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  • 1
    Online Resource
    Online Resource
    Elsevier BV ; 2020
    In:  American Journal of Preventive Medicine Vol. 59, No. 2 ( 2020-08), p. 228-236
    In: American Journal of Preventive Medicine, Elsevier BV, Vol. 59, No. 2 ( 2020-08), p. 228-236
    Type of Medium: Online Resource
    ISSN: 0749-3797
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2020236-2
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  • 2
    In: American Journal of Preventive Medicine, Elsevier BV, Vol. 59, No. 1 ( 2020-07), p. 68-78
    Type of Medium: Online Resource
    ISSN: 0749-3797
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2020236-2
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  • 3
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 29, No. 2 ( 2020-02-01), p. 308-317
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 29, No. 2 ( 2020-02-01), p. 308-317
    Abstract: With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States. Methods: We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18–64 or 65+ years). Results: Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P & lt; 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices. Conclusions: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors. Impact: Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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  • 4
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2021
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 30, No. 11 ( 2021-11-01), p. 2010-2017
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 30, No. 11 ( 2021-11-01), p. 2010-2017
    Abstract: Non-white patients with childhood cancer have worse survival than Non-Hispanic (NH) White patients for many childhood cancers in the United States. We examined the contribution of socioeconomic status (SES) and health insurance on racial/ethnic disparities in childhood cancer survival. Methods: We used the National Cancer Database to identify NH White, NH Black, Hispanic, and children of other race/ethnicities ( & lt;18 years) diagnosed with cancer between 2004 and 2015. SES was measured by the area-level social deprivation index (SDI) at patient residence and categorized into tertiles. Health insurance coverage at diagnosis was categorized as private, Medicaid, and uninsured. Cox proportional hazard models were used to compare survival by race/ethnicity. We examined the contribution of health insurance and SES by sequentially adjusting for demographic and clinical characteristics (age group, sex, region, metropolitan statistical area, year of diagnosis, and number of conditions other than cancer), health insurance, and SDI. Results: Compared with NH Whites, NH Blacks and Hispanics had worse survival for all cancers combined, leukemias and lymphomas, brain tumors, and solid tumors (all P & lt; 0.05). Survival differences were attenuated after adjusting for health insurance and SDI separately; and further attenuated after adjusting for insurance and SDI together. Conclusions: Both SES and health insurance contributed to racial/ethnic disparities in childhood cancer survival. Impact: Improving health insurance coverage and access to care for children, especially those with low SES, may mitigate racial/ethnic survival disparities.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2021
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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  • 5
    Online Resource
    Online Resource
    Harborside Press, LLC ; 2020
    In:  Journal of the National Comprehensive Cancer Network Vol. 18, No. 3 ( 2020-03), p. 315-327
    In: Journal of the National Comprehensive Cancer Network, Harborside Press, LLC, Vol. 18, No. 3 ( 2020-03), p. 315-327
    Abstract: Background: A cancer diagnosis can impose substantial medical financial burden on individuals and may limit their ability to work. However, less is known about worry for nonmedical financial needs and food insecurity among cancer survivors. Methods: The National Health Interview Survey (2013–2017) was used to identify cancer survivors (age 18–39 years, n=771; age 40–64 years, n=4,269; age ≥65 years, n=7,101) and individuals without a cancer history (age 18–39 years, n=53,262; age 40–64 years, n=60,141; age ≥65 years, n=30,261). For both cancer survivors and the noncancer group, adjusted proportions were generated for (1) financial worry (“very/moderately/not worried”) about retirement, standard of living, monthly bills, and housing costs; and (2) food insecurity (“often/sometimes/not true”) regarding whether food would run out, the fact that food bought did not last, and the inability to afford balanced meals. Further adjusted analyses examined intensity measures (“severe/moderate/minor or none”) of financial worry and food insecurity among cancer survivors only. Results: Compared with individuals without a cancer history, cancer survivors aged 18 to 39 years reported consistently higher “very worried” levels regarding retirement (25.5% vs 16.9%; P 〈 .001), standard of living (20.4% vs 12.9%; P 〈 .001), monthly bills (14.9% vs 10.3%; P =.002), and housing costs (13.6% vs 8.9%; P =.001); and higher “often true” levels regarding worry about food running out (7.9% vs 4.6%; P =.004), food not lasting (7.6% vs 3.3%; P =.003), and being unable to afford balanced meals (6.3% vs 3.4%; P =.007). Findings were not as consistent for cancer survivors aged 40 to 64 years. In contrast, results were generally similar for adults aged ≥65 years with/without a cancer history. Among cancer survivors, 57.6% (age 18–39 years; P 〈 .001), 51.9% (age 40–64 years; P 〈 .001), and 23.8% (age ≥65 years; referent) reported severe/moderate financial worry intensity, and 27.0% (age 18–39 years; P 〈 .001), 14.8% (age 40–64 years; P 〈 .001), and 6.3% (age ≥65 years; referent) experienced severe/moderate food insecurity intensity. Lower income and higher comorbidities were generally associated with greater intensities of financial worry and food insecurity in all 3 age groups. Conclusions: Younger cancer survivors experience greater financial worry and food insecurity. In addition to coping with medical costs, cancer survivors with low income and multiple comorbidities struggle to pay for daily living needs, such as food, housing, and monthly bills.
