Cost Of Cancer Treatment Research Articles

Women's Lived Experiences in the Use of Complementary and Alternative Medicine for Breast Cancer Management: A Phenomenological Study.

This study aimed to explore women with breast cancer (WBC) lived experiences on the use of Complementary and Alternative Medicine (CAM) for breast cancer management. van Manen's phenomenology of practice was used as the methodology and method in this study. In-depth interviews guided by semi-structured questions were conducted with 21 WBC recruited using convenience sampling. The thematic analysis generated four main themes: Access, affordability and support for medical treatment, beliefs in CAM treatment, feeling the potential benefits of CAM, and Acknowledging the negative aspects of CAM. The outcomes from using CAM based on the lived experiences of WBC indicated that some CAM treatments could improve quality of life. However, some fraudulent CAM obtained from unprofessional CAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs. Therefore, there is an urgent need to enhance the awareness of appropriate treatment, including evidence-based CAM, for WBC. Improved understanding in the use of CAM as a part of quality breast cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer.

Budget impact analysis of introducing digital breast tomosynthesis in breast cancer screening in Italy.

This study quantifies the impact on budget and cost per health benefit of implementing digital breast tomosynthesis (DBT) in place of digital mammography (DM) for breast cancer screening among asymptomatic women in Italy. A budget impact analysis and a cost consequence analysis were conducted using parameters from the MAITA project and literature. The study considered four scenarios for DBT implementation, i.e., DBT for all women, DBT for women aged 45-49years, DBT based on breast density (BI-RADS C + D or D only), and compared these to the current DM screening. Healthcare provider's perspective was adopted, including screening, diagnosis, and cancer treatment costs. Introducing DBT for all women would increase overall screening costs by 20%. Targeting DBT to women aged 45-49years or with dense breasts would result in smaller cost increases (3.2% for age-based and 1.4-10.7% for density-based scenarios). The cost per avoided interval cancer was significantly higher when DBT was applied to all women compared to targeted approaches. The cost per gained early-detected cancer slightly increases in targeted approaches, while the assumptions on the clinical significance and overdiagnosis of cancers detected by DBT and not by DM have a strong impact. Implementing DBT as a primary breast cancer test in screening programs in Italy would lead to a substantial increase in costs. Tailoring DBT use to women aged 45-49 or with dense breasts could enhance the feasibility and sustainability of the intervention. Further research is needed to clarify the impact of DBT on overdiagnosis and the long-term outcomes.

Financial toxicity of oral chemotherapy in patients with primary brain tumors

Abstract Background Cancer treatment costs continue to rise with the development of new agents. Financial toxicity is defined as the quantifiable costs associated with cancer and cancer treatment in addition to the patient’s associated distress. This study’s rationale is to better understand the financial burden of oral chemotherapies from the perspective of patients with primary brain tumors. Methods After one cycle of oral chemotherapy, we requested patients to complete the financial toxicity-functional assessment of chronic illness therapy (COST-FACIT) survey and additional questions relevant to insurance and cost. We summarized responses with descriptive statistics within strata defined by on-label or off-label oral therapy. Results Sixty surveys were completed, with most patients (n = 53, 88%) receiving on-label therapy; only 7 patients (12%) received off-label oral agents. The mean overall financial toxicity score was 23.1 (SD = 11.3). When asked if their provider discussed treatment cost before initiation, 21 patients (35%) stated that they did, and 39 patients (65%) said they did not discuss cost or did not recall. However, in the off-label cohort, all 7 patients stated that their provider discussed the cost before prescribing. Most patients (70%) had copays. Nine (17%) in the on-label group and 3 (43%) in the off-label group had chemotherapy-associated costs that negatively affected their quality of life. A higher percentage of financial distress occurred in the off-label group. Conclusions Discussing medication costs with patients is an essential part of chemotherapy initiation and may mitigate undue psychosocial and financial distress.

The Annual Cost of Cancer Screening in the United States.

Cancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown. To estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021. Model using national health care survey and cost resources data. U.S. health care systems and institutions. People eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data. The number of people screened and associated health care system costs by insurance status in 2021 dollars. Total health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening. All data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured. The $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services. None.

Cost-Effectiveness of Low-Dose Computed Tomography Screenings for Lung Cancer in High-Risk Populations: A Markov Model.

Domestic and foreign studies on lung cancer have been oriented to the medical efficacy of low-dose computed tomography (LDCT), but there is a lack of studies on the costs, value and cost-effectiveness of the treatment. There is a scarcity of conclusive evidence regarding the cost-effectiveness of LDCT within the specific context of Taiwan. This study is designed to address this gap by conducting a comprehensive analysis of the cost-effectiveness of LDCT and chest X-ray (CXR) as screening methods for lung cancer. Markov decision model simulation was used to estimate the cost-effectiveness of biennial screening with LDCT and CXR based on a health provider perspective. Inputs are based on probabilities, health status utility (quality-adjusted life years (QALYs)), costs of lung cancer screening, diagnosis, and treatment from the literatures, and expert opinion. A total of 1,000 simulations and five cycles of Markov bootstrapping simulations were performed to compare the incremental cost-utility ratio (ICUR) of these two screening strategies. Probability and one-way sensitivity analyses were also performed. The ICUR of early lung cancer screening compared LDCT to CXR is $-24,757.65/QALYs, and 100% of the probability agree to adopt it under a willingness-to-pay (WTP) threshold of the Taiwan gross domestic product (GDP) per capita ($35,513). The one-way sensitivity analysis also showed that ICUR depends heavily on recall rate. Based on the prevalence rate of 39.7 lung cancer cases per 100,000 people in 2020, it could be estimated that LDCT screening for high-risk populations could save $17,154,115. LDCT can detect more early lung cancers, reduce mortality and is cost-saving than CXR in a long-term simulation of Taiwan's healthcare system. This study provides valuable insights for healthcare decision-makers and suggests analyzing cost-effectiveness for additional variables in future research.

Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review.

To review the economic burden assessment of cervical cancer in low- and middle-income countries (LMICs) and use the findings to develop a pragmatic, standardized framework for such assessment. We first systematically reviewed articles indexed in scientific databases reporting the methodology for collecting and calculating costs related to the cervical cancer burden in LMICs. Data on study design, costing approach, cost perspective, costing period, and cost type (direct medical costs [DMC], direct nonmedical costs [DNMC], and indirect costs [IC]) were extracted. Finally, we summarized the reported limitations in the methodology and used the solutions to inform our framework. Cervical cancer treatment costs across LMICs vary greatly and can be extremely expensive, up to 70,968 International US dollars. Economic and financial assessment methods also vary greatly across countries. Of the 28 reviewed articles, 25 studies reported DMC for cervical cancer treatment by extracting cost information from billing or insurance databases (eight studies), conducting surveys (five), and estimating the costs (12). Only 11 studies-mainly through surveys-reported DNMC and IC. The economic burden assessment framework includes health care/payer and societal perspectives (DMC, DNMC, IC, and human capital loss) across the cervical cancer screening and treatment continuum. To assess health care/payer costs, we recommend combining the predefined treatment standards with actual local treatment practices, multiplied by unit costs. To assess societal costs, we recommend conducting a cost survey in line with a standardized yet adaptable protocol. Our standardized, pragmatic framework allows assessment of economic and financial burden of cervical cancer in LMICs despite the different levels of available resources across countries. This framework will facilitate global comparisons and monitoring and may also be applied to other cancers.

