Risk factors for financial toxicity in patients with gynecologic cancer

Aviki, Emeline; Manning‐Geist, Beryl; Sokolowski, Stefania; Newman, Tiffanny; Blinder, Victoria S.; Chino, Fumiko; Doyle, Stephanie; Liebhaber, Allison; Gordhandas, Sushmita; Brown, Carol L.; Broach, Vance; Dennis, S.; Jewell, Elizabeth L.; Leitao, Mario M.; Roche, Kara Long; Mueller, Jennifer J.; Sonoda, Yukio; Zivanovic, Oliver; Gardner, Ginger J.; Abu‐Rustum, Nadeem R.

doi:10.1016/j.ajog.2021.12.012

Cited by 22 publications

(20 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a recent study using objective data such as bills sent to collections and utilization of financial assistance programs, 25% of gynecologic oncology patients at a single institution experienced financial toxicity. Risk factors for high financial toxicity from this objective review included younger age, non-partnered marital status, Black or Hispanic race/ethnicity, cervical cancer diagnosis, and higher disease stage 23. In addition, this study found that more imaging studies and outpatient visits were associated with financial toxicity in gynecologic oncology patients, possibly due to higher co-payments and deductibles with health plans with low monthly premiums 23…”

Section: Financial Toxicity In Gynecologic Oncologymentioning

confidence: 72%

Financial toxicity in ovarian cancer

Swiecki-Sikora

Craig

Chu

2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

Ovarian cancer is the most costly and deadly of the gynecologic malignancies. Financial toxicity from out-of-pocket costs for direct care and medications as well as indirect costs from lost income is a growing challenge in oncology. The aim of this review is to focus on recent financial toxicity literature in the gynecologic oncology sphere and highlight specific issues and challenges regarding financial toxicity in ovarian cancer. Treatment options for ovarian cancer lead to variable costs for patients, and there are risk factors for high financial toxicity unique to gynecologic oncology patients. Identification and prompt intervention for those most at risk can help alleviate financial distress from ovarian cancer care.

show abstract

Section: Financial Toxicity In Gynecologic Oncologymentioning

confidence: 72%

Financial toxicity in ovarian cancer

Swiecki-Sikora

Craig

Chu

2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…In a cohort of geographically diverse patients, moderate or severe toxicity was associated with economic cost-coping strategies, and severe toxicity was associated with decreased medication adherence 14. Risk factors for financial toxicity include cervical cancer, advanced disease, Black or Hispanic race/ethnicity, younger age, single marital status, self-pay or commercial insurance, clinical trial participation 1 15. One study demonstrated an association with financial toxicity if patients had one or more emergency visit, nine or more imaging studies, and 20 or more outpatient provider visits 15…”

Section: Discussionmentioning

confidence: 99%

Patient-reported drivers of financial toxicity in gynecologic cancers: a focus group study

Nicholson

Baig

Gladstone

et al. 2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveTo understand how treatment-related financial burden affects patients with gynecologic cancer and to identify targets for interventions to reduce financial toxicity.MethodsPatients with gynecologic cancer were invited to participate in a qualitative focus group study. Each participant completed an online, secure survey that included questions regarding diagnosis, treatment, employment status, and income. The Comprehensive Score for Financial Toxicity (COST) tool was used to measure economic burden (COST score 0–44), with lower scores indicating worse toxicity. Each participant then took part in a virtual semistructured focus group with a social worker and a study staff member. Three investigators independently analyzed the transcripts for common themes and reconciled disagreements through consensus.ResultsOver 60% of participants had private insurance, and 54% had moderate to high financial toxicity (COST scores <26). The five most commonly discussed themes included extent of insurance coverage, out-of-pocket health expenses, employment status changes, health system inefficiencies, and opportunity costs. Minor themes included issues surrounding delayed care, provider conversations, parking, and transportation. Participants with moderate to high toxicity reported strain associated with employment status changes, opportunity costs, and health system inefficiencies more often than those with mild toxicity.ConclusionsOur findings suggest that patient-centered interventions to optimize insurance coverage and enhance care coordination may reduce financial toxicity. Both targets are potentially immediately actionable and could have downstream effects on health outcomes. Meanwhile, advocacy efforts to improve work leave policies and reduce out-of-pocket health expenditure are system-level interventions that also should be considered to curtail financial toxicity.

show abstract

“…While insurance quality and longer, more complicated surgeries may be associated with increased financial burden, non-White race implies racial healthcare disparities, consistent with other research. For example, work by our team found that of 4655 patients with gynecological cancer, 25% experienced financial toxicity with increased risk in patients of Black race or Hispanic ethnicity, among other correlates [6]. It is important to note that prior studies including our own showed public insurance to be protective of financial toxicity, presumably due to lower or more favorable out of pocket maximums with Medicaid and Medicare.…”

mentioning

confidence: 84%

“…The risk of financial toxicity within the context of gynecological cancers is a growing area of investigation in clinical research [4][5][6], and has been specifically explored with respect to insurance status in a study by Ng et al 2022 in this issue of Gynecologic Oncology [7]. Their analysis of insurance-based disparities and risk for financial toxicity is important in further delineating high risk patients, especially as Medicaid expansion through the Affordable Care Act (ACA) may obscure public perception of healthcare access and affordability [8].…”

mentioning

confidence: 99%