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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
    Oxford University Press (OUP) ; 2021
    In:  JNCI: Journal of the National Cancer Institute Vol. 113, No. 8 ( 2021-08-02), p. 997-1004
    In: JNCI: Journal of the National Cancer Institute, Oxford University Press (OUP), Vol. 113, No. 8 ( 2021-08-02), p. 997-1004
    Abstract: Cancer and its treatment can result in lifelong medical financial hardship, which we aimed to describe among adult survivors of adolescent and young adult (AYA) cancers in the United States. Methods We identified adult (aged ≥18 years) survivors of AYA cancers (diagnosed ages 15-39 years) and adults without a cancer history from the 2010-2018 National Health Interview Surveys. Proportions of respondents reporting measures in different hardship domains (material [eg, problems paying bills], psychological [eg, distress] , and behavioral [eg, forgoing care due to cost]) were compared between groups using multivariable logistic regression models and hardship intensity (cooccurrence of hardship domains) using ordinal logistic regression. Cost-related changes in prescription medication use were assessed separately. Results A total of 2588 AYA cancer survivors (median = 31 [interquartile range = 26-35] years at diagnosis; 75.0% more than 6 years and 50.0% more than 16 years since diagnosis) and 256 964 adults without a cancer history were identified. Survivors were more likely to report at least 1 hardship measure in material (36.7% vs 27.7%, P & lt; .001) and behavioral (28.4% vs 21.2%, P & lt; .001) domains, hardship in all 3 domains (13.1% vs 8.7%, P & lt; .001), and at least 1 cost-related prescription medication nonadherence (13.7% vs 10.3%, P = .001) behavior. Conclusions Adult survivors of AYA cancers are more likely to experience medical financial hardship across multiple domains compared with adults without a cancer history. Health-care providers must recognize this inequity and its impact on survivors’ health, and multifaceted interventions are necessary to address underlying causes.
    Type of Medium: Online Resource
    ISSN: 0027-8874 , 1460-2105
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2992-0
    detail.hit.zdb_id: 1465951-7
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  • 8
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2020
    In:  JNCI: Journal of the National Cancer Institute Vol. 112, No. 5 ( 2020-05-01), p. 498-506
    In: JNCI: Journal of the National Cancer Institute, Oxford University Press (OUP), Vol. 112, No. 5 ( 2020-05-01), p. 498-506
    Abstract: Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. Methods We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. Results Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. Conclusions Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.
    Type of Medium: Online Resource
    ISSN: 0027-8874 , 1460-2105
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2992-0
    detail.hit.zdb_id: 1465951-7
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  • 9
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2018
    In:  Journal of Clinical Oncology Vol. 36, No. 30_suppl ( 2018-10-20), p. 68-68
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 36, No. 30_suppl ( 2018-10-20), p. 68-68
    Abstract: 68 Background: Policy makers, health care providers and patients are increasingly concerned about rising costs for prescription drugs and cost-related medication non-adherence (CRN). This study aims to evaluate the relationship between cancer history and CRN as well as cost-coping strategies, by health insurance coverage. Methods: We used the National Health Interview Survey data from 2013-2016 to identify adults age 18-64 with (n = 3 599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included a) CRN (skipping, taking less or delaying medication because of cost), and b) cost-coping strategies (requesting lower cost medication or using alternative therapies to save money). Separate multivariable logistic regressions were used to calculate the adjusted percentages of CRN and cost-coping strategies associated with cancer history, stratified by health insurance. Results: Cancer survivors reported higher percentages of CRN (14.5% vs. 12.1%, P 〈 .001) and were slightly more likely to report using cost-coping strategies (24.4% vs. 22.8%, P = .060) compared with adults without a cancer history. The magnitude of differences in CRN by cancer history varied by insurance type (any private 10.2% vs. 8.6%, P = .034; public only 17.9% vs. 14.2%, P = .010; uninsured 41.0% vs. 33.2%, P = .064). Among the privately insured, the difference in CRN by cancer history was greatest among those enrolled in high deductible health plans (HDHP) without health saving accounts (HSA) (16.9% vs. 10.9%, P = .002). Regardless of cancer history, CRN and use of cost-coping strategies were highest for those uninsured, enrolled in HDHP and without HSA, and without prescription drugs coverage under their health plan (all P 〈 .001). Conclusions: Cancer survivors are prone to CRN and more likely to use cost-coping strategies to minimize financial hardship. Expanding options for health insurance coverage and use of HSA, and prescription drug coverage may be effective strategies to address CRN.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2018
    detail.hit.zdb_id: 2005181-5
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  • 10
    Online Resource
    Online Resource
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 27_suppl ( 2019-09-20), p. 143-143
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 27_suppl ( 2019-09-20), p. 143-143
    Abstract: 143 Background: Childhood cancer survival varies by race/ethnicity in the United States. This study evaluated the impact of potentially modifiable characteristics - health insurance and area-level social deprivation - on racial/ethnic disparities in childhood cancer survival nationwide. Methods: We identified 65,113 childhood cancer patients aged 〈 18 years newly diagnosed with any of 10 common cancer types (e.g. central nervous system (CNS) neoplasms, acute lymphoblastic leukemia (ALL), Hodgkin lymphoma) from the 2004-2014 National Cancer Database. Cox proportional hazard models were used to compare survival probabilities by race and ethnicity (non-Hispanic white (NHW) vs non-Hispanic black (NHB), Hispanic, and non-Hispanic other (NH other)) for each cancer type. We conducted mediation analyses by the mma R package to evaluate the racial/ethnic survival disparities mediated by health insurance (private, Medicaid, and uninsured) and social deprivation index (SDI) quartile. SDI is a composite measure of deprivation based on seven characteristics (e.g. income, education, employment). Results: Compared to NHW, worse survival were observed for NHB (HR (hazard ratio): 1.4, 95% CI: 1.3-1.5), Hispanic (HR: 1.2, 95% CI: 1.1-1.2), and NH other (HR: 1.2, 95% CI: 1.1-1.3) for all cancer sites combined after adjusting for sociodemographic characteristics other than health insurance and SDI. Health insurance explained 20% of the survival disparities and SDI explained 19% of the disparity between NHB vs NHW; health insurance explained 48% of the survival disparities and SDI explained 45% of the disparity between Hispanic vs NHW. For ALL, health insurance significantly explained 15% and 18% of the survival disparities between NHB and Hispanic vs NHW, respectively. SDI significantly explained 19% and 31% of the disparities, respectively. Conclusions: Health insurance and SDI mediated racial/ethnic survival disparities for several childhood cancers. Expanding insurance coverage and improving healthcare access in disadvantaged areas may effectively reduce disparities for these cancer sites.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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