Análise do perfil de devoluções de quimioterapias endovenosas em um hospital filantrópico de Salvador-BA

Introduction: The increase in the costs of cancer treatments is configured as a relevant problem for health services linked to the constant incorporation of new drugs for cancer treatment. This growth in expenses reflects the challenge of managing resources to meet the needs of the oncologic area. It is necessary to optimize resources in view of the growing demand and associated costs. In the scenario where patients receive personalized treatments, changes in therapy are possible, causing some returns of antineoplastic drugsand increasing costs in health services. Objective: To analyze the profile of returns of chemotherapy drugs handled by the Pharmacy sector and the relationship with costs in a philanthropic hospital in Salvador. Method: This was a cross-sectional, retrospective, and analytical study conducted between August 2019 and August 2020. Data were collected through forms obtained after the return of chemotherapy. Information such as the drug name, dose, reuse status, and reason for return were evaluated. Data were tabulated using SPSS software. Results: 171 chemotherapy bags were returned involving 19 active ingredients. The clinical factor accounted for 59.1% of the returns. Cisplatin accounted for 14.6% of the returns. Carboplatin was the most discarded drug, representing 16.9% of the lost bags, whereas Cisplatin had the highest rate of reuse. In pharmacoeconomics, the returns represented the value of R$ 13,887.87. The hospital lost R$ 7,475.61 with the discarded products but saved R$ 6,412.21 through reuse. Conclusions: Oncology needs to be linked to pharmacoeconomics and to minimize discards, strategies should be adopted.

Assessment of Financial Toxicity and Coping Strategies Associated With Cancer Treatment Among Caregivers of Patients With Cancer From a Lower-Middle-Income Country.

The rising cost of cancer treatment causes out-of-pocket spending among patients or caregivers in lower-middle-income countries, resulting in acute misery and insolvency. This study aimed to assess the financial toxicity associated with cancer treatment and the coping strategies for cancer treatment adopted among the caregivers of patients with cancer in a tertiary cancer care center. This prospective cross-sectional study was conducted among the primary caregivers of patients with cancer undergoing curative treatment from March to June 2023. The estimated sample size was 403 caregivers. The financial toxicity was assessed using a modified Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy tool, and coping strategies were explored using a validated questionnaire of 20 questions. Univariate and multivariate analyses investigated the associations and factors influencing financial toxicity. The caregivers recruited in the study were 403; 83.8% were younger than 50 years, and 66.5% were male. The common cancer types included were breast cancer (27.3%), GI cancer (17.9%), head and neck cancer (12.4%), and gynecological cancer (11.6%). The mean financial toxicity score was 22.32 (standard deviation, 9.55), with 64% experiencing moderate to severe financial toxicity. The most common coping strategies used were spending a portion or all of the savings, borrowing money from others, restructuring their spending habits, seeking financial assistance from the cancer center, and resorting to gold loans. Screening patients and their primary caregivers using a modified COST tool can help identify families experiencing severe financial toxicity and provide necessary intervention.

"I Just Had to Do What I Had to Do": Characterizing Direct and Indirect Prostate Cancer Treatment Costs for Black Survivors and Their Caregivers.

Direct and indirect costs have a wide-ranging impact on the material, behavioral, and psychosocial aspects of financial well-being of Black prostate cancer survivors and their caregivers.These results emphasize the need for sharing cost information to support medical decision making.Future research should focus on the design of cost-sharing interventions that target the complexities of direct and indirect costs collectively, rather than separately.

Unraveling the Influence of Social, Economic, and Demographic Factors in Texas on Breast Cancer Survival.

According to the Centers for Disease Control (CDC), breast cancer is the second most common cancer among women in the United States. Affected people are financially challenged due to the high out-of-pocket cost of breast cancer treatment, as it is the most expensive treatment. Using a 16-year cohort study of breast cancer survival data in Texas, we investigate the factors that might explain why some breast cancer patients live longer than others. Performing a survival analysis consisting of the log-rank test, a survival time regression, and Cox proportional hazards regression, we explore the breast cancer survivors' specific attributes to identify the main determinants of survival time. Analyses show that the factors: stage, grade, primary site of the cancer, number of cancers each patient has, histology of the cancer, age, race, and income are among the main variables that enlighten why some breast cancer survivors live much longer than others. For instance, compared to White non-Hispanics, Black non-Hispanics have a shorter length of survival with a hazard ratio of (1.282). The best prognostic for White non-Hispanics, Hispanics (all races), and Black non-Hispanics is a woman aged between 40 to 49 years old, diagnosed with localized stage and grade one with Axillary tail of breast as a primary site with only one cancer and with a household income of 75,000.00 and over. Policymakers should promote early diagnosis and screening and better assist the older and the poor to improve the survival time for breast cancer patients.

