Anthony Lowe

A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can't Pay the Co-Pay.

ObjectiveTo determine the extent of financial toxicity (FT) among cancer survivors, identify the determinants and how FT is measured.MethodsA systematic review was performed in MEDLINE, CINAHL and PsycINFO, using relevant terminology and included articles published from 1 January, 2013 to 30 June, 2016. We included observational studies where the primary outcomes included FT and study samples were greater than 200. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.ResultsFrom 417 citations, a total of 25 studies were included in this review. Seventy outcomes of FT were reported with 47 covering monetary, objective and subjective indicators of FT. A total of 28–48% of patients reported FT using monetary measures and 16–73% using subjective measures. The most commonly reported factors associated with FT were: being female, younger age, low income at baseline, adjuvant therapies and more recent diagnosis. Relative to non-cancer comparison groups, cancer survivors experienced significantly higher FT. Most studies were cross-sectional and causal inferences between FT and determinants were not possible. Measures of FT were varied and most were not validated, while monetary values of out-of-pocket expenses included different cost components across studies.ConclusionsA substantial proportion of cancer survivors experience financial hardship irrespective of how it is measured. Using standardised outcomes and longitudinal designs to measure FT would improve determination of the extent of FT. Further research is recommended on reduced work participation and income losses occurring concurrently with FT and on the impacts on treatment non-adherence.

Defining Young in the Context of Prostate Cancer

The experience of prostate cancer is for most men a major life stress with the psychological burden of this disease falling more heavily on those who are younger. Despite this, being young as it applies to prostate cancer is not yet clearly defined with varied chronological approaches applied. However, men’s responses to health crises are closely bound to life course and masculinities from which social roles emerge. This paper applied qualitative methodology (structured focus groups and semistructured interviews with expert informants) using interpretative phenomenological analysis to define what it means to be young and have prostate cancer. Structured focus groups were held with 26 consumer advisors (men diagnosed with prostate cancer who provide support to other men with prostate cancer or raise community awareness) and health professionals. As well, 15 men diagnosed with prostate cancer and in their 40s, 50s, or 60s participated in semi-structured interviews. Participants discussed the attributes that describe a young man with prostate cancer and the experience of being young and diagnosed with prostate cancer. Chronological definitions of a young man were absent or inconsistent. Masculine constructions of what it means to be a young man and life course characteristics appear more relevant to defining young as it applies to prostate cancer compared with chronological age. These findings have implications for better understanding the morbidities associated with this illness, and in designing interventions that are oriented to life course and helping young men reconstruct their identities after prostate cancer.

Cost-effectiveness analysis of multiparametric MRI with increased active surveillance for low-risk prostate cancer in Australia

To evaluate the cost‐effectiveness of multiparametric magnetic resonance imaging (mpMRI) to diagnose prostate cancer and direct all low‐risk patients into active surveillance (AS).

Financial toxicity: a potential side-effect of prostate cancer treatment among Australian men

The purpose of this study was to understand the extent, nature and variability of the current economic burden of prostate cancer among Australian men. An online cross‐sectional survey was developed that combined pre‐existing economic measures and new questions. With few exceptions, the online survey was viable and acceptable to participants. The main outcomes were self‐reported out‐of‐pocket costs of prostate cancer diagnosis and treatment, changes in employment status and household finances. Men were recruited from prostate cancer support groups throughout Australia. Descriptive statistical analyses were undertaken. A total of 289 men responded to the survey during April and June 2013. Our study found that men recently diagnosed (within 16 months of the survey) (n = 65) reported spending a median AU

Men’s help-seeking in the first year after diagnosis of localised prostate cancer

8000 (interquartile range AU

Advocacy, support and survivorship in prostate cancer

14 000) for their cancer treatment while 75% of men spent up to AU

What does it cost Medicare to diagnose and treat men with localized prostate cancer in the first year

17 000 (2012). Twenty per cent of all men found the cost of treating their prostate cancer caused them ‘a great deal’ of distress. The findings suggest a large variability in medical costs for prostate cancer treatment with 5% of men spending

Estimating the healthcare costs of treating prostate cancer in Australia: A Markov modelling analysis

250 or less in out‐of‐pocket expenses and some men facing very high costs. On average, respondents in paid employment at diagnosis stated that they had retired 4–5 years earlier than planned.

Measuring masculinity in the context of chronic disease

This study describes sources of support utilised by men with localised prostate cancer in the first year after diagnosis and examines characteristics associated with help‐seeking for men with unmet needs. A cross‐sectional survey of 331 patients from a population‐based sample who were in the first year after diagnosis (M = 9.6, SD = 1.9) was conducted to assess sources of support, unmet supportive care needs, domain‐specific quality of life and psychological distress. Overall, 82% of men reported unmet supportive care needs. The top five needs were sexuality (58%); prostate cancer‐specific (57%); psychological (47%); physical and daily living (41%); and health system and information (31%). Professional support was most often sought from doctors (51%). Across most domains, men who were older (Ps ≤ 0.03), less well educated (Ps ≤ 0.04) and more depressed (Ps ≤ 0.05) were less likely to seek help for unmet needs. Greater sexual help‐seeking was related to better sexual function (P = 0.03), higher education (P ≤ 0.03) and less depression (P = 0.05). Unmet supportive care needs are highly prevalent after localised prostate cancer diagnosis with older age, lower education and higher depression apparent barriers to help‐seeking. Interventions that link across medicine, nursing and community based peer support may be an accessible approach to meeting these needs. Clinical Trial Registry: Trial Registration: ACTRN12611000392965.

Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors

Across Australia, prostate cancer support groups (PCSG) have emerged to fill a gap in psychosocial care for men and their families. However, an understanding of the triggers and influencers of the PCSG movement is absent. We interviewed 21 SG leaders (19 PC survivors, two partners), of whom six also attended a focus group, about motivations, experiences, past and future challenges in founding and leading PCSGs. Thematic analysis identified four global themes: illness experience; enacting a supportive response; forming a national collective and challenges. Leaders described mens feelings of isolation and neglect by the health system as the impetus for PCSGs to form and give/receive mutual help. Negotiating health care systems was an early challenge. National affiliation enabled leaders to build a united voice in the health system and establish a group identity and collective voice. Affiliation was supported by a symbiotic relationship with tensions between independence, affiliation and governance. Future challenges were group sustainability and inclusiveness. Study findings describe how a grassroots PCSG movement arose consistent with an embodied health movement perspective. Health care organisations who seek to leverage these community resources need to be cognisant of SG values and purpose if they are to negotiate effective partnerships that maximise mutual benefit.