Financial Toxicity Research Articles

Mediating Role of Financial Toxicity in the Relationships Between Health-Related Quality of Life and Its Risk Factors in Chinese Patients With Cancer.

Factors influencing health-related quality of life (HRQoL) and financial toxicity (FT) have been found to overlap, and the robust correlation between HRQoL and FT raises the possibility that FT mediates the relationships between the shared risk factors and HRQoL. However, empirical evidence supporting this hypothesis is limited. This study aimed to explore whether FT mediates the relationships between HRQoL and its risk factors. A cross-sectional study was conducted, with 1208 participants from 12 hospitals (6 tertiary, 6 secondary) in 6 cities across 3 income-level-diverse provinces in China from February to October 2022. FT and HRQoL were measured using the COmprehensive Score for financial Toxicity and the Functional Assessment of Cancer Therapy-General. Twenty-two risk factors for both HRQoL and FT were included for analysis. Mediation analyses were conducted using Mplus 8.3. FT predominantly mediated the relationships between HRQoL and both annual household income and hospital level. Meanwhile, it partially mediated the relationships of HRQoL with the number of treatment modalities, social support, perceived stress, healthcare provider-patient discussion regarding cancer care costs, and social medical insurance, and the mediating effect accounted for 19.7%, 7.8%, 10.7%, 22.3%, and 46.8% of the total effect, respectively. FT plays a significant mediating role in the associations between HRQoL and some of its risk factors among patients with cancer. Developing a more comprehensive and patient-centered approach to cancer care that addresses the unique challenges posed by cancer-related FT is urgently needed to improve the HRQoL among this population.

Associations of Financial Toxicity with Employment Concerns and Cancer-Related Distress: A Cross-Sectional Survey among Korean Working-Age Cancer Survivors.

Although South Korea's health insurance has a co-payment-decreasing policy for cancer survivors, information on the extent of financial toxicity and its related factors is limited. We assessed the level of financial toxicity and the association of high levels of financial toxicity with employment concerns after diagnosis and cancer-related distress in working-age cancer survivors. A cross-sectional study was conducted. Study participants were recruited from the National Cancer Survivorship Center between November and December 2022. Financial burden was assessed using the Korean version of the Comprehensive Score for Financial Toxicity, and cancer-related distress was measured using the NCCN Distress Thermometer. Multivariate logistic regression analyses were used to explore the associations between high financial toxicity, cancer-related distress, and changes in employment status after cancer diagnosis. Of 1,403 working-age cancer survivors, approximately 62% reported high levels of financial distress. Survivors reporting early retirement and taking time off work with the intent to return were more likely to report high financial toxicity (adjusted OR 1.69, 95% CI 1.14-2.5; and adjusted OR 2.82, 95% CI 1.24-6.43, respectively) than those with a full-time or part-time job. Moreover, cancer survivors with high distress levels were more likely to report high financial toxicity than those with low distress levels (adjusted OR 4.36, 95% CI 3.17-5.99). High financial toxicity is associated with adverse employment concerns and cancer-related distress among working-age cancer survivors. Therefore, developing cancer survivorship interventions within the healthcare system is necessary to ensure improvements in financial well-being.

Integrating Out-of-Pocket Costs Into Shared Decision-Making for Heart Failure With Reduced Ejection Fraction: A Stepped-Wedge Trial (POCKET-COST-HF).

Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction can entail high out-of-pocket (OOP) costs, prompting concerns about financial toxicity and access. OOP costs are generally unavailable during encounters. This trial assessed the impact of providing patient-specific OOP costs to patients and clinicians. This trial was conducted between June 2021 and August 2023 at 6 clinics in 2 health systems using a stepped-wedge, clinic-level cluster-randomized design. Adult patients with HF with reduced ejection fraction (left ventricular ejection fraction ≤40%) were enrolled. The intervention was built upon the EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) checklist of approved HF with reduced ejection fraction medications. Patients and clinicians received this checklist with (intervention) or without (control) patient-specific OOP cost estimates for higher-cost medications at the time of encounter. Estimates were obtained by providing pharmacy benefit information to a financial navigation firm. Encounters were audio-recorded, and patients were surveyed 2 weeks later. The primary outcome was cost-informed decision-making, defined by mentioning HF medication cost during the encounter. The primary analysis used a generalized linear mixed model. Secondary outcomes were assessed via transcript subcoding and analysis of survey responses. Demographic characteristics of 247 patients (mean age, 62.9 years; 29.5% female; 26.3% Black; and 3.2% Hispanic/LatinX) treated by 39 clinicians in intervention and control periods were similar. In the primary model, the rate of cost-informed decision-making was higher in the intervention group than the control group (68% versus 49%; P=0.021). Baseline rates of cost discussions and the impact of the intervention varied across sites. When cost discussions were present, fewer discussions in the intervention group involved contingency plans to address potential costs (16.5% versus 31.9%; P=0.028). Most other secondary outcomes were not significantly different. Disclosing comprehensive OOP medication costs to patients with HF with reduced ejection fraction increased cost-informed decision-making. Further work is needed to optimize implementation and assess the impact on medication choices and adherence. URL: https://www.clinicaltrials.gov; Unique identifier: NCT04793880.

