scholarly journals Socio-Economic and Rural-Urban Differences in Healthcare and Catastrophic Health Expenditure Among Cancer Patients in China: Analysis of the China Health and Retirement Longitudinal Study

2022 ◽  
Vol 9 ◽  
Author(s):  
Yang Zhao ◽  
Shenglan Tang ◽  
Wenhui Mao ◽  
Tomi Akinyemiju
Keyword(s):  
Longitudinal Study ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Health Expenditure ◽  
Healthcare Service ◽  
Catastrophic Health Expenditure ◽  
Cancer Treatments ◽  
Increased Risk ◽  
Different Types

Objective: In China, cancer accounts for one-fifth of all deaths, and exerts a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine the temporal trends in socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among adult cancer patients in China. We also investigate the relationship between different types of treatment and healthcare service utilization, as well as the incidence of CHE.Materials and Methods: We analyzed data from the 2011 and 2015 China Health and Retirement Longitudinal Study, a nationally representative survey including 17,224 participants (234 individuals with cancer) in 2011 and 19,569 participants (368 individuals with cancer) in 2015. The study includes six different types of cancer treatments: Chinese traditional medication (TCM); western modern medication (excluding TCM and chemotherapy medications); a combination of TCM & western medication; surgery; chemotherapy; and radiation therapy. Multivariable regression models were performed to investigate the association between cancer treatments and healthcare service utilization and CHE.Results: The age-adjusted prevalence of cancer increased from 1.37% to 1.84% between 2011 and 2015. More urban patients (54%) received cancer treatment than rural patients (46%) in 2015. Patients with high socio-economic status (SES) received a higher proportion of surgical and chemotherapy treatments compared to patients with low SES in 2015. Incidence of CHE declined by 22% in urban areas but increased by 31% in rural areas. We found a positive relationship between cancer treatment and outpatient visits (OR = 2.098, 95% CI = 1.453, 3.029), hospital admission (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE.Conclusions: Significant improvements in health insurance benefit packages are necessary to ensure universal, affordable and patient-centered health coverage for cancer patients in China.

scholarly journals Socio-economic and rural-urban differences in healthcare and catastrophic health expenditures among cancer patients in China: analysis of the China Health and Retirement Longitudinal Study

2021 ◽  
Author(s):  
Yang Zhao ◽  
Shenglan Tang ◽  
Wenhui Mao ◽  
Tomi F Akinyemiju
Keyword(s):  
Longitudinal Study ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Rural Areas ◽  
Urban Areas ◽  
Healthcare Service ◽  
Service Use ◽  
Increased Risk ◽  
Chinese Cancer Patients

Abstract Background In China, cancer deaths account for one-fifth of all deaths and exert a heavy toll on patients, families, healthcare systems, and society as a whole. This study aims to examine socio-economic and rural-urban differences in treatment, healthcare service utilization and catastrophic health expenditure (CHE) among Chinese cancer patients, and to investigate the relationship between different treatment types and healthcare service use as well as incidence of CHE. Methods We analyzed a nationally representative sample from the China Health and Retirement Longitudinal Study including 17,224 participants in 2011 and 19,569 participants in 2015. Multivariable regression models were performed to investigate the association of cancer treatments with healthcare service utilization and CHE. Results The age-adjusted prevalence of cancer is 1.37% for 2011 and 1.84% for 2015. Approximately half of the cancer patients utilized treatment for their disease, with a higher proportion of urban residents (54%) than rural residents (46%) receiving cancer treatment in 2015. CHE declined by 22% in urban areas (25% in 2011 and 19% in 2015) but increased by 31% in rural areas (25% in 2011 to 33% in 2015). There was a positive relationship between cancer treatment and outpatient visit (OR = 2.098, 95% CI = 1.453, 3.029), admission to hospital (OR = 1.961, 95% CI = 1.346, 2.857) and CHE (OR = 1.796, 95% CI = 1.231, 2.620). Chemotherapy and surgery were each associated with a 2-fold increased risk of CHE. Conclusions Meaningful changes to improve health insurance benefit packages are needed to ensure universal, affordable and patient-centered health coverage for the Chinese cancer patients.

scholarly journals Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

2020 ◽  
Vol 17 (4) ◽  
pp. 1327 ◽  
Author(s):  
Yang Zhao ◽  
Lin Zhang ◽  
Yu Fu ◽  
Minyu Wang ◽  
Luwen Zhang
Keyword(s):  
Health Service ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Service Utilization ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Service Use ◽  
Catastrophic Health Expenditure ◽  
Socioeconomic Disparities ◽  
Health Service Use