Onco@home: comparing the costs and reimbursement of cancer treatment at home with the standard of care

BackgroundOncological home hospitalization (HH) was implemented in a Belgian context to evaluate the feasibility of oncological HH. In a first HH model (HH1), implemented by three Belgian hospitals, two home nursing organizations and a grouping of independent nurses, the blood draw and monitoring prior to intravenous therapy was performed by a trained home nurse at the patient’s home the day before the visit to the day hospital. In a second HH model (HH2), implemented in one hospital, the administration of two subcutaneous treatments (Azacitidine and Bortezomib) for myelodysplastic syndrome and multiple myeloma were provided at home instead of in the hospital. A previous study on this pilot showed that oncological HH is feasible and safe and improves the Quality of Life. The aim of this study is to investigate the cost and reimbursement of cancer treatment in these two HH models compared to the Standard of Care (SOC).MethodsA bottom-up micro-costing study was conducted to compare the costs and revenues for the providers (hospitals and home care organizations) of the SOC and the HH models.ResultsCosts associated to HH were higher than the SOC in the hospital. Comparing revenues with costs, the research revealed that the reimbursement from the National Health Insurance of HH for oncological patients is insufficient. In HH1, costs were higher than in the SOC (+ €50.4). There was a reduction in costs in the hospital by moving the blood draw to the home setting (-€23.9), but the costs in home care were higher (+ €74.3). The extra revenues in home care (+ €33.6) were insufficient to cover the costs. The cost difference between the SOC and HH2 (+ €9.5 for Azacetidine) was smaller than in HH1. But, there was almost no funding for subcutaneous administration in home care. If the product is administered in a day hospital, the hospital receives a revenue of €124 per administration, while in home care the funding is €5 per visit.ConclusionCosts of HH are higher and the reimbursement from Belgian NHI is insufficient to organize HH. As a result, HH for oncology patient is still limited in Belgium.

Out-of-pocket Health Expenditure and Factors Affecting Them in Breast Cancer Patients in Iran

Background: Breast cancer (BC) is the most common type of cancer among Iranian women. The cost of breast cancer treatment is high, and many families struggle to afford it. Objectives: This study was conducted with the aim of determining the out-of-pocket (OOP) health expenditure and factors affecting it in BC patients in Shahid Jalil Hospital affiliated to Yasuj University of Medical Sciences, Iran. Methods: This study was conducted in a cross-sectional descriptive-analytical way. Based on the inclusion criteria, the health expenditure of 82 patients with BC were collected. The data was gathered from Shahid Jalil Hospital, affiliated with Yasuj University of Medical Sciences. It includes inpatient and outpatient information from the Iran Health Insurance Organization, as well as patient-declared costs in 2022. The study data analyzed using descriptive statistics methods including frequency, percentage, mean and standard deviation, and stepwise linear regression to investigate the effect of variables on the amount of OOP health expenditure in SPSS 21 software. Results: The OOP expenses for BC patients accounted for 32.89% of the total direct medical expenses. Of the OOP costs, 47.18% were attributed to drug expenses, 16.19% to laboratory costs, 11.74% to imaging expenses, 11.20% to visit costs, 8.40% to hospitalization expenses, 2.84% to doctor’s services, and 2.45% to physical therapy-related expenses. Factors such as age, place of residence, occupation, education, and household income were among the factors that had a significant effect on OOP payments (P < 0.05). Marital status, housing situation, and social coverage had no significant effect on patients' OOP payments (P > 0.05). Conclusions: BC patients incur a lot of expenses, and about 32.89% of these expenses are OOP payments. It is essential for insurance organizations to increase their coverage, while also requiring additional support from the government for patients with breast cancer in obtaining necessary medication and medical supplies.