Disparities in cancer-related financial toxicity across economically diverse provinces in China: A multi-center cross-sectional study

Disparities in cancer-related financial toxicity across economically diverse provinces in China: A multi-center cross-sectional study

High-Risk Credit Borrowing Patterns: A Comparison of Cancer With Major Chronic Diseases.

Although financial toxicity from cancer care is well documented, how cancer and other high-mortality chronic diseases affect credit overuse and high-risk borrowing remains unknown. We retrospectively analyzed households in the 2012-2018 Health and Retirement Study. Outcomes included nonhousing financial debt and credit card debt. For homeowning households, outcomes also included access to a home equity line of credit (HELOC) and a loan against HELOC. Linear probability regression models compared changes in financial outcomes among households with new cancer diagnosis or major chronic diseases (diabetes, stroke, or heart disease) with those without health shocks. Analyses were stratified by wealth. Among 14,188 households (age 68 years, 42% male, 21% Black, 13% Hispanic), 33% had financial debt, 26% had credit card debt, and 10% of homeowners used HELOC. Below-median wealth households were more likely to be Black or Hispanic. They were less likely to be headed by a female and to have college-level education. In these households, 22% had negative financial wealth (v 0% for above-median wealth), and new cancer was associated with a 4.9 percentage point (PPT) increase in rates of financial debt (13.1% effect size; P = .03; 95% CI, 0.005 to 0.094) and a 3.9 PPT increase in HELOC use (65%; P = .04; 95% CI, 0.002 to 0.076) compared with households with no new health changes. Households developing major chronic diseases were 3.6 PPT more likely to develop financial debt (9.6%; P = .015; 95% CI, 0.007 to 0.065) without affecting HELOC use. Such differences disappeared in above-median wealth households. Below-median wealth households with cancer incurred higher financial debt and refinanced their home more often compared with those without cancer, highlighting credit overuse and borrowing even in a fully insured population.

COVID-19 testing and financial toxicity in cancer survivors.

To investigate the financial strain placed upon cancer survivors during the COVID-19 pandemic. We investigated the association of COVID-19 testing with financial toxicity among individuals with a history of cancer from using cross-sectional data from the 2020 National Health Interview Survey. Multivariable logistic regression (MLR) analysis assessed associations between clinical and sociodemographic covariates with being unable to pay medical bills currently and having problems paying medical bills over the last 12months. Of the 4,130 individuals assessed, 420 (10.2%) reported difficulty paying bills currently and 758 (18.4%) reported difficulty paying bills over the last 12months. Respondents who reported being currently unable and/or having problems paying medical bills over the last 12months were, on average, younger than those who did not. MLR analysis demonstrated that older age and annual income > $35,000 were associated with lower odds of being unable to pay medical bills currently, while ever being tested for COVID-19 increased likelihood. Older age and annual income over $100,000 were associated with decreased odds of having difficulty paying medical bills over the last 12months, whereas ever being tested for COVID-19 was associated with increased odds. Cancer patients who report having difficulty paying medical bills were more likely to have been tested for COVID-19, indicating an association between COVID-19 testing and increased financial toxicity among cancer survivors. Healthcare providers should be aware of the financial strain placed upon patients with cancer during the pandemic so sufficient support may be provided.

Chronic illness and financial burden in Switzerland (FINK): a protocol for a mixed methods research project

IntroductionPeople with cancer and other chronic illnesses, their families and caregivers report financial burden as a problem that affects multiple aspects of daily life. While cancer research has coined the...

Optimizing resources: low-dose nivolumab combinations in the management of relapsed/refractory Hodgkin lymphoma.

