JCO oncology practice最新文献

The direct and indirect financial burden of cancer care, from medication costs to lost wages, results in financial toxicity for patients. Despite the growing recognition of financial toxicity as a problem for patients, there are few solutions available at the point of care. Structured cost conversations between oncologists and patients to help identify financial toxicity and intervene early when it is recognized have been posited as a patient facing intervention. Cost conversations fit into a framework of shared decision making within cancer care. Although more than 90% of patients with cancer express a desire to discuss the costs of their care, <15% report that such conversations occurred. This contrasts with oncologists who self-report that they discuss costs with patients up to 60% of the time. Poor utilization of cost conversations may be due to both patient and oncologist reluctance of discussing money; this can be driven by fear that lower cost care is less effective and lack of training/guidance for oncologists on how to effectively conduct cost conversations. Currently, there is an abundance of small, pilot studies showing benefits of cost conversation or other decision aids in meaningfully reducing financial toxicity. However, no large randomized prospective study has assessed the role of structured conversations designed exclusively to address costs in cancer care. This review suggests a framework for cost conversations in oncology and outlines the steps necessary to develop a full cost conversation guide.

Purpose: As oncology practices implement routine screening for financial hardship (FH) and health-related social needs, interventions that address these needs must be implemented. A growing body of literature has reported on FH interventions.

Methods: We conducted a scoping review of the literature using PubMed, EMBASE, PsychInfo, and CINAHL to identify key studies (2000-2024) reporting on interventions to address cancer-related FH. Full-length manuscripts were included in the review if they detailed a research, quality improvement, or community-based intervention to address at least one element of FH and drew association with an outcome of interest. Studies were categorized by intervention type and qualitatively analyzed to identify critical components, outcomes, and limitations.

Results: Forty-four publications reporting on 43 interventions were included in the final analysis and were categorized as research interventions (n = 20) and real-world programs (n = 20). Studies reporting on financial navigation programs (n = 17) and specialty pharmacy assistance programs (n = 11) were most common; enrolled patients received concrete assistance with direct medical costs and cost-of-living expenses (eg, transportation and food). In addition, several of these programs improved overall patient-reported financial toxicity, decreased appointment no-shows, and improved enrollment in clinical trials.

Conclusion: Interventions to address FH are feasible and can address all domains of FH-material, behavioral, and psychosocial. Future research should address the uptake and implementation of these interventions across diverse cancer care delivery settings. Such programs will be an essential part of cancer care delivery until broad social and policy changes can address the underlying factors that contribute to FH in Americans with cancer.

Financial toxicity (FT) is now a well-recognized issue affecting many patients with cancer and their families. The field is rapidly moving from a focus on describing this problem to efforts to optimize screening and identify management solutions. There are now multiple validated tools to study FT in the research setting. Although there is currently no standard tool for screening in the setting of routine clinical practice, many of the scales for FT were developed with clinical screening in mind, and there is emerging evidence regarding potential to screen with one or two questions to detect financial distress. This narrative review is intended to provide an update on validated scales that have been used to study FT in the research context and provide examples of tools of varying length that are being studied for implementation of screening in clinical practice. It is important for clinicians to seek to identify and assist patients who may be experiencing FT as a result of cancer or cancer therapy.

Financial Toxicity is a global issue requiring international efforts, but importantly, where to next?

Purpose: Financial toxicity (FT) of cancer treatment likely affects more patients in low- and middle-income countries (LMICs); however, most of the research on FT comes from high-income countries, which may not apply to LMICs. The causes and consequences of FT in patients with cancer in LMICs remain understudied.

Methods: Following PRISMA guidelines, we searched MEDLINE, Web of Science, and CINAHL for FT literature in cancer originating from LMICs from inception until the end of 2023, and documented the different definitions used to define FT in LMICs, and the magnitude of FT documented using those definitions. LMIC was defined using the World Bank Country and Lending Group classification.

Results: Sixty-eight studies met the inclusion criteria. Studies on FT in cancer originating from LMICs have increased in recent years (>75% studies published 2020 onward) and used varying criteria to define FT, broadly categorized into five themes. Majority of the studies defined FT in terms of catastrophic health expenditure (45%) or household impoverishment (10%), while 26% of the studies used the Comprehensive Score for Financial Toxicity tool, developed and validated in US patients, to measure FT in LMIC settings. Twenty-six percent of the studies defined FT in terms of coping mechanisms and 10% in terms of subjective financial burden. The magnitude of FT in patients with cancer was substantial irrespective of the definitions used.

Conclusion: This review synthesizes the different definitions of FT for LMICs that have been used in the literature so far. We conclude that the definitions that capture the coping mechanisms or hardships might reflect the magnitude of FT better than absolute dollar values or relative percentages of expenditures. Future studies can use our results to devise locally tailored definitions of FT.