The annual cost of cancer screening in the U.S.

11051 Background: Cancer screening can decrease cancer incidence, mortality, and treatment costs. However, the annual cost of screening to the U.S. healthcare system is unknown. Methods: We used data from national healthcare surveys and standard costing sources to model the healthcare system cost of breast, cervical, colorectal, lung, and prostate cancer screening in the U.S. in 2021. Models projected the number of individuals in the U.S. eligible for each screening test based on current guidelines/recommendations; the number of eligible individuals screened by insurance status; and the costs associated with screening (in 2021 US dollars). Multiple sensitivity analyses were performed to examine the effects of changing model population parameters and costs on projected outcomes. Results: Total 2021 cancer screening costs to the U.S. healthcare system were estimated to be $57 billion; approximately 88% of the costs were attributable to private insurance, 9% to Medicare, and 3% to Medicaid, other government programs, and uninsured individuals. Most screened individuals had private insurance except for lung cancer screening, where a majority of individuals screened had Medicare coverage. Individuals with private insurance accounted for the majority of costs for each screening modality. Screening for colorectal cancer represented approximately two-thirds of the total cost; screening colonoscopy was approximately 60% of the total cost of cancer screening. Breast and cervical cancer screening represented the second and third largest screening costs, 15.4% and 14.7% (respectively) of total screening costs. Facility costs (amounts paid to facilities where testing occurred) were generally larger components of the total estimated costs of screening than were physician costs. Cost estimates were robust to a range of variations in eligible populations and screening costs. Conclusions: The $57 billion estimated annual cost for cancer screening in the U.S. in 2021 is similar to the estimated annual cost of cancer treatment in the U.S. in the first 12 months following diagnosis. Screening may have been suboptimal in 2021, with higher screening rates and costs in subsequent years. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities. The model can be used to estimate the increased costs of enhanced access to recommended cancer screening services among underscreened populations, which would provide population-wide benefits.

In search of strategies to mitigate financial toxicity in survivorship care: A survey of 347 head and neck cancer survivors.

11060 Background: High costs of cancer treatment exert substantial financial toxicity for patients undergoing treatment. Growing literature suggests lasting financial toxicity (FT) after treatment completion. This calls for the development and integration of mitigating strategies in survivorship care to reduce FT; thereby improving the overall well-being of survivors. Methods: Cross-sectional survey data from 347 head and neck cancer survivors were analyzed to explore the relationship between FT and potential targets for intervention. We measured FT using the COmprehensive Score for financial Toxicity (COST, v1), and defined severe, moderate, and mild-to-no FT as having COST score ≤13, 14 to 25, and ≥26, respectively. The survey also collected information on demographics, quality of life, work and activity impairment, and cancer care coordination (CCC) communication and navigation subscales. We conducted logistic regression to examine which COST item is most predictive of severe FT, and mediation analysis using structural equation model to explore potential targets for interventions to reduce FT. Results: The average age of respondents was 65.5 yrs (SD=11.3). 334 completed COST; 6.3%, 22.2% reported severe and moderate FT, respectively. Study cohort included 20% diagnosed within 2 yrs, 45% 3-4 yrs and 35% ≥5 yrs; the proportion of patients reporting severe FT did not decrease by year since diagnosis (6%, 5.3%, and 7.7%, respectively, P=0.73). Of the 11 items in COST, financial stress was most predictive of severe FT. Survivors who rated financial stress as “very much” or “quite a bit” were 92.8 (P=0.02) times more likely to have severe FT. Higher financial stress was significantly associated with being < age 65, having higher comorbidity score, lower CCC-navigation score, higher activity impairment; navigation and activity impairment are potentially actionable. None of these four variables were statistically significantly associated with severe FT. Mediation analysis showed financial stress has strong mediation effect on severe FT, and survivors with low CCC-navigation scores and high activity impairment were 3.2 times (95% CI: 1.3 – 7.8; P=0.01) and 2.5 (95% CI: 1.1 – 5.2; P=0.02) more likely, respectively, to report high financial stress. Survivors with high financial stress were significantly more likely to be interested or very interested in receiving resources covering financial issues compared to those without (63.4% vs 17.8%, P<0.01). Conclusions: Survivorship care that incorporates interventions designed to improve coordination and navigation and decrease activity impairment can potentially mitigate FT for cancer survivors through reducing their financial stress. The Centers for Medicare and Medicaid Services began paying for navigation services in 2024, opening the opportunity to integrate these interventions into covered navigation services.