Up to one-third of patients with classical Hodgkin lymphoma (cHL) are not responsive to first-line therapy or eventually relapse. Immune checkpoint inhibitors (ICIs) have been successfully employed to treat relapsed/refractory cHL (r/r cHL) but place patients at risk of financial toxicity. Early-phase trials and observational data suggest that low doses of ICIs may achieve similar results to those obtained with high doses. In this study, we report a single-center experience using low-dose nivolumab (LD-Nivo) in different combinations for r/r cHL, including monotherapy, LD-Nivo plus brentuximab vedotin (BV), and LD-Nivo plus chemotherapy. The primary outcome was to assess the efficacy of LD-nivo in patients with r/r cHL. We included 23 consecutive patients (median age 27years; 57% female). LD-Nivo was prescribed in 40, 100, and 140mg fixed doses Q2W. Survival analysis was performed employing the Kaplan-Meier method. 73% of patients achieved an overall response, 43% complete response, and 30% partial response. One-year overall survival was 94.4% (95% CI, 0.84-1), and the 1-year progression-free survival was 89.4% (95% CI, 0.77-1). OS and PFS were similar accross combinations. The median dose of nivolumab was 0.78mg/kg (range, 0.62-1.11), and the median number of cycles until a response was documented was 6 (range, 2-9). During follow-up, 18 patients received transplantation (11 autologous, 6 allogeneic). No statistically significant differences in survival or response were detected between nivolumab combinations or doses. Adverse events were observed in 61% of the patients, with none grade 3-4. LD-Nivo demonstrated promising results in relapsed/refractory HL, highlighting its potential as a cost-effective treatment option. Further research is needed to validate these findings and guide clinical practice.

Financial toxicity in patients with chronic kidney disease undergoing peritoneal dialysis

Abstract Objective: To investigate financial toxicity (FT) and the factors influencing it in patients with chronic kidney disease undergoing peritoneal dialysis (PD). Methods: A cross-sectional design was used. From August 2023 to December 2023, 148 PD patients were selected for investigation. The selection was conducted using the convenience sampling method across Shenzhen Third People’s Hospital, Peking University Shenzhen Hospital, and The First Affiliated Hospital of Guangzhou University of Chinese Medicine. Patients’ financial toxicity was assessed using a general demographic questionnaire, laboratory test results, and the Comprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT). T-tests, ANOVA, Pearson’s chi-squared test and multiple linear regression analysis were used to evaluate the predictors of FT in patients with PD. Results: Seventy-nine patients (53.38%) had mild FT, and 61 patients (41.21%) had moderate FT. Age, working status, monthly household income per capita, and PD-related complications were significantly associated with FT in PD patients (P < 0.05). Conclusions: There were varying degrees of FT in PD patients. Measuring FT can help medical professionals develop treatment care strategies, reduce the financial burden on patients, and avoid treatment interruption.

Financial Toxicity Among Patients With Traumatic Finger Amputation: A Retrospective Study.

Patients face increasing financial toxicity (FT), defined as emotional distress due to the cost of medical treatment. However, little is known regarding FT in the context of upper extremity trauma. We surveyed patients who sustained traumatic finger amputation (October 21, 2011-January 1, 2021). We collected patient-reported financial distress using the Comprehensive Score for Financial Toxicity (COST-11), where a lower score indicates worse FT. We also collected data of patients' perceptions regarding the costs of their treatment. We used linear regression to assess patient-level characteristics associated with FT as measured by the COST-11 score. Of the 191 eligible patients, 46 patients completed the survey (response rate of 24%). A total of 41 respondents (89%) received an initial treatment of revision amputation, with the remaining patients receiving a semi-occlusive dressing. Patients with commercial insurance had significantly lower COST-11 scores (ie, worse FT) than patients with Medicare (β = 7.5, 95% CI: 0.5 to 14.5) and Worker's Compensation (β = 8.7, 95% CI: 1.8 to 15.6). Patients who were single/never married had significantly worse FT (β = -11.3, 95% CI: -18.7 to -3.9). Approximately 35% (n = 16) reported that the costs were higher than expected. More than a third of patients (39%) reported decreasing spending on basic items, such as food, at least once since surgery. Patients face FT when obtaining surgery following traumatic finger amputation. Variation in the FT is associated with type of insurance and marriage status, highlighting how underinsurance and social support likely affect the overall economic well-being of patients.

Financial toxicity of total cancer care immunotherapy patients and caregivers: impacts of COVID-19 pandemic and inflation.

