Financial Burden of Pediatric Cancer for Patients and their Families
-
Upload
dylanturner22 -
Category
Healthcare
-
view
268 -
download
2
Transcript of Financial Burden of Pediatric Cancer for Patients and their Families
![Page 1: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/1.jpg)
Financial Burden of Pediatric Cancer for
Patients and their Families
ECHO L. WARNER, MPH
CANCER CONTROL AND POPULATION SCIENCES
HUNTSMAN CANCER INSTITUTE
![Page 2: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/2.jpg)
Pediatric Cancer is Expensive
Costs for families include direct and indirect expenses◦ Hospitalizations
◦ $233 million per year from 2000-2005◦ $860 million in 2009 alone
◦ Work disruptions◦ 84% of families experience work disruptions◦ 20% of families lost >40% of their income due to cancer
![Page 3: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/3.jpg)
Why Utah? Primary Children’s Hospital serves a large catchment area
![Page 4: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/4.jpg)
Study AimsDetermine whether caregivers’ perceived financial burden of cancer differs due to:
1. Socioeconomic factors
2. Healthcare utilization factors
![Page 5: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/5.jpg)
Methods
![Page 6: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/6.jpg)
Participants◦ PCH’s Pediatric Hematology-Oncology outpatient clinic
◦ July 2010 – July 2012
◦ Diagnosed with cancer between ages 0-21 years ◦ Parents of eligible patients were eligible starting +2 months
after initial diagnosis ◦ Caregivers completed a 48 item survey exploring indices of
their families’ financial burden from cancer◦ Response rate of 77%
◦ 310 of 403 seen in out-patient
![Page 7: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/7.jpg)
ExclusionsExcluded patients
◦ >5 years past diagnosis (N=28) ◦ Missing relevant data on time since diagnosis or financial burden
(N=26)◦ Uninsured (N=2)
Final sample size N=254
![Page 8: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/8.jpg)
Outcome Perceived Financial Burden
“Using the scale below, how much of a financial burden has your child’s cancer treatment been on your household?”
No burden Very large burden
1 72 3 4 5 6
(0) (100)
![Page 9: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/9.jpg)
DemographicsPatient CaregiverCurrent age 0-4 5-9 10-14 15-26Age at diagnosis 0-4 5-9 10-14 15-21Diagnosis Acute Lymphoblastic Leukemia (ALL) Solid tumors (Wilms’, sarcoma etc.) Brain tumor Acute Myeloid Leukemia (AML)
Gender Female MaleHousehold income <$39,999 $40,000-$59,999 $60,000-$99,999 Over $100,000Education ≤High school/GED ≥Some college/vocational
![Page 10: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/10.jpg)
Independent factorsSocioeconomic Healthcare utilization
Insurance Private (employer/military) Public (Medicaid, Medicare, CHIP)Place of residence Rural UrbanParental employment
Quit/changed job due to cancer No change in employment
Unexpected HospitalizationsNo admissions1-4 admissions≥5 admissions
Outside hospital Yes No
![Page 11: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/11.jpg)
Statistical Analysis Stata 12
Bivariate associations by time since diagnosis◦ Socioeconomic & healthcare utilization factors◦ Chi-square and t-tests
3 multivariable linear regression models ◦ To assess the impact of socioeconomic factors & healthcare utilization factors
on financial burden◦ Controlled for patient sex, age at diagnosis, insurance and place of residence
1. Full sample2. <1 year3. 1-5 years
![Page 12: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/12.jpg)
Results
![Page 13: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/13.jpg)
Demographics
< 1 year from diagnosis
N=113
1-5 years from diagnosis
N=141 Current Age % % p-value 0-4 39.8 22.7 <0.01 5-9 23.0 38.3 10-14 23.9 17.7 15-26 13.3 21.3 Gender Female 47.8 44.0 0.54Current Household Income <$39,999 25.7 33.5 0.35 $40,000 - $59,999 31.4 19.4 $60,000 - $99,999 32.4 32.1 Over $100,000 10.5 14.9 Caregiver Education ≥Some college/vocational 90.9 81.9 0.04
![Page 14: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/14.jpg)
Cancer Diagnosis
ALL42%
Solid tumor41%
Brain tumor11%
AML6%
ALLSolid tumorBrain tumorAML
![Page 15: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/15.jpg)
Financial Burden Mean financial burden
◦ <1 year = 64.4 ◦ (SD 33.0; IQR 49-87)
◦ 1-5 years = 69.0 ◦ (SD 28.7; IQR 50-87)
0-25 26-50 51-75 76-100
0102030405060708090
100< 1 year 1-5 years
Financial Burden
Perc
enta
ge
![Page 16: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/16.jpg)
Socioeconomic Factors Bivariate
◦ No significant differences in insurance, place of residence or parental work status
◦ Over 30% of parents quit or changed work
< 1 year 1-5 years0
20
40
60
80
100Parental work status
Quit or changed jobNo change in employment
Perc
enta
ge
![Page 17: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/17.jpg)
Socioeconomic Factors Multivariable Linear Regression Models
1. Full Sample◦ Rural residence
◦ β=12.3 (95% CI 2.8-21.9, p=0.01)
2. <1 year from diagnosis◦ No significant differences
3. 1-5 years from diagnosis◦ Parents quitting or changing their employment
◦ β=13.4 (95% CI 3.2-23.6, p=0.01)
![Page 18: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/18.jpg)
Healthcare Utilization Factors
Bivariate◦ Care at another hospital
◦ <1 year: 43.4%◦ 1-5 years: 63.1%◦ p<0.01
◦ ≥5 Unexpected hospitalizations◦ <1 year: 12.4%◦ 1-5 years: 34.7%◦ p<0.01
< 1 year 1-5 years0
20
40
60
80
100
Unexpected Hospitaliza-tions
0 1-4 ≥5
Perc
enta
ge
![Page 19: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/19.jpg)
Healthcare Utilization Factors
Multivariable linear regression models
1. Full sample◦ Receipt of care at a hospital outside of PCH
◦ β=9.4 (95% CI 1.7-17.0, p=0.02)
2. < 1 year from diagnosis◦ No significant differences
3. 1-5 years from diagnosis◦ ≥5 unexpected hospitalizations
◦ β=24.9 (95% CI 9.1-40.7, p<0.01)
![Page 20: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/20.jpg)
Discussion
![Page 21: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/21.jpg)
DiscussionCertain factors may increase financial burden
◦ Unexpected hospitalizations◦ Caregiver employment disruption◦ Place of residence◦ Care at outside hospital
Unmanaged costs at the time of diagnosis could reduce financial capabilities later in life
Costs can be managed by meeting with a financial advisor◦ Early in the diagnosis and treatment process
![Page 22: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/22.jpg)
RecommendationsFlexibility in appointment scheduling
◦ To support parents’ employment
Use of telemedicine◦ To reduce travel related expenses for rural patients
Patient Protection and Affordable Care Act◦ Focus on improving health insurance coverage◦ Limits out of pocket costs◦ Eliminates lifetime dollar limitations
![Page 23: Financial Burden of Pediatric Cancer for Patients and their Families](https://reader033.fdocuments.in/reader033/viewer/2022042816/558b32e5d8b42a49648b45a3/html5/thumbnails/23.jpg)
THANK YOU! Mark Fluchel, MD, MS Anne Kirchhoff, PhD, MPH Gina Nam, BS, BA Patients & Families Funding: Hyundai Hope on Wheels & Huntsman Cancer Institute