Karen Meneses

Does economic burden influence quality of life in breast cancer survivors

GOALS Economic burden is emerging as a crucial dimension in our understanding of adjustment to cancer during treatment. Yet, economic burden is rarely examined in cancer survivorship. The goal of this paper is to describe the effect of economic hardship and burden among women with breast cancer. METHODS We examined baseline and follow-up (3 and 6 month) data reported by 132 stage I and II breast cancer survivors assigned to the Wait Control arm of the Breast Cancer Education Intervention (BCEI), a clinical trial of education and support interventions. Repeated measures models fitted with linear mixed models were used to examine relationships between aspects of economic burden and overall quality of life (QOL) scores. Structural equation models (SEM) were used to examine the relationship between overall economic burden and QOL. RESULTS Nineteen economic events were reported. The proportion of survivors who reported increase in insurance premiums increased in the 6-month study period (p=.022). The proportion of survivors reporting change in motivation (p=.016), productivity (p=.002), quality of work (p=.01), days missed from work (p<.001) and sacrificing other things (p=.001) declined. An increase in economic events was significantly associated with poorer quality of life at each of the study time points. CONCLUSION Economic burden of breast cancer extends into post-treatment survivorship. Better understanding of economic impact and managing economic burden may help maintain QOL.

Preliminary evaluation of psychoeducational support interventions on quality of life in rural breast cancer survivors after primary treatment.

Although most cancer survivors are at risk for being lost in the transition from treatment to survivorship, rural breast cancer survivors face special challenges that might place them at particular risk. This small-scale preliminary study had 2 specific aims: (aim 1) establish the feasibility of rural breast cancer survivors participation in a longitudinal quality of life (QOL) intervention trial and (aim 2) determine the effects of the Breast Cancer Education Intervention (BCEI) on overall QOL. Fifty-three rural breast cancer survivors were randomized to either an experimental (n = 27) or a wait-control arm (n = 26). Participants in the experimental arm received the BCEI consisting of 3 face-to-face education and support sessions and 2 face-to-face and 3 telephone follow-up sessions, along with supplemental written and audiotape materials over a 6-month period. Breast Cancer Education Intervention modules and interventions are organized within a QOL framework. To address the possible effects of attention, wait-control participants received 3 face-to-face sessions and 3 telephone sessions during the first 6 months of participation in the study, but not the BCEI intervention. Research questions addressing aim 1 were as follows: (a) can rural breast cancer survivors be recruited into a longitudinal intervention trial, and (b) can their participation be retained. Research questions for aim 2 were as follows: (a) do participants who received the BCEI show improvement in overall QOL, and (b) is the QOL improvement sustained over time. Data were analyzed using repeated-measures general linear mixed models. Results demonstrated the ability to recruit and retain 53 rural breast cancer survivors, that the experimental arm showed improvement in overall QOL (P = .013), and that there were significant differences in overall QOL between the experimental and wait-control groups at both months 3 and 6. Thus, it appears that at least some rural breast cancer survivors can and will participate in a larger trial and will maintain their participation and that those that do participate experience significant QOL benefit.

Self-assessed knowledge of treatment and fertility preservation in young women with breast cancer

Young women with breast cancer do not identify themselves as knowledgeable about the effect of cancer treatment on fertility or fertility preservation treatments and resources. These women need access to high-quality health information to support their participation in medical decision making about fertility preservation.

Technology, cognitive remediation, and nursing: directions for successful cognitive aging.

Many older adults experience cognitive difficulties and declines as a part of normal aging. Nurses and other health care professionals will require assistance in technologies that can help older patients maintain or improve cognition. Cognitive remediation represents a well-established laboratory approach that augments cognitive functioning in older adults. Emerging technologies allow such cognitive remediation to be self-administered through gaming software, making it convenient, fun, and inexpensive to deliver. As such, guiding older patients, as well as some facilities, in this direction may be a way to help. However, certain caveats and suggestions are warranted.

The Patient Care Connect Program: Transforming Health Care Through Lay Navigation

The Patient Care Connect Program (PCCP) is a lay patient navigation program, implemented by the University of Alabama at Birmingham Health System Cancer Community Network. The PCCPs goal is to provide better health and health care, as well as to lower overall expenditures. The program focuses on enhancing the health of patients, with emphasis on patient empowerment and promoting proactive participation in health care. Navigator training emphasizes palliative care principles and includes development of skills to facilitate advance care planning conversations. Lay navigators are integrated into the health care team, with the support of a nurse supervisor, physician medical director, and administrative champion. The intervention focuses on patients with high needs to reach those with the greatest potential for benefit from supportive services. Navigator activities are guided by frequent distress assessments, which help to identify patient concerns across multiple domains, triage patients to appropriate resources, and ultimately overcome barriers to health care. In this article, we describe the PCCPs development, infrastructure, selection and training of lay navigators, and program operations.

Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer

Importance Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. Objective To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. Design, Setting, and Participants This observational study from January 1, 2012, through December 31, 2015, used propensity score–matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. Exposures The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Main Outcomes and Measures Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). Results In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by

Quality of Life in Cancer Survivorship: 20 Years Later

781.29 more per quarter per navigated patient (&bgr; = −781.29, SE = 45.77, P < .001), for an estimated

An introduction to tree-structured modeling with application to quality of life data

19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at

Dealing with the financial burden of cancer: perspectives of older breast cancer survivors

294 and

Attention and memory deficits in breast cancer survivors: implications for nursing practice and research.

275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001). Conclusions and Relevance Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.