Financial toxicity, cancer-treatment-related financial harm, is associated with expensive treatments like immunotherapy. The purpose of this study was to explore financial toxicity among advanced cancer patients receiving immunotherapies and their caregivers and, secondarily, to study how recent inflation and the COVID-19 pandemic impacted these experiences. Advanced cancer patients receiving immunotherapies and their caregivers were recruited to participate in semi-structured interviews about supportive care needs from 2022 to 2023. The Comprehensive Score for Financial Toxicity was collected. Guided by Jones et al.'s cancer financial toxicity model, the content analysis was conducted by two trained coders using NVIVO R1. Sixteen patients and 10 caregivers (including 7 dyads) across 5 states participated in interviews in 2022-2023. Participants averaged 63.43years (SD = 12.75), and patients received an average of 14.6months of immunotherapy (SD = 9.415). The majority lived in non-metropolitan areas (67%) and were white (95%). Three theory-driven themes were developed: (1) Sources of Financial Toxicity, (2) Buffers of Financial Toxicity, and (3) Consequences of Financial Toxicity. Inflation was added to financial toxicity for non-metropolitan dwelling participants due to increased prices of gas and accommodation. Social support systems buffered the impact of financial toxicity. Material and psychological impacts of financial toxicity disproportionately affected younger and privately insured participants. While immunotherapy patients face high medical costs of treatment, the burdens of accessing treatment for people living at a distance from the cancer center can exacerbate financial toxicity. Clinicians and researchers should also consider external financial pressures such as national economic impacts that compound the financial toxicity of treatment.

What's the Cost: Financial Toxicity and Screening Fatigue in Li-Fraumeni Syndrome.

Patients with Li-Fraumeni syndrome are recommended to follow a comprehensive surveillance protocol, but the demanding nature may limit adherence. We sought to identify barriers to adherence, and to determine whether screening fatigue and financial hardship are contributors. A 39-item online survey was developed and distributed to patients presenting to a LFS clinic between 2017 and 2022. Of the 39 patients eligible, 20 responded to the survey (51%). Of respondents, 75% reported they do not skip surveillance tests, though this was not consistent when asked about specific tests, with only 65% and 40% up to date with colonoscopy and esophagogastroduodenoscopy, respectively. 100% of those diagnosed within the last 5 years said they never skip tests, whereas only 50% of those diagnosed over 5 years ago reported the same (p=0.01). Barriers to adherence were reported by 85% and most commonly included finances (40%), time (25%), and difficulty scheduling (25%). Only 21% felt no financial stress. 63% worried at least somewhat about their future financial situation because of LFS. Even with insurance, 65% felt their share of healthcare costs was too high. Adherence to rigorous cancer surveillance is imperfect and decreases over time among patients with LFS. While number of tests was not a commonly cited barrier, time and difficulty scheduling were common and may contribute to screening fatigue. The degree of financial stress in the affluent population studied should raise even greater concern about financial strain in the LFS population in general.

Abstract 4118451: A Real-world Evaluation of Longitudinal Healthcare Expenses in a Health System Registry of Type-2 Diabetes Mellitus and Cardiovascular Disease Enabled by the 21 st Century Cures Act

Background: An evaluation of the longitudinal burden of healthcare expenses in type-2 diabetes mellitus (T2DM) is limited to self-selected cohorts and claims-based or self-reported spending. Leveraging the 21 st Century Cures Act rule that made reporting hospital-level service prices mandatory, we demonstrate healthcare spending in T2DM with and without cardiovascular disease in a diverse multisite EHR-based T2DM cohort. Methods: Patients with T2DM seeking regular care (≥ 1 visit/2 years) across 5 hospitals and a large outpatient network (2013-2023) in the Yale New Haven Health System (YNHHS). Cohorts were defined by the presence of atherosclerotic cardiovascular disease (ASCVD) and/or heart failure (HF) before or up to 1 year after the T2DM diagnosis. We used the YNHHS chargemaster file to extract Medicare and insurance-negotiated cash prices. We linked census data using residential zip codes to estimate household income, used multivariable logistic regression to identify factors associated with financial hardship (health expenses >20% of income), and evaluated expenses during the last year of life. All values were inflation-adjusted to 2023 US$. Results: Overall, 106881 patients with T2DM followed for 5.4 years (3.1-7.5) had 147919 hospitalizations, representing $3.41B in expected healthcare expenses. 8% of patients with T2DM without ASCVD/HF, 14% with ASCVD, 23% with HF, and 28% with ASCVD and HF had a financial obligation for healthcare above the threshold for financial hardship. Compared with White patients, Black and Hispanic patients were more likely, and Asians were less likely to have financial hardship (OR: Black, 1.81 [1.73-1.91]; Hispanic, 1.39 [1.31-1.48]; Asian, 0.46 [0.37-0.57]), after accounting for age, sex, and comorbidities. Comorbid HF at baseline portended 2x higher odds of financial hardship (OR: HF, 2.20 [2.00-2.42]; ASCVD and HF, 1.98 [1.84-2.14]) compared with T2DM alone. Care in the last year of life represented 72-80% of overall health expenses, with 55-61% of patients at risk for financial hardship across cohorts. Conclusion: A digital individualized expense-linked registry of patients enabled by recent US price transparency rules defined that annually, one-fifth of patients with T2DM and cardiovascular disease had healthcare events exceeding 20% of their annual income, and vulnerable racial/ethnic minorities were at high risk for financial toxicity.