Carcinogenic formaldehyde in U.S. residential buildings: Mass inventories, human health impacts, and associated healthcare costs

Formaldehyde, a human carcinogen, is formulated into building materials in the U.S. and worldwide. We used literature information and mass balances to obtain order-of-magnitude estimates of formaldehyde inventories in U.S. residential buildings as well as associated exposures, excess morbidity, and healthcare costs along with other economic ramifications. Use of formaldehyde in building materials dates to the 1940s and continues today unabated, despite its international classification in 2004 as a human carcinogen. Global production of formaldehyde was about 32 million metric tons (MMT) in 2006. In the U.S., 5.7 ± 0.05 to 7.4 ± 0.125 MMT of formaldehyde were produced annually from 2006 to 2022, with 65 ± 5 % of this mass (3.7 ± 0.03 to 4.8 ± 0.08 MMT) entering building materials. For a typical U.S. residential building constructed in 2022, we determined an average total mass of formaldehyde containing chemicals of 48.2 ± 10.1 kg, equivalent to 207 ± 40 g of neat formaldehyde per housing unit. When extrapolated to the entire U.S. housing stock, this equates to 29,800 ± 5760 metric tons of neat formaldehyde. If the health threshold in indoor air of 0.1 mg/m3 is never surpassed in a residential building, safe venting of embedded formaldehyde would take years. Using reported indoor air exceedances, up to 645 ± 33 excess cancer cases may occur U.S. nationwide annually generating up to US$65 M in cancer treatment costs alone, not counting ~16,000 ± 1000 disability adjusted life-years. Other documents showed health effects of formaldehyde exist, but could not be quantified reliably, including sick building syndrome outcomes such as headache, asthma, and various respiratory illnesses. Opportunities to improve indoor air exposure assessments are discussed with special emphasis on monitoring of building wastewater. Safer alternatives to formaldehyde in building products exist and are recommended for future use.

An assessment of the direct and indirect costs of breast cancer treatment in leading cancer hospitals in Ghana.

In Ghana, breast cancer remains the most common cancer and the leading cause of cancer deaths among women. The cost of treating cancer is huge and poses a great challenge for patients, their families, and health care systems. While comprehensive studies have been conducted on the economic burden of cancers in developed economies such as the EU and the US, there are limited studies in Africa, and Ghana, in particular. This study quantitatively assessed Ghana's direct and indirect costs of breast cancer treatment. Primary data were collected using a questionnaire administered to 217 breast cancer patients at the Korle-Bu and Komfo Anokye Teaching Hospitals, Ghana's two leading hospitals, and Sweden Ghana Medical Centre. Direct and indirect costs were computed using the Cost-of-Illness Approach. Quantitative analysis was done using multivariate linear regression. The findings showed that the breast cancer patients studied paid a median amount of Ghana cedis (GHC) 31,021.0 (IQR; 25,262.5-42,147.0), approximating USD 5,500.2 (IQR: 4,477.0-7,469.2 USD) for their treatment within one year of active treatment in 2019. About 61.9% (95% CI: 61.8-62.0%) of this cost was direct cost, while the remaining 38.1% (95% CI: 38.0-38.1%) was indirect cost. Patients who sought care from public facilities for breast cancer paid a median amount of GHC 29,606.3 (USD 5,249.3), while those who sought care from private facilities paid GHC 55,071.2 (USD 9,744.4). Findings from the multivariate linear regression indicate that being married/cohabiting, divorced/separated and having tertiary level education predicted higher cost of breast cancer treatment while patients on retirement and patients in the middle stage (Stage II) of breast cancer diagnoses were associated with lower cost of breast cancer treatment. The cost of breast cancer treatment poses a significant burden on patients and their families. There is a need for increased public funding for breast cancer treatment to reduce the huge economic burden its treatment poses for patients and their families.