    Type of Medium: Online Resource
    ISSN: 1540-1405 , 1540-1413
    Language: Unknown
    Publisher: Harborside Press, LLC
    Publication Date: 2020
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  • 6
    Online Resource
    Online Resource
    Harborside Press, LLC ; 2022
    In:  Journal of the National Comprehensive Cancer Network Vol. 20, No. 11 ( 2022-11), p. 1244-1254.e3
    In: Journal of the National Comprehensive Cancer Network, Harborside Press, LLC, Vol. 20, No. 11 ( 2022-11), p. 1244-1254.e3
    Abstract: Background: We sought to examine the lack of paid sick leave among working cancer survivors by sociodemographic/socioeconomic and employment characteristics and its association with preventive services use in the United States. Methods: Working cancer survivors (ages 18–64 years; n=7,995; weighted n=3.43 million) were identified using 2001–2018 National Health Interview Survey data. Adjusted prevalence of lack of paid sick leave by sociodemographic and socioeconomic characteristics, as well as job sector, working hours, and employer size, were generated using multivariable logistic regression models. Separate analyses examined the associations of lack of paid sick leave with use of various preventive services. Results: Of all working cancer survivors, 36.4% lacked paid sick leave (n=2,925; weighted n=1.25 million), especially those working in food/agriculture/construction/personal services occupations or industries (ranging from 54.9% to 88.5%). In adjusted analyses, working cancer survivors with lower household income ( 〈 200% of the federal poverty level, 48.7%), without a high school degree (43.3%), without health insurance coverage (70.6%), and who were self-employed (89.5%), were part-time workers (68.2%), or worked in small businesses ( 〈 50 employees, 48.8%) were most likely to lack paid sick leave. Lack of paid sick leave was associated with lower use of influenza vaccine (ages 18–39 years, 21.3% vs 33.3%; ages 40–49 years, 25.8% vs 38.3%; ages 50–64 years, 46.3% vs 52.4%; P 〈 .001 for all), cholesterol screening (ages 18–39 years, 43.1% vs 62.5%; P 〈 .05), and blood pressure check (ages 18–39 years, 43.1% vs 62.5%; P 〈 .05) compared with survivors having paid sick leave. Conclusions: In the United States, more than one-third of all working cancer survivors and more than half of survivors working for small employers and in certain occupations/industries lack paid sick leave. Survivors with lower household income or educational attainment are particularly vulnerable. Moreover, lack of paid sick leave is associated with lower use of some recommended preventive services, suggesting that ensuring working cancer survivors have access to paid sick leave may be an important mechanism for reducing health disparities.