DISP-03. HEALTH DISPARITIES IN NEURO-ONCOLOGY

Abstract Significant disparities in diagnosis, research, and treatment exist in neuro-oncology. Patients who identify as racial or ethnic minorities, sexual or gender minorities, elderly, rural, or have low socioeconomic status are more likely to have adverse outcomes. Using PubMed and expert opinion, we summarized the existing literature on health disparities in neuro-oncology. We categorized disparities based on primary central nervous system tumors (CNS), secondary CNS tumors, pediatric neuro-oncology, clinical trial enrollment and diversity, and financial toxicity. For patients with primary CNS tumors, we found that marginalized groups faced delays in diagnosis, lower rates of resection, and lower rates of postoperative radiation. For secondary CNS tumors, marginalized groups had lower rates of indicated cancer screening, less access to genetic testing, less access to advanced imaging, and lower rates of stereotactic radiosurgery and targeted therapies. Pediatric neuro-oncology patients had differences in morbidity and mortality based on socioeconomic status and race and faced substantial delays in diagnosis. Financial toxicity, the side effects of the high financial cost of a cancer diagnosis, disproportionately affects marginalized populations. This may be further exacerbated by the use of long-term medications such as IDH inhibitors. There is also unequal representation of diverse populations in neuro-oncology clinical trials. Compared to other cancer subspecialties, there is less available data on disparities, however, the types of disparities such as delays in diagnosis and outcomes are similar. Notably, there are not many interventions focused on mitigating these disparities. There needs to be additional research on health disparities in neuro-oncology, including both descriptions of existing disparities, but also on methods and interventions to address these disparities.

DISP-13. TELEHEALTH UTILIZATION IN NEURO-ONCOLOGY: EXPERIENCE AFTER THE COVID-19 PANDEMIC

Abstract BACKGROUND Central nervous system (CNS) tumors are frequently characterized by physical disabilities, and treatment is often associated with side effects, as well as financial toxicity and loss of income owing to disease-related neurological deficits. Treatment at centers with specialized neuro-oncology care is associated with an overall survival benefit. However, access to such centers can be limited for many patients. Telehealth services represent an option for improving access to specialized care. During the COVID-19 pandemic public health emergency (PHE), regulatory and reimbursement changes provided patients improved access to neuro-oncology by telehealth. METHODS We retrospectively analyzed our institutional utilization of telehealth visits in the neuro-oncology vs solid tumor oncology practice after the COVID-19 pandemic. RESULTS Between July 2020 and April 2021, telehealth represented 24.1% of all neuro-oncology visits compared to 13.3% for all solid tumor groups. Between May 2021 and April 2023, telehealth visits remained frequent in neuro-oncology compared to solid tumor groups (34.6% vs 15.2%). Utilization rates declined across the practice in the year following expiration of the COVID-19 PHE in May 2023, though remained high for neuro-oncology at 34.1% vs 15.2% for solid tumor groups. Overall, telehealth visit utilization for neuro-oncology has remained more than double that of the oncology practice as a whole. CONCLUSIONS The striking difference between telehealth visit utilization in neuro-oncology compared with general medical oncology indicates that patients with CNS tumors, and those that provide care for these patients, have come to depend on this mode of care delivery. Even after expiration of the COVID-19 PHE, telehealth use remains high in neuro-oncology at our institution. Prospective evaluation to determine the safety of and clinical outcomes associated with telehealth visits for individuals with CNS tumors are critically needed. Such data may promote regulatory and reimbursement reform enabling broader adoption, service sustainability, and improved access to specialized care.

Updates in Treatment of HER2-positive Metastatic Breast Cancer.