Background: This study aims (1) to assess socioeconomic disparities in healthcare use and catastrophic health expenditure (CHE) among cancer patients in China, which is defined as the point at which annual household health payments exceeded 40% of non-food household consumption expenditure, and (2) to examine the association of different treatments for cancers with health service utilization and CHE. Methods: We used nationally representative data from the China Health and Retirement Longitudinal Study in 2015 with 17,018 participants in which 381 with doctor-diagnosed cancer. The main treatments for cancer included the Chinese traditional medicine (TCM), western modern medicine (refers to taking western modern medications excluding TCM and other treatments for cancers), surgery, and radiation/chemotherapy. Concentration curve was used to assess economic-related disparities in healthcare and CHE. Multivariate regression models were used to examine the impact of the cancer treatment on health service use and incidence of CHE. Results: The main cancer treatments and health service use were more concentrated among the rich patients than among the poor patients in 2015. There was a positive association between the treatment of cancer and outpatient visit (Adjusted Odds Ratio (AOR) = 2.492, 95% CI = 1.506, 4.125), inpatient visit (AOR = 1.817, 95% CI = 1.098, 3.007), as well as CHE (AOR = 2.744, 95% CI = 1.578, 4.772). All cancer therapies except for medication treatments were associated with a higher incidence of CHE, particularly the surgery therapy (AOR = 6.05, 95% CI = 3.393, 27.866) in urban areas. Conclusion: Disparities in treatment and health service utilization among Chinese cancer patients was largely determined by financial capability. The current insurance schemes are insufficient to address these disparities. A comprehensive health insurance policy of expanding the current benefits packages and strengthening the Public Medical Assistance System, are essential for Chinese adults with cancer.

scholarly journals Prolonged SARS-CoV-2-RNA Detection from Nasopharyngeal Swabs in an Oncologic Patient: What Impact on Cancer Treatment?

2021 ◽  
Vol 28 (1) ◽  
pp. 847-852
Author(s):  
Anna Ferrari ◽  
Marco Trevenzoli ◽  
Lolita Sasset ◽  
Elisabetta Di Liso ◽  
Toni Tavian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
Palliative Radiotherapy ◽  
Rt Pcr ◽  
Cancer Treatments ◽  
Global Challenge ◽  
Viral Culture ◽  
Pcr Assays

The pandemic of SARS-CoV-2 is a serious global challenge affecting millions of people worldwide. Cancer patients are at risk for infection exposure and serious complications. A prompt diagnosis of SARS-CoV-2 infection is crucial for the timely adoption of isolation measures and the appropriate management of cancer treatments. In lung cancer patients the symptoms of infection 19 may resemble those exhibited by the underlying oncologic condition, possibly leading to diagnostic overlap and delays. Moreover, cancer patients might display a prolonged positivity of nasopharyngeal RT-PCR assays for SARS-CoV-2, causing long interruptions or delay of cancer treatments. However, the association between the positivity of RT-PCR assays and the patient’s infectivity remains uncertain. We describe the case of a patient with non-small cell lung cancer, and a severe ab extrinseco compression of the trachea, whose palliative radiotherapy was delayed because of the prolonged positivity of nasopharyngeal swabs for SARS-CoV-2. The patient did not show clinical symptoms suggestive of active infection, but the persistent positivity of RT-PCR assays imposed the continuation of isolation measures and the delay of radiotherapy for over two months. Finally, the negative result of SARS-CoV-2 viral culture allowed us to verify the absence of viral activity and to rule out the infectivity of the patient, who could finally continue her cancer treatment.

Propping up the parents: An environmental scan of childcare programs available to cancer patients in North America.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18805-e18805
Author(s):  
Katherine Preston ◽  
Mackenzie MacDonald ◽  
Meredith Elana Giuliani ◽  
Barbara L. Melosky ◽  
Bonnie Leung ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Current Knowledge ◽  
Grey Literature ◽  
The United States ◽  
Care Needs ◽  
Cancer Treatments ◽  
Environmental Scan ◽  
Pediatric Hospitals ◽  
Current State ◽  
Increased Risk