    Type of Medium: Online Resource
    ISSN: 1540-1405 , 1540-1413
    Language: Unknown
    Publisher: Harborside Press, LLC
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 16_suppl ( 2022-06-01), p. 6581-6581
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. 6581-6581
    Abstract: 6581 Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in delayed medical care that may have led to increased death rates in 2020 among people with medical conditions such as cancer. This study examined changes in cancer-related mortality between 2019 and 2020. Methods: We used the US 2019-2020 Multiple Cause of Death database from the CDC WONDER to identify cancer-related deaths, defined as decedents with invasive or noninvasive cancer as a contributing cause of death (ICD-10 codes: C00-C97 and D00-D09). We compared age-standardized cancer-related annual and monthly mortality rates (per 100,000 person-years and person-months, respectively) in January-December 2020 (pandemic) versus January-December 2019 (pre-pandemic) overall and stratified by rurality and place of death. We calculated the 2020 excess death by comparing the numbers of observed death with the projected death based on age-specific cancer-related death rate from 2015 to 2019. Results: The number of cancer-related deaths was 686 054 in 2020, up from 664 888 in 2019, with an annual increase of 3.2%. Compared to the number of projected deaths for 2020 (666 286), the number of cancer-related excess deaths was 19 768 in 2020. Annual age-standardized cancer-related mortality rate (per 100,000 person-years) continuously decreased from 173.7 in 2015 to 162.1 in 2019, while it increased to 164.1 in 2020 (2020 vs 2019 rate ratio (RR): 1.013, 95% confidence interval (CI): 1.009 - 1.016). The cancer-related monthly mortality rate was higher in April 2020 (RR: 1.032, 95% CI: 1.020 – 1.044) when healthcare capacity was most challenged by the pandemic, subsequently declined in May and June 2020, and higher mortality rates were again observed each month from July to December 2020 compared to 2019. In large metropolitan areas, the largest increase in cancer-related mortality was observed in April 2020, while in non-metropolitan areas, the largest increases occurred from July to December 2020, coinciding with the time-spatial pattern of COVID-19 incidence in the country. Compared to 2019, cancer-related mortality rates were lower from March to December 2020 in medical facilities, hospice facilities, and nursing homes or long-term care settings but higher in decedent's homes. Conclusions: The COVID-19 pandemic led to significant increases in cancer-related deaths in 2020 versus 2019. Ongoing evaluation of the spatial-temporal effects of the pandemic on cancer care and outcomes is warranted, especially in relation to patterns in vaccine uptake and COVID-19 hospitalization rates.[Table: see text]
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
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  • 8
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2022
    In:  Journal of Clinical Oncology Vol. 40, No. 16_suppl ( 2022-06-01), p. 6600-6600
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 40, No. 16_suppl ( 2022-06-01), p. 6600-6600
    Abstract: 6600 Background: Use of genomic testing, especially multi-marker tumor panels, is increasing in the United States. Not all tests and related treatments are covered by health insurance, which can result in substantial patient out-of-pocket (OOP) costs. Although most patients are concerned about OOP costs, little is known about oncologists’ treatment decisions with respect to patient health insurance coverage and OOP costs for genomic testing. Methods: We identified 1,049 oncologists who reported using multi-marker tumor panels from the 2017 National Survey of Precision Medicine in Cancer Treatment. Separate multivariable ordinal logistic regression analyses were used to assess the associations of oncologist, practice, and patient characteristics and the oncologist ratings of the importance of health insurance coverage and OOP cost for genomic testing as part of treatment decisions. Results: Among oncologists, 47.3%, 32.7% and 20.0% reported that patient insurance coverage for genomic testing was very important, somewhat important, and a little/not important, respectively, in treatment decisions. 56.9%, 28.0%, and 15.2% reported patient OOP costs for genomic testing were very, somewhat, or a little/not important in treatment decisions, respectively. In adjusted ordinal logistic regression analyses, oncologists who used next-generation gene sequencing tests were more likely to report patient health insurance and OOP costs for testing as important (odds ratio (OR) = 2.0; 95% confidence interval (CI): 1.2, 3.5) and (OR = 2.1; 95%CI: 1.2, 3.7), respectively) in treatment decisions. Oncologists with more years of experience, who treated solid tumors (rather than only hematological cancers), worked in practices without molecular tumor boards for genomic tests, and with higher percentages of patients insured by Medicaid or self-paid/uninsured also reported insurance coverage or OOP costs for testing were important in treatment decisions (all p 〈 0.05). Conclusions: Physician, practice, and patient characteristics were associated with oncologists’ ratings of the importance of patient health insurance and OOP costs in treatment decisions. Identifying factors that influence physicians’ priorities in treatment decisions may inform the development and targeting of interventions to support patient and physician discussions about oncology care.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2022
