Addressing Cancer-Related Financial Toxicity In Rural Oncology Care Settings

解决农村肿瘤护理机构中与癌症相关的财务毒性

• 批准号: 9788857
• 负责人: DONALD ROSENSTEIN
• 金额: $ 49.2万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788857
• 关键词: Address; Affect; Affordable Care Act; American; Anxiety; Bankruptcy; Behavior; Behavioral; Cancer Burden; Cancer Etiology; Cancer Patient; Caring; Characteristics; Chronic Disease; Climate; Clinical; Community Clinical Oncology Program; Complex; Coping Behavior; Development; Distress; Effectiveness; Eligibility Determination; Evidence based intervention; Face; Family; Financial Hardship; Financial Support; Geography; Goals; Health; Health Insurance; Health Services Accessibility; Insurance; Insurance Coverage; Intervention; Interview; Life; Link; Logistics; Malignant Neoplasms; Manufacturer Name; Maps; Medical; Mental Health; Minority; Morbidity - disease rate; Outcome; Participant; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; President' s Cancer Panel; Problem Solving; Process; Quality of Care; Readiness; Reporting; Resources; Rural; Rural Community; Rural Population; Services; Shock; Structure; Surveys; System; Time; Training; Travel; Treatment Cost; Uninsured Medical Expense; Wages; Work; arm; barrier to care; behavioral outcome; behavioral response; cancer care; cancer health disparity; cancer site; care costs; care delivery; care outcomes; care providers; cost; emotional distress; evidence base; expectation; experience; financial toxicity; health related quality of life; high risk; implementation research; implementation strategy; improved; improved outcome; medically underserved population; mortality; oncology; post intervention; prescription drug costs; prevent; primary outcome; programs; psychologic; psychological outcomes; psychosocial; recruit; rural area; rural cancer care; rural patients; rural setting; satisfaction; secondary outcome; socioeconomics; uptake; urban disparity

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.

项目概要和摘要 财务毒性（FT），用于描述癌症患者的高成本和与成本相关的心理社会负担的术语 对病人及其家属的照顾，是一个主要的和未得到重视的问题，影响到至少20%的所有 癌症患者，对结果具有潜在的破坏性影响。FT不成比例地影响农村患者 由于多种社会经济、访问和临床因素，癌症相关财务的最新综述 困难的特点是财政负担属于三个领域之一：（1）物质困难，包括 高额的自付费用和工资损失;（2）高血压引起的痛苦和焦虑的心理负担 癌症成本;（3）癌症护理成本高导致的行为变化，包括两者的变化 医疗和非医疗支出。在癌症的各个部位和阶段， 癌症一直与消极的心理和行为结果有关，包括降低 与健康相关的生活质量、更高的情绪困扰、治疗延迟/中止和申请破产。 重要的是，FT也与死亡率增加有关。有害的心理影响和改变照料方式 行为反应，如延迟或放弃治疗，在农村患者中更常见， 护理方面存在相当大的地理障碍和更大的财务脆弱性（例如，缺乏健康保险），可能 导致广泛观察到的农村/城市癌症死亡率差异。迫切需要采取干预措施， 预防和减轻生活在农村地区的癌症患者的高FT。我们之前与患者的合作，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用财政干预 导航（FN），由于在这种环境中复杂的物质、结构和心理需求， 现有的财政支持资源，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，可以识别高风险患者 对于FT，评估现有联邦、非营利组织、制造商和地方财政支持资源的资格，澄清 治疗费用预期，并制定战略，以科普高成本的护理。我们的长期目标是 改善癌症护理提供，减少FT，并改善服务不足的农村人口的结果， 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，以优化定制战略，支持FN的实施;（2）评估FN干预措施 在农村肿瘤学实践中的实施;（3）评估FN实施对患者的影响 结果，包括FT和健康相关的生活质量，在农村肿瘤学的做法。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范围和质量”。 预期成果是制定和完善必要的业务和后勤流程， 在农村地区提供有效的新生力量，减少资助，有可能减少农村地区的成果差距。