Cytotoxic activity of liposomal Thymus capitatus essential oil on HT-29 human colorectal cancer cell line.

Multidrug resistance, severe side effects, and high cancer treatment costs are still well-known issues and remain an open challenge. These factors reduce the therapy's efficiency and safety, seriously affecting human health. Developing therapeutic approaches based on plant extracts, especially based on essential oils with cytotoxic and antioxidant properties, could be of efficacious strategies. This work incorporated Thymus capitatus essential oil (TEO) in liposomes. Thymus capitatus is a plant native to the northern region of Albania and found specifically in the Mediterranean region. TEO has several biological activities and cytotoxic properties. Due to its volatility, poor solubility, and chemical instability, however, its applicability is restricted. Incorporation into liposomes enables its effective use because the exposure time to the active compounds can be extended, increasing its efficacy against colorectal cancer cell lines, as highlighted in in vitro studies. TEO demonstrated detectable cytotoxic action against HT-29 colorectal cancer cells, and this action could be enhanced by applying various formulations of TEO-loaded liposomes to this cell line. Among the tested nanosystems, TEO-Phospholipon 90H liposomes showed more significant cytotoxic effects than TEO-Lipoid S100 liposomes and TEO-Phospholipon 85G liposomes. TEO-Phospholipon 90 H liposomes also maintained its physicochemical stability for six months at 25 °C. This research suggests that TEO, particularly when encapsulated in TEO-Phospholipon 90 H liposomes, may offer a promising therapeutic approach. However, these findings are based on in vitro studies and further in vivo research is needed to validate the efficacy and safety of this approach in clinical settings.

AWARENESS ABOUT THE ORAL CANCER AMONG UNDERGRADUATE STUDENTS OF ALLIED HEALTH SCIENCES IN PESHAWAR.

Oral cancer is a malignancy that affects the lips or oral cavity. Oral cancer causes about 20000 deaths worldwide. In Pakistan, it is the second most prevalent kind of cancer. The main obstacle to early diagnosis of oral cancer is the lack of information about oral cancer. Therefore, raising awareness among students is necessary and very helpful in controlling, early identification and prevention of oral cancer. Objective: To assess the level of awareness regarding oral cancer among undergraduate students. Methods. A descriptive cross-sectional study was carried out among undergraduate students of Allied Health Sciences Institutes in Peshawar. Data were collected from 312 undergraduate students through questionnaires. A convenient sampling technique was used for participant selection. Written informed consent was taken from all participants. Results: Out of 312 participants there were 124(39.7%) females and 188(60.3%) were males. About 65.7% were aware of oral cancer, and 71.2% were aware that oral cancer is due to alcohol drinking habits. 79.2% were aware that consumption of paan masala or guthka may cause oral cancer. 70.8% were aware that oral cancer is an infectious disease. Most of the students had poor knowledge regarding oral cancer as a disease of old age. Only 58.9% had information concerning the prevention of oral cancer. The majority of students were unaware of the treatment cost of oral cancer. More than half of the students (78.5%) were interested in information and education regarding oral cancer. Conclusion: The study concluded that students are decent or moderately aware. However, many lack basic knowledge regarding the initial signs and symptoms of oral cancer and its subsequent causes and effects, which could minimize the approach to overcoming the said problem.

