Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

Hastert, Theresa A.; Banegas, Matthew P.; Hamel, Lauren M.; Reed, Amanda R.; Baird, Tara; Beebe‐Dimmer, Jennifer L.; Schwartz, Ann G.

doi:10.1007/s11764-019-00764-y

Cited by 42 publications

(46 citation statements)

References 24 publications

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“…Affordability is affected by the inability of rural minority populations to access health insurance, either as a result of limited Medicaid expansion in states with large rural minority populations or because of the Affordable Care Act regulations associated with immigration status [ 62 ]. Furthermore, compared to their White counterparts, racial/ethnic minority populations are more likely to face financial hardship in paying for cancer care [ 63 ].…”

Section: Social Determinants Of Health and Their Role In Rural Andmentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

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One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

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Section: Social Determinants Of Health and Their Role In Rural Andmentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

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“…Financial toxicity, or the financial burden of cancer and treatment on patients and their family members, also has social predisposing factors. Identified risk factors in various cancer samples include younger age, female gender, racial and ethnic minority status, unemployment, absence of health insurance, and greater out of pocket health care costs [ 69 , 70 , 71 , 72 , 73 ]. Prevention efforts may target these social predisposing factors for disease progression, survival, distress, and financial quality of life.…”

Section: The Predisposing Precipitating and Perpetuating (3p) Momentioning

confidence: 99%

Living with Metastatic Cancer: A Roadmap for Future Research

Tometich

Hyland

Soliman

et al. 2020

Cancers

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Living with metastatic cancer, or metavivorship, differs from cancer survivorship and has changed as novel treatments have increased survival time. The purpose of this narrative review is to describe factors that impact challenges in metavivorship within a conceptual framework to guide future research. This review focuses on the specific metavivorship outcomes of progressive disease, survival time, symptoms, distress, financial toxicity, and quality of life. We describe the predisposing, precipitating, and perpetuating (3P) model of metavivorship. Understanding the biological, psychological, and social 3P factors that contribute to the development and maintenance of challenges in metavivorship provides a roadmap for future research. Implications of this model include prevention by targeting predisposing factors, management of precipitating factors after onset of metastatic disease, and treatment of perpetuating factors to reduce symptoms and improve quality of life during the chronic phase of metavivorship. This can be accomplished through biopsychosocial screening efforts, monitoring of patient-reported outcomes, education and communication interventions, interdisciplinary symptom management, advance care planning, and behavioral interventions to cultivate psychological resilience.

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“…Cancer treatment cost and nancial toxicity can in uence treatment decisions, treatment adherence, and health outcomes, including an increased risk of mortality [1,[14][15][16][17][18][19][20]. Treatment costs factor into patients' decisions about treatment, [21][22][23][24] including whether to participate in clinical trials [22,25].…”

Section: Introductionmentioning

confidence: 99%

The DISCO App: Evaluating an Electronic Patient Intervention to Reduce The Financial Burden of Cancer Through Improved Cost Communication In A Non-Randomized Pilot Trial

Hamel

Dougherty

Hastert

et al. 2021

Preprint

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Background: Financial toxicity affects 30-50% of people with cancer in the US. Although experts recommend patients and oncologists discuss treatment cost, cost discussions occur infrequently. Using a non-randomized pre-test post-test design, we pilot-tested the feasibility, acceptability and preliminary effectiveness of the DIScussions of COst (DISCO) App, a patient communication intervention designed to improve the frequency of cost discussions and related outcomes. Methods: While waiting to see their oncologist, patients (n=32) used the DISCO App on a tablet. Clinic visits were video recorded and patients completed pre- and post-intervention measures of self-efficacy for managing treatment costs, self-efficacy for interacting with oncologists, cost-related distress, and perceptions of the DISCO App. Coders observed the recordings to determine the presence of cost discussions, initiators, and topics. Results: Most patients (84%) reported needing <15 minutes to use the DISCO App. Patients reported the DISCO App made it easier to ask cost-related questions. Findings showed increased self-efficacy for managing treatment costs (p=.02) and for interacting with oncologists (p=.001). All clinic visits included a cost discussion. Conclusion: The DISCO App is feasible, acceptable, and effective in prompting cost discussions and improving outcomes. Prompting patients to discuss costs before meeting with an oncologist may improve treatment cost discussions and related outcomes.Trial registration: Clinical Trials.gov registration number: NCT03676920 (September 19, 2018)

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Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors

Cited by 42 publications

References 24 publications

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Living with Metastatic Cancer: A Roadmap for Future Research

The DISCO App: Evaluating an Electronic Patient Intervention to Reduce The Financial Burden of Cancer Through Improved Cost Communication In A Non-Randomized Pilot Trial

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