Fumiko Chino

Patient-Oncologist Cost Communication, Financial Distress, and Medication Adherence

BACKGROUND Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care. METHODS We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions. RESULTS Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence. CONCLUSION Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.

Self-Reported Financial Burden and Satisfaction With Care Among Patients With Cancer

BACKGROUND Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction. METHODS This was an observational, cross-sectional, survey-based study assessing patient-reported financial burden (FB). Eligible patients were ≥ 21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for ≥ 1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale. RESULTS Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction (coefficient: -.29), satisfaction with technical quality (coefficient: -.26), and satisfaction with financial aspects of care (coefficient: -.62). Older age was associated with higher scores in all satisfaction subscales except patient-physician communication and financial aspects. Annual household income of <

Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care

20,000 was associated with lower satisfaction scores in all subscales except time spent with doctor. High FB was not associated with patient satisfaction scores for accessibility and convenience, communication, interpersonal manner, or time spent with doctor. CONCLUSION FB is a potentially modifiable correlate of poor satisfaction with cancer care including general satisfaction and satisfaction with the technical quality of care. Addressing cancer-associated FB may lead to improved satisfaction, which in turn can influence adherence, outcomes, and quality of life.

Stereotactic Body Radiation Therapy–Induced Abscopal Effect on Hepatocellular Carcinoma After Treatment for Lung Cancer: A Case Report

This cross-sectional survey study examines financial distress and cost expectations among patients with cancer presenting for anticancer therapy.

Place of death for patients with cancer in the United States, 1999 through 2015: racial, age, and geographic disparities: Place of Death for Patients With Cancer

The abscopal effect is a phenomenon in which localized radiation treatment is associated with cancer regression at a site distant from that irradiated. Stereotactic body radiation therapy (SBRT) delivers precise high-dose radiation treatments to tumors while minimizing exposure of surrounding normal tissue. SBRT is standard treatment for many primary and metastatic cancers and has an increasing role in the treatment of hepatocellular carcinoma (HCC).(1) The abscopal effect after radiation treatment is theorized to result from radiation “priming” of the immune system, enhancing immune recognition through increased antigen presentation, resulting in antitumor effects outside irradiated areas. We report an unusual case of HCC regression after SBRT to a different primary cancer in the lung.

The role of external beam radiotherapy in the treatment of hepatocellular cancer: Radiation for HCC

Place of death is an essential component of high quality cancer care and comprehensive national trends and disparities in place of death are unknown.

The utility of cost discussions between patients with cancer and oncologists.

Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long‐term survival has improved from 3% in 1970 to an 18% 5‐year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one‐third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image‐guided radiation therapy, used as monotherapy or in combination with other liver‐directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a “bridge to transplant” and a definitive treatment.