatively sparse, studies examining lung, colorectal, cervical, prostate, head and neck, breast, and esophageal cancer, as well as lymphoma, indicate an unfortunate commonality in barriers to optimal RT access for Appalachian patients with cancer. These barriers are predominantly socioeconomic in nature (low income and lack of private insurance) but are exacerbated by paucities in both the number and quality of radiation centers that are accessible to this patient population.ConclusionsRegardless of organ system, there are significant barriers for Appalachian patients with cancer to receive RT. Such diminished access is alarming and warrants resources devoted to addressing these disparities, which often go overlooked because of the assumption that the overall wealth of the United States is tangibly applicable to all of its citizens. Without intelligently targeted investments of time and finances in this arena, there is great risk of exacerbating rather than alleviating the already heavy burden facing Appalachian patients with cancer.

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Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study

Cited by 63 publications

References 17 publications

Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors

Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors

Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States—Part 4: Appalachian patients

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