Christine M. Veenstra

The personal financial burden of complications after colorectal cancer surgery

Patients with colorectal cancer (CRC) may suffer significant economic hardship during treatment. Complications are common after surgery for CRC and may exacerbate the financial burden of CRC even further.

A Composite Measure of Personal Financial Burden Among Patients With Stage III Colorectal Cancer

Background:Despite improved survival with chemotherapy for stage III colorectal cancer (CRC), patients may suffer substantial economic hardship during treatment. Methods for quantifying financial burden in CRC patients are lacking. Objective:To derive and validate a novel patient-reported measure of personal financial burden during CRC treatment. Data Collection:Within a population-based survey of patients in the Detroit and Georgia Surveillance, Epidemiology and End Results regions diagnosed with stage III CRC between 2011 and 2013, we asked 7 binary questions assessing effects of disease and treatment on personal finances. Data Analysis:We used factor analysis to compute a composite measure of financial burden. We used &khgr;2 tests to evaluate relationships between individual components of financial burden and chemotherapy use with &khgr;2 analyses. We used Mantel-Haenszel &khgr;2 trend tests to examine relationships between the composite financial burden metric and chemotherapy use. Results:Among 956 patient surveys (66% response rate), factor analysis of 7 burden items yielded a single-factor solution. Factor loadings of 6 items were >0.4; these were included in the composite score. Internal consistency was high (Cronbach &agr;=0.79). The mean financial burden score among all respondents was 1.72 (range, 0–6). The 812 (85%) who reported chemotherapy use had significantly higher financial burden scores than those who did not (mean burden score 1.88 vs. 0.88, P<0.001). Conclusions:Financial burden is high among CRC patients, particularly those who use adjuvant chemotherapy. We encourage use of our instrument to validate our measure in the identification of patients in need of additional financial support during treatment.

Fragmentation in specialist care and stage III colon cancer.

Patients with cancer frequently transition between different types of specialists and across care settings. This study explored how frequently the surgical and medical oncology care of stage III colon cancer patients occurred across more than 1 hospital and whether this was associated with mortality and costs.

Trends in surveillance for resected colorectal cancer, 2001-2009.

Little is known about recent trends in surveillance among the more than 1 million US colorectal cancer (CRC) survivors. Moreover, for stage I disease, which accounts for more than 30% of survivors, the guidelines are limited, and the use of surveillance has not been well studied. Guidelines were changed in 2005 to include recommendations for computed tomography (CT) surveillance in select patients, but the impact of these changes has not been explored.

The effect of care setting in the delivery of high-value colon cancer care.

The effect of care setting on value of colon cancer care is unknown.

Association of Paid Sick Leave With Job Retention and Financial Burden Among Working Patients With Colorectal Cancer

Association of Paid Sick Leave With Job Retention and Financial Burden Among Working Patients With Colorectal Cancer Workers who develop serious illnesses, such as colorectal cancer (CRC), can incur economic hardship, regardless of insurance coverage.1-4 Paid sick leave could reduce the need to take unpaid time off during treatment. However, 40% of US workers have no paid sick leave. Its provision is not mandated under the Affordable Care Act or the Family Medical Leave Act, nor is it part of health insurance coverage.5 This study examined the association between access to paid sick leave and job retention and personal financial burden among patients with CRC.

Hospital Academic Status and Value of Care for Nonmetastatic Colon Cancer

PURPOSE The relationship between oncologic hospital academic status and the value of care for stage II and III colon cancer is unknown. METHODS Retrospective SEER-Medicare analysis of patients age ≥ 66 years with stage II or III colon cancer and seen by medical oncology. Eligible patients were diagnosed 2000 to 2009 and followed through December 31, 2010. Hospitals reporting a major medical school affiliation in the NCI Hospital File were classified as academic medical centers. The association between hospital academic status and survival was assessed using Kaplan-Meier curves and Cox proportional hazards models. The association with mean cost of care was estimated using generalized linear models with log link and gamma family and with cost of care at various quantiles using quantile regression models. RESULTS Of 24,563 eligible patients, 5,707 (23%) received care from academic hospitals. There were no significant differences in unadjusted disease-specific median survival or adjusted risk of colon cancer death by hospital academic status (stage II hazard ratio = 1.12; 95% CI, 0.98 to 1.28; P = .103; stage III hazard ratio = 0.99; 95% CI, 0.90 to 1.08; P = .763). Excepting patients at the upper limits of the cost distribution, there was no significant difference in adjusted cost by hospital academic status. CONCLUSION We found no survival differences for elderly patients with stage II or III colon cancer, treated by a medical oncologist, between academic and nonacademic hospitals. Furthermore, cost of care was similar across virtually the full range of the cost distribution.

Employment benefits and job retention: evidence among patients with colorectal cancer

A “health shock,” that is, a large, unanticipated adverse health event, can have long‐term financial implications for patients and their families. Colorectal cancer is the third most commonly diagnosed cancer among men and women and is an example of a specific health shock. We examined whether specific benefits (employer‐based health insurance, paid sick leave, extended sick leave, unpaid time off, disability benefits) are associated with job retention after diagnosis and treatment of colorectal cancer. In 2011–14, we surveyed patients with Stage III colorectal cancer from two representative SEER registries. The final sample was 1301 patients (68% survey response rate). For this study, we excluded 735 respondents who were not employed and 20 with unknown employment status. The final analytic sample included 546 respondents. Job retention in the year following diagnosis was assessed, and multivariable logistic regression was used to evaluate associations between job retention and access to specific employment benefits. Employer‐based health insurance (OR = 2.97; 95% CI = 1.56–6.01; P = 0.003) and paid sick leave (OR = 2.93; 95% CI = 1.23–6.98; P = 0.015) were significantly associated with job retention, after adjusting for sociodemographic, clinical, geographic, and job characteristics.

Decision-support networks of women newly diagnosed with breast cancer

Little is known about the size and characteristics of the decision‐support networks of women newly diagnosed with breast cancer and whether their involvement improves breast cancer treatment decisions.

Emerging Systemic Therapies for Colorectal Cancer

Abstract Despite advances over the past 20 years in colorectal cancer (CRC) screening, diagnosis, and treatment, survival outcomes remain suboptimal. Five‐year survival for patients with locally advanced CRC is 69%; 5‐year survival drops to 12% for patients with metastatic disease. Novel, effective systemic therapies are needed to improve long‐term outcomes. In this review, we describe currently available systemic therapies for the treatment of locally advanced and metastatic CRC and discuss emerging therapies, including encouraging advances in identifying novel targeted agents and exciting responses to immunotherapeutic agents.