Severe Financial Distress Research Articles

Factors Associated with Unmet Supportive Needs in Adult Cancer Survivors in South Korea

Abstract Purpose As the number of cancer survivors increases, addressing their unmet supportive care needs (USCNs) has become crucial. This study aimed to evaluate the influence of financial toxicity on USCNs and identify comprehensive factors associated with USCNs among adults’ cancer survivors. Methods A cross-sectional survey using convenience sampling from the 2022 Korean Population Census. Data were collected online between November 17 and December 15, 2022. The study included 1,038 cancer survivors aged 19 years or older who had completed primary treatment. Multivariable logistic regression was analyzed to identify factors associated with USCNs. Results Two-thirds (65.7%) of cancer survivors experienced severe financial toxicity, correlating with high unmet supportive care needs. Among those who reported a severe financial burden, a substantial 170 out of 187 respondents, or approximately 90.9%, were identified as having high unmet supportive care needs. Cancer survivors had the highest needs in the order of ‘management of psychological symptoms’ and ‘coping and emotional needs’. Cancer survivors diagnosed between 5 and 10 years ago were found to be less likely to report unmet supportive care needs compared to those diagnosed more recently, with an odds ratio of