e18805 Background: Approximately 20% of newly diagnosed cancer patients are between the ages of 20 and 54, and many of these patients are also the primary caregivers of children. Qualitative studies focusing on this demographic indicate that patients who are parents struggle to balance their own care needs with those of their children. Further, a lack of childcare support during cancer treatments can negatively impact compliance and increase existing psychological stress for patients. In the efforts to establish a child-minding program at a major Canadian cancer centre, we carried out an environmental scan to evaluate the current state of childcare support for cancer patients. Methods: Firstly, a literature scan was conducted in order to assess current knowledge about childcare and cancer patients, which included the use of search engines, directed internet searches, a review of oncology conference proceedings and websites of oncology associations. Literature was selected based on pre-determined criteria. Secondly, 12 representatives from major Canadian cancer centres (CCC) completed a questionnaire assessing current childcare strategies at their respective institutions. Finally, a broad scan of the grey literature was conducted by investigating 161 Canadian and American hospitals for on-site childcare services, using lay-accessible searching techniques (hand-searching hospital websites, phone and email correspondences). Results: The literature scan identified seventeen primary articles, which focused largely on exploring the role strain faced by patients who are also parents. A single study explored the instrumental challenges of being a parent with cancer, and formally assessed the childcare needs of these patients. The questionnaire results indicated that only two of the twelve investigated CCCs had established an approach to child-minding for patients. The grey literature scan identified twenty-six on-site, patient-accessible child-minding centres at hospitals in Canada and the US based on pre-determined inclusion criteria. Of these, 76.9% of centres were associated with pediatric hospitals, and 69.2% were located in the United States. Most centres (76.9%) were open for over 30 hours per week, and 88.5% of centres were free of charge to users. Conclusions: These findings generally indicate that a minority of Canadian and American hospitals and cancer centres have formal childcare services in place to support patients who are also parents. As cancer patients are at increased risk for financial toxicity, they may be particularly in need of this kind of instrumental support. This highlights the importance of carrying out a targeted needs assessment in order to fully elucidate the need for patient-accessible childcare services at CCCs.

scholarly journals Cancer-associated pathways and biomarkers of venous thrombosis

Blood ◽  
2017 ◽  
Vol 130 (13) ◽  
pp. 1499-1506 ◽  
Author(s):  
Yohei Hisada ◽  
Nigel Mackman
Keyword(s):  
Cancer Patients ◽  
Brain Cancer ◽  
Cancer Type ◽  
Increased Risk ◽  
Different Types ◽  
Multiple Biomarkers ◽  
Podoplanin Expression ◽  
Potential Factors ◽  
Cancer Associated Thrombosis ◽  
Pai 1

Abstract Cancer patients have an increased risk of venous thromboembolism (VTE). In this review, we summarize common and cancer type–specific pathways of VTE in cancer patients. Increased levels of leukocytes, platelets, and tissue factor–positive (TF+) microvesicles (MVs) are all potential factors that alone or in combination increase cancer-associated thrombosis. Patients with lung or colorectal cancer often exhibit leukocytosis. Neutrophils could increase VTE in cancer patients by releasing neutrophil extracellular traps whereas monocytes may express TF. Thrombocytosis is often observed in gastrointestinal, lung, breast, and ovarian cancer and this could decrease the threshold required for VTE. Soluble P-selectin has been identified as a biomarker of cancer-associated thrombosis in a general cancer population and may reflect activation of the endothelium. P-selectin expression by the endothelium may enhance VTE by increasing the recruitment of leukocytes. Studies in patients with pancreatic or brain cancer suggest that elevated levels of PAI-1 may contribute to VTE. Although elevated levels of TF+ MVs have been observed in patients with different types of cancer, an association between TF+ MVs and VTE has been observed only in pancreatic cancer. Podoplanin expression is associated with VTE in patients with brain cancer and may activate platelets. Future studies should measure multiple biomarkers in each cancer type to determine whether combinations of biomarkers can be used as predictors of VTE. A better understanding of the pathways that increase VTE in cancer patients may lead to the development of new therapies to reduce the morbidity and mortality associated with thrombosis.

scholarly journals COVID-19 pandemic and Thyroid cancer treatment in perspective of Bangladesh

2021 ◽  
Vol 29 (2) ◽  
pp. 178-181
Author(s):  
Mahmud Asif Rifat ◽  
Mostafa Kamal Arefin ◽  
Abu Yusuf Fakir ◽  
SK Nurul Fattah Rumi ◽  
Husne Qumer Osmany ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Hospital Admissions ◽  
Lung Metastases ◽  
Vulnerable Groups ◽  
Severe Illness ◽  
Medical College ◽  
Increased Risk

Background: The COVID-19 pandemic in Bangladesh is part of the worldwide pandemic of coronavirus disease 2019 which has crowded out services for both covid and non-covid patients, in a country where the health care system was already under huge stress even before the pandemic. Objectives: To postpone non-urgent surgeries along with active surveillance of thyroid cancer patients to make sure the hospitals are not unnecessarily occupied. Methods: Document based categorization of thyroid cancer patients, like- low risk, high risk and clinically extremely vulnerable groups who are at greatest risk of severe illness from coronavirus are to be done accordingly. Individuals with thyroid cancer are mostly not susceptible to COVID- 19. However, patients with thyroid cancer (papillary or medullary) having lung metastases or undergoing certain types of cancer treatment might be at increased risk of viral infection or complications. Risk benefit ratio is checked and explained to the patient and their attendants. Recommendations: As COVID-19 is spreading across the Bangladesh, hospitals are being forced to reallocate resources to the care of critically ill. So it is crucial to adhere to the advice from experts to reduce the risk of infection. All non-essential surgeries and hospital admissions can be postponed to make sure that hospitals are not unnecessarily occupied. Conclusion: In the face of the COVID-19 pandemic, cancer care has had to adapt rapidly given recommendations to postpone nonurgent surgeries with active surveillance of thyroid cancer patients except thyroid tumors requiring acute airway management. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 178-181

scholarly journals Adverse Childhood Experiences (ACEs) in Newly-Diagnosed Childhood and Adolescent/Young Adult (AYA) Cancer Patients with Hematologic Malignancies

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4108-4108
Author(s):  
Lindsay F Schwartz ◽  
Marcia M Tan ◽  
Julie S McCrae ◽  
Tiffany Burkhardt ◽  
Kirsten K. Ness ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Premature Mortality ◽  
Chronic Medical Conditions ◽  
Medical Conditions ◽  
Health Issues ◽  
Mental Health Issues ◽  
Increased Risk

Abstract Background and Aims: Childhood and adolescent/young adult (AYA) cancer survivors are at increased risk for emotional distress, chronic health conditions, and premature mortality compared to peers with no cancer history. Some, but not all, of this increased risk is explained by cancer- and treatment-related exposures. Because cancer treatment remains necessary to achieve cure, it is critical to identify and target other factors to reduce sub-optimal outcomes. Adverse Childhood Experiences (ACEs) are traumatic events occurring during childhood, such as experiencing violence and/or neglect, which are associated with poor mental health, chronic health conditions, and premature mortality in the adult general population. Little is known on how ACEs impact health in children and AYAs with cancer. Research indicates that otherwise healthy individuals exposed to ACEs experience fewer adverse health outcomes if they possess resilience, which can be learned. This provides a potential target for intervention. This pilot study aimed to identify demographic characteristics associated with ACEs and resilience as well as associations between ACEs, resilience, and the presence of chronic medical conditions, mental health issues, and substance abuse in children and AYAs with cancer. Methods: Childhood and AYA leukemia and lymphoma patients undergoing cancer treatment at the University of Chicago were included for analysis (N=38, 55.26% female, 50% non-Hispanic white, mean age at assessment 14.74±6.97 years). Participants ≤17 years old completed the study with one parent/caregiver. ACEs were measured using age-specific instruments adapted from the original ACEs study by Kaiser Permanente and the Centers for Disease Control and Prevention. Resilience was analyzed using age-specific instruments provided by the Resilience Research Centre, and resilience scores were categorized as low (≤62), moderate (63-70), high (71-76), and exceptional (≥77). For participants 0-11 years old, a parent/guardian completed the study on their behalf. 12-17 year old participants and their parent/guardian both completed the study, and participants over 18 completed the study alone. Descriptive statistics characterized demographic, biologic, treatment, and health behavior variables. The association between total scores for ACEs and resilience were measured using Pearson's correlation. Regression analysis assessed ACEs (logistic model) and resilience scores (linear model) adjusting for age, sex, race/ethnicity, household income, and insurance type. Participants were then stratified, and two sample t-tests compared potential outcomes based on ACE exposures. Results: 23 participants (60.53%) reported prior ACEs (mean total number of ACEs 1.45±1.77; range 1-7), and the mean resilience score for participants was 73.76±9.61 (range 49-85) indicating high resilience overall. Regression analyses showed the odds of reporting ACEs increased with age (OR: 1.18; 95% CI: 1.02-1.37), while resilience scores decreased with age (β=0.76; t(32)=-2.74, p=0.01) holding other variables constant. Sex, race/ethnicity, household income, and insurance type were not associated with ACEs or resilience scores. There was a strong negative correlation between the total number of ACEs and resilience, r(36)=-0.57, p<0.01; the total number of ACEs explained 32% of the variation in resilience scores. Compared to participants who did not report prior ACEs, those with ACEs were more likely to report chronic medical conditions, t(31.41)=-2.47, p=0.02, prior psychiatric diagnoses or mental health issues, t(34.16)=-2.13, p=0.04, as well as substance abuse t(31.41)=-2.47, p=0.02. Conclusions: ACEs were associated with endorsement of chronic medical conditions, mental health issues, and substance abuse in our sample of childhood and AYA patients currently receiving cancer treatment. As the total number of ACEs increased, resilience scores decreased for participants. The results of this study provide the groundwork for further investigations of ACEs and resilience in large cohorts of childhood and AYA cancer patients and survivors. This future work could provide valuable information for creating and implementing interventions designed for childhood and AYA cancer patients and survivors who have experienced ACEs, thus potentially reducing additional morbidity and premature mortality for these high-risk patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals How We Treat Genitourinary Cancers During COVID-19 Pandemic?

