Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act

Nipp, Ryan David; Shui, Amy; Perez, Giselle K.; Kirchhoff, Anne C.; Peppercorn, Jeffrey; Moy, Beverly; Kuhlthau, Karen; Park, Elyse R.

doi:10.1001/jamaoncol.2018.0097

Cited by 63 publications

(71 citation statements)

References 57 publications

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“…After controlling for other variables, some of the strongest predictors of prolonged treatment intervals were those potentially related to socioeconomic status including residence in areas with low education levels and Medicaid insurance. Disparities in access to timely treatment have been reported in other oncologic populations and may be explained by decreased access to care, low health literacy, poor compliance, or transportation barriers . Patients with HPV‐associated tumors also had significantly shorter treatment intervals, potentially related to different demographic profiles among patients with HPV‐positive OSCC, who are more likely to be white, have private insurance, and earn higher income than patients with HPV‐negative OSCC .…”

Section: Discussionmentioning

confidence: 89%

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

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Background The impact of treatment delays on survival in oropharyngeal cancer and whether the effect varies by human papillomavirus (HPV) status have yet to be defined. Methods Retrospective analysis of the survival impact of time from diagnosis to surgery (DTS), surgery to radiation (SRT), and duration of radiation (RTD) for patients in the National Cancer Database with resected oropharyngeal cancer who underwent adjuvant radiation from 2010 to 2014. Results We identified optimal thresholds of 30, 40, and 51 days for DTS, SRT, and RTD, respectively, with treatment times exceeding these thresholds associated with significantly worse overall survival. Prolonged SRT and RTD were associated with mortality regardless of HPV status, although rising DTS was only predictive among patients with HPV‐negative tumors. Conclusions Treatment delays significantly impact survival in oropharyngeal cancer. The consequences of prolonged DTS may be stronger in HPV‐negative than HPV‐positive disease. These data serve as a foundation for future research and clinical management.

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Section: Discussionmentioning

confidence: 89%

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

et al. 2019

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“…Adult participants were asked whether they had ever had a cancer diagnosis, and for those who answered yes, the type of cancer was recorded. Those with nonmelanoma skin cancer were excluded from the analysis to be consistent with other studies of cancer survivors . To minimize the contribution of symptoms associated with the acute diagnosis and treatment interval, participants reporting a diagnosis of cancer less than 2 years ago were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of chronic pain among cancer survivors in the United States, 2010‐2017

Sanford

Sher

Butler

et al. 2019

Cancer

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Background There are a growing number of cancer survivors in the United States who are at risk for chronic pain due to cancer disease and treatments. The prevalence of chronic pain among cancer survivors has not been comprehensively reported. Methods This study used data from the National Health Interview Survey (2010‐2017) to compare the prevalence of chronic pain between participants with a cancer diagnosis and participants without one. Adjusted odds ratios (AORs) of having chronic pain were assessed by multivariable logistic regression, which included an age (less than the median age vs greater than or equal to the median age) × cancer diagnosis (yes vs no) interaction term. Among cancer survivors, multivariable logistic regression defined the odds of feeling depressed, feeling worried/nervous/anxious, being unable to work, and needing assistance for activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Results Among 115,091 participants, a cancer diagnosis was associated with an increased AOR of chronic pain in comparison with the general population (30.8% vs 15.7%; AOR, 1.48; 95% confidence interval, 1.38‐1.59). Older age was associated with higher odds of chronic pain (P < .001 across all increasing age categories); however, the positive association between older age and chronic pain was seen only in participants without cancer and was not seen in those with a cancer diagnosis (Page×cancer < .001). Among patients reporting a cancer diagnosis, chronic pain was associated with greater odds of feeling depressed, feeling worried/nervous/anxious, being unable to work, and needing assistance with ADLs or IADLs (P < .001 for all). Conclusions Cancer survivors appear to have a high prevalence of chronic pain, which is associated with worse mental, functional, and employment outcomes. Screening and management of chronic pain should be addressed by policymakers to improve cancer survivorship care.

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“…reported in the years following PPACA both access to and affordability had improved for cancer survivors. Specifically, the proportion of cancer survivors delaying or forgoing care declined each year, as did the proportion reporting being unable to afford prescription medication …”

Section: Impact Of Ppaca On the Reduction Of Uninsuredmentioning

confidence: 99%

Adolescent and young adult cancer care: Financial hardship and continued uncertainty

Parsons

Kumar

2018

Pediatric Blood & Cancer

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Since 2005, there has been a steady increase in the number of new cancer diagnoses among adolescents and young adults (AYA) in the United States (US), likely due to improved awareness and detection within this age group, as well as the possible contribution of insurance expansion under the Patient Protection and Affordable Care Act. AYAs with cancer remain highly vulnerable financially, a situation that will only worsen with proposed rollbacks in access to and affordability of healthcare. In this review, we will discuss existing aspects of financial hardship and highlight areas of uncertainty, based on the current US political climate.

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Patterns in Health Care Access and Affordability Among Cancer Survivors During Implementation of the Affordable Care Act

Cited by 63 publications

References 57 publications

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status

Prevalence of chronic pain among cancer survivors in the United States, 2010‐2017

Adolescent and young adult cancer care: Financial hardship and continued uncertainty

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