The therapeutic landscape for HER2-positive metastatic breast cancer has exploded in the last two decades following the initial advent of trastuzumab, a monoclonal antibody. While the first line treatment has remained a combination of dual HER2 blockade with taxane chemotherapy, we now have several exciting options in the second line and beyond. The introduction of antibody-drug conjugates, in specific trastuzumab deruxtecan, has resulted in the best progression-free survival among patients with this subtype of breast cancer. Given the excellent outcomes of these drugs, clinical trials are now evaluating the role of ADCs in the front-line setting in previously untreated patients. In addition, there are also clinical trials evaluating the role of other targets in patients with HER2-positive cancers, including PI3KCA mutations, PD-L1 and CDK4/6. Given the predilection for brain metastases in this population, there is enthusiasm to identify the optimal combination of effective treatments. Tucatinib, capecitabine, and trastuzumab combination represent one such promising strategy. With the increasing longevity of these patients, important clinical questions include optimal treatment sequencing, the role of de-escalation of treatment in excellent responders, and the associated financial toxicity. Despite the aggressive nature of this subtype of breast cancer, the outcomes continue to improve for these patients with the evolving treatments.

Cancer survivor preferences on the timing and content of interventions to mitigate financial toxicity associated with cancer treatment.

Despite growing research on financial toxicity among cancer survivors, large gaps remain in understanding how to intervene to minimize financial toxicity. Uptake and efficacy of interventions mitigating cancer financial toxicity, though promising, remain limited and inconsistent. To date, survivor preferences for financial toxicity interventions are underexplored. This study aimed to evaluate survivor preferences for timing and content of a survivor-facing intervention to address financial toxicity. Adult survivors (N = 105) of colorectal cancer (N = 55) or Non-Hodgkin Lymphoma (N = 50) from three tertiary care centers self-reported demographic and clinical characteristics, comorbidities, mental health, financial impact of cancer (Comprehensive Score for Financial Toxicity scale), and preferences for intervention timing and content. Chi-square tests examined associations between intervention timing and content preferences with financial toxicity score. ANOVAs and correlation analyses described associations between the number of intervention components survivors endorsed and survivors' characteristics. Regarding intervention timing, 79% of survivors favored intervention before treatment. The most frequently endorsed content was understanding out-of-pocket costs and insurance (48.6%) and applying for aid (39%). Survivors experiencing higher financial toxicity reported greater interest in all intervention components. Survivors with colorectal cancer (p = .018), < 65years (p = .019), higher financial toxicity (p < .001), greater life-altering (p < .001) and care-altering (p = .014) coping behaviors, and poorer mental health (p = .008) endorsed more intervention components. Actionable insights to improve financial toxicity interventions may be to offer assistance earlier than currently provided(i.e. before treatment) and to include certain topics currently rarely offered (e.g., stress management, budget development support) in line with survivors' preferences.

Financial Toxicity Among Asian American Cancer Survivors

This Viewpoint highlights financial toxicity specific to Asian American cancer survivors and presents steps forward within the framework of the social ecological model of health, considering individual, interpersonal, community, and policy-level dimensions.

A Costly Cure: Understanding and Addressing Financial Toxicity in Cardiovascular Disease Health Care Within the Domain of Social Determinants of Health.

Cardiovascular disease (CVD) represents a significant financial burden on patients and families, compounded by both direct and indirect healthcare costs. The increasing prevalence of CVD, coupled with the rising costs of treatment, exacerbates financial toxicity-defined as the economic strain and associated physical, emotional, and behavioral consequences on patients. This review explores the scope of financial toxicity in CVD care, detailing its prevalence, associated risk factors, and the complex interplay with social determinants of health such as income, insurance status, and comorbidities. Drawing from models in oncology, we highlight key interventions aimed at mitigating financial toxicity, including patient counseling, financial navigation, and enhanced patient-physician cost discussions. By adopting these approaches, healthcare providers can better support patients with CVD in managing both their health and financial well-being, potentially improving clinical outcomes. Future research is needed to develop standardized assessment tools for financial toxicity in CVD and implement system-wide mitigation strategies.

Financial Toxicity, Health-Related Quality of Life, and Medication Adherence Patient-Reported Outcomes (PROs) in Patients with Chronic Lymphocytic Leukemia (CLL) on First-Line Oral Oncolytics

Financial Toxicity, Health-Related Quality of Life, and Medication Adherence Patient-Reported Outcomes (PROs) in Patients with Chronic Lymphocytic Leukemia (CLL) on First-Line Oral Oncolytics