The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer.

The Patient Protection and Affordable Care Act (ACA) significantly reduced uninsured individuals and improved financial protection; however, escalating costs of cancer treatment has led to substantial out-of-pocket expenses, causing severe financial and mental health distress for individuals with cancer. Mixed evidence on the ACA's ongoing impact highlights the necessity of assessing health-spending changes across income groups for informed policy interventions. In our nationally representative survey evaluating the early- and long-term effects of the ACA on nonelderly adult patients with cancer, we categorized individuals-based income subgroups defined by the ACA for eligibility. We found that ACA implementation increased insurance coverage, which was particularly evident after 2 years of implementation. Early post-ACA (within two years of implementation), there were declines in out-of-pocket spending for the lowest and low-income groups by 26.52% and 38.31%, respectively, persisting long-term only for the lowest-income group. High-income groups experienced continuously increased out-of-pocket and premium spending by 25.39% and 34.28%, respectively, with a notable 122% increase in the risk of high-burden spending. This study provides robust evidence of income-based disparities in financial burden for cancer care, emphasizing the need for health care policies promoting equitable care and addressing spending disparities across income brackets.

Factors Affecting Breast Cancer Screening Behavior Among Women in Saudi Arabia: A Retrospective Cross-Sectional Study.

Background Early detection of breast cancer is crucial for effective treatment and minimizing mortality, requiring effective screening methods like self-examination, clinical examination, and mammography. However, not all women in Saudi Arabia comply with these examinations, and studies examining its practice and barriers of low uptake are scant. The aim of this study is to investigate factors influencing breast cancer screening behavior among women in Saudi Arabia. Methods This cross-sectional study involving 806 women from October to November 2022 used an online questionnaire for the data collection process, including questions about demographic characteristics, awareness assessment, breast cancer screening behavior, symptoms, risk factors, and screening programs. Factors affecting the screening behavior were analyzed using the logistic regression model with adjusted odds ratio (AOR) and 95% confidence interval (CI). Results Among the 806 women who participated in the study, 479 (59.4%) were under 40 years old, and half of them were urban residents (n = 394, 48.9%). Only 134 subjects (16.6%) had a history of breast screening. Social media (n = 519, 64.5%) was the predominant source of screening information. The primary obstacles to breast cancer screening were the absence of tumor symptoms (n = 333, 41.3%), insufficient knowledge about early detection (n = 249, 31%), lack of time (n = 245, 30%), fear of discovering a tumor (n = 187, 23%), and lack of awareness about screening centers (n = 155, 19%).In regression analysis, predictive factors for breast cancer screening behavior were as follows: age over 40 years old (AOR: 2.56; 95% CI: 1.70-3.87), residents of big cities (AOR: 3.57; 95% CI: 1.02-12.56), positive family history of breast cancer (AOR: 2.53; 95% CI: 1.50-4.28), proximity to the screening center (AOR: 2.56; 95% CI: 1.22-5.39), and using contraceptive pills for more than five years (AOR: 1.78; 95% CI: 1.04-3.04), and were statistically significant (all p-values < 0.05). Conclusions In this study, the most perceived barriers to BSE were the absence of tumor symptoms, followed by insufficient knowledge about early detection, lack of time, fear of discovering a tumor, and lack of awareness about screening centers. Additionally, the predictive factors for breast cancer screening behavior were as follows: age over 40 years old, residents of big cities, positive family history of breast cancer, proximity to the screening center, and using contraceptive pills for more than five years. Given the identified factors affecting breast self-examination behavior in this study, public education initiatives are crucial for raising awareness, facilitating self-examination, and ultimately improving health outcomes and reducing breast cancer treatment costs in society.