    detail.hit.zdb_id: 2005181-5
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  • 9
    In: Cancer Research Communications, American Association for Cancer Research (AACR), Vol. 3, No. 9 ( 2023-09-12), p. 1830-1839
    Abstract: Financial hardship (FH), defined as adverse patient effects due to cancer costs, is experienced by approximately half of individuals diagnosed with cancer. Many individuals diagnosed with cancer also experience disruptions with their employment. This study examines associations of employment disruptions and FH among a nationally representative sample of individuals diagnosed with cancer in the United States. We utilized 2016/2017 Medical Expenditure Panel Survey Experiences with Cancer data from individuals who worked for pay following cancer diagnosis. Employment disruption included taking extended paid time off work; switching to part-time/less demanding jobs; and/or retiring early due to cancer diagnosis/treatment. FH domains included: material (e.g., borrowing money/financial sacrifices); psychologic (e.g., worrying about medical bills/income); and behavioral (delaying/forgoing healthcare services because of cost). Multivariable logistic regression analyses determined associations of employment disruption and FH. Among 732 individuals with a cancer history, 47.4% experienced employment disruptions; 55.9% experienced any FH. Any FH was significantly more common among individuals with versus without employment disruptions across multiple measures and domains (68.7% vs. 44.5%; P value of difference & lt;0.0001). Individuals with employment disruptions were more likely to have any FH [OR, 2.38; 95% confidence interval (CI), 1.62–3.52] and more FHs (OR, 2.76; 95% CI, 1.96–3.89] . This study highlights that employment disruptions are common and significantly associated with multiple domains of FH among individuals with a cancer history. Employer workplace accommodation, physician discussions regarding potential impacts of cancer care on employment, and other policies to minimize employment disruptions among individuals diagnosed with cancer may reduce FH in this vulnerable population. Significance: Individuals diagnosed with cancer may have employment disruptions; they may also develop FHs. People with cancer who have employment changes are more likely to also have FHs. Physicians and employers can help individuals with cancer through advancing planning, workplace assistance, and improved medical leave and insurance policies.
    Type of Medium: Online Resource
    ISSN: 2767-9764
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
    detail.hit.zdb_id: 3098144-X
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  • 10
    Online Resource
    Online Resource
    American Association for Cancer Research (AACR) ; 2020
    In:  Cancer Epidemiology, Biomarkers & Prevention Vol. 29, No. 11 ( 2020-11-01), p. 2134-2140
    In: Cancer Epidemiology, Biomarkers & Prevention, American Association for Cancer Research (AACR), Vol. 29, No. 11 ( 2020-11-01), p. 2134-2140
    Abstract: Lack of health insurance is associated with having problems with access to high-quality care. We estimated prevalence and evaluated associations of insurance coverage disruptions and access to health care and affordability among cancer survivors in the United States. Methods: Adult cancer survivors ages 18 to 64 years with current private or public health insurance were identified from the 2011 to 2018 National Health Interview Survey (n = 7,186). Health insurance coverage disruption was measured as self-reports of any time in the prior year without coverage. Outcomes included preventive services use, problems with care affordability, and cost-related medication nonadherence in the prior year. We used separate multivariable logistic models to evaluate associations between coverage disruptions and study outcomes by current insurance coverage. Results: Among currently insured survivors, 3.7% [95% confidence interval (95% CI), 3.0%–4.4%] with private, and 7.8% (95% CI, 6.5%–9.4%) with public insurance reported coverage disruptions in 2011 to 2018. We estimated that approximately 260,000 survivors ages 18 to 64 years had coverage disruptions in 2018. Among privately and publicly insured survivors, those with coverage disruptions were less likely to report all preventive services use (16.9% vs. 36.2%; 14.6% vs. 25.3%, respectively) and more likely to report any problems with care affordability (55.0% vs. 17.7%; 71.1% vs. 38.4%, respectively) and any cost-related medication nonadherence (39.4% vs. 10.1%; 36.5% vs. 16.3%, respectively) compared with those continuously insured (all P & lt; 0.05). Conclusions: Coverage disruptions in the prior year were associated with problems with health care access and affordability among currently insured survivors. Impact: Reducing coverage disruptions may help improve access and affordability for survivors.
    Type of Medium: Online Resource
    ISSN: 1055-9965 , 1538-7755
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2020
    detail.hit.zdb_id: 2036781-8
    detail.hit.zdb_id: 1153420-5
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