2020 ◽  
Vol 5 (S1) ◽  
pp. 147-152
Author(s):  
Deepak Dabkara ◽  
Sandip Ganguly ◽  
Joydeep Ghosh ◽  
Amol Patel ◽  
Atul Batra ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Treatment Guidelines ◽  
National Level ◽  
Local Treatment ◽  
Oncological Outcome ◽  
Professional Organizations ◽  
Daily Routine ◽  
Cancer Treatments ◽  
Healthcare Settings

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome - coronavirus 2 (SARS-CoV-2) has become a pandemic and affected the entire globe. Daily routine life is affected due to global restriction of movement and infected more than 3.7 million peoples in more than 200 countries. It’s an invisible enemy which has imposed a clear threat to the humanity. Patients other than COVID-19 is also suffering a lot due to this unforeseen circumstances. This pandemic also shaken the powerful nations with best of healthcare settings. Oncology is a unique sector of healthcare as cancer patients are at more risk of SARS-CoV-2 infection and cancer treatments are also affected. Many regulatory bodies and professional organizations have come up with guidelines for healthcare personals and patients to guide anti-cancer treatment during COVID-19 pandemic. It’s time to formulate local treatment guidelines to guide cancer treatment with optimum use of healthcare resources at society and national level keeping in mind the load of COVID-19 at the concerned region. We have formulated guidelines to manage genitourinary cancer patients during this pandemic, especially in resource constraint setting with the aim of – optimum treatment of these patients with reduction of risk of contracting SARS-CoV-2 infection without affecting oncological outcome.  

scholarly journals “I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

2020 ◽  
pp. 104990912096912
Author(s):  
Salimah H. Meghani ◽  
Kristin Levoy ◽  
Kristin Corey Magan ◽  
Lauren T. Starr ◽  
Liana Yocavitch ◽  
...  
Keyword(s):  
Palliative Care ◽  
African American ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Risk Mitigation ◽  
Care Delivery ◽  
Care Transitions ◽  
Financial Toxicity ◽  
Cancer Treatments ◽  
Illness Trajectory

Background: National oncology guidelines recommend early integration of palliative care for patients with cancer. However, drivers for this integration remain understudied. Understanding illness concerns at the time of cancer treatment may help facilitate integration earlier in the cancer illness trajectory. Objective: To describe cancer patients’ concerns while undergoing cancer treatment, and determine if concerns differ among African Americans and Whites. Methods: A 1-time, semi-structured qualitative interview was conducted with a purposive subsample of cancer patients participating in a larger study of illness concerns. Eligible patients were undergoing cancer treatments and had self-reported moderate-to-severe pain in the last week. Analysis encompassed a qualitative descriptive approach with inductive thematic analysis. Results: Participants (16 African American, 16 White) had a median age of 53 and were predominantly females (72%) with stage III/IV cancer (53%). Illness concerns were largely consistent across participants and converged on 3 themes: symptom experience (pain, options to manage pain), cancer care delivery (communication, care coordination and care transitions), and practical concerns (access to community and health system resources, financial toxicity). Conclusions: The findings extend the scope of factors that could be utilized to integrate palliative care earlier in the cancer illness trajectory, moving beyond the symptoms- and prognosis-based triggers that typify current referrals to also consider diverse logistical concerns. Using this larger set of concerns aids anticipatory risk mitigation and planning (e.g. care transitions, financial toxicity), helps patients receive a larger complement of support services, and builds cancer patients’ capacity toward a more patient-centered treatment and care experience.

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