Addressing Cancer-Related Financial Toxicity In Rural Oncology Care Settings

项目总结与摘要 经济毒性(FT)，这个术语用来描述癌症带来的高成本和与成本相关的心理社会负担 患者及其家属的护理场所是一个影响到至少20%的人的重大且未得到充分认识的问题 癌症患者，对预后有潜在的破坏性影响。FT对农村患者的影响不成比例 由于多种社会经济、获取途径和临床因素造成的环境。癌症相关金融研究的最新进展 艰难困苦将《金融时报》的负担定性为属于以下三个领域之一：(1)物质困难，包括 高自付费用和工资损失；(2)高收入带来的痛苦和焦虑带来的心理负担 癌症费用；以及(3)高癌症护理费用导致的行为变化，包括两者的变化 医疗和非医疗支出。在癌症部位和阶段，相当大的物质困难造成 癌症一直与负面的心理和行为结果有关，包括较低 与健康相关的生活质量，更高的情绪困扰，治疗延迟/停止，以及申请破产。 重要的是，英国《金融时报》也与死亡率上升有关。有害的心理影响和护理改变 行为反应，如推迟或提前治疗，在农村患者中更常见，他们也面临 可能存在相当大的护理地理障碍和更大的财政脆弱性(例如，缺乏医疗保险) 造成了被广泛观察到的癌症死亡率的城乡差异。迫切需要干预措施来 预防和缓解生活在农村地区的癌症患者的高FT。我们之前与病人的工作，癌症护理 专业人士和农村肿瘤学实践的区域网络强烈主张通过金融干预 导航(FN)，由于复杂的物质、结构和心理需求，在这种背景下，支离破碎 现有财政支助资源不足，以及复杂的援助资格要求。FN是一种 在实践或系统层面实施循证干预，以识别高危患者 对于英国《金融时报》，评估现有联邦、非营利、制造商和地方财政支持资源的资格，澄清 治疗费用预期，并制定应对高额护理费用的战略。我们的长期目标是 改善癌症护理服务，减少FT，并通过以下方式改善服务不足的农村人口的预后 可持续、可扩展的干预措施。本申请的目的是：(1)了解农村肿瘤学 实践背景，以优化量身定制的战略，以支持FN的实施；(2)评估FN干预 在农村肿瘤学实践中的实施；以及(3)评估FN实施对患者的影响 农村肿瘤学实践中的结果，包括FT和与健康相关的生活质量。我们的建议是直接 响应RFA-CA-18-026，旨在“提高农村人口癌症护理的覆盖面和质量”。 预期成果是制定和完善所需的业务和后勤流程 在农村环境中提供有效的FN并减少FT，有可能减少农村结果差异。

PROJECT SUMMARY & ABSTRACT Financial toxicity (FT), a term used to describe the high cost and cost-related psychosocial burden that cancer care places on patients and their families, is a major and underappreciated problem affecting at least 20% of all cancer patients, with potentially devastating effects on outcomes. FT disproportionately affects patients in rural settings due to multiple socioeconomic, access, and clinical factors. A recent review of cancer-related financial hardship characterized the burden of FT as belonging to one of three domains: (1) material hardship, including high out-of-pocket expenses and lost wages; (2) psychological burden from distress and anxiety caused by high cancer costs; and (3) behavioral changes resulting from high cancer care costs, including changes in both medical and non-medical spending. Across cancer sites and stages, the considerable material hardship caused by cancer has been linked consistently to negative psychological and behavioral outcomes, including lower health-related quality of life, higher emotional distress, treatment delay/discontinuation, and filing for bankruptcy. Importantly, FT is also associated with increased mortality. Harmful psychological effects and care-altering behavioral responses, such as delaying or foregoing treatment, are more common in rural patients who also face considerable geographic barriers to care and greater financial vulnerability (e.g., lack of health insurance), likely contributing to widely-observed rural/urban disparities in cancer mortality. Interventions are urgently needed to prevent and mitigate high FT for cancer patients living in rural areas. Our prior work with patients, cancer care professionals, and a regional network of rural oncology practices argues strongly for intervening with financial navigation (FN), due to the complex material, structural, and psychological needs in this setting, fragmentation of existing financial support resources, and complicated assistance eligibility requirements. FN is one type of evidence-based intervention implemented at the practice or system level that can identify patients at high risk for FT, assess eligibility for existing federal, nonprofit, manufacturer, and local financial support resources, clarify treatment cost expectations, and develop strategies to cope with high costs of care. Our long-term goal is to improve cancer care delivery, reduce FT, and improve outcomes in underserved, rural populations through sustainable, scalable interventions. The objectives of this application are to: (1) understand the rural oncology practice context to optimize tailored strategies to support FN implementation; (2) assess FN intervention implementation in rural oncology practices; and (3) evaluate the effects of FN implementation on patient outcomes, including FT and health-related quality of life, in rural oncology practices. Our proposal is directly responsive to RFA-CA-18-026, which seeks to “improve the reach and quality of cancer care in rural populations”. Expected outcomes are the development and refinement of the operational and logistical processes needed to deliver effective FN in rural settings and reduction in FT, with potential to reduce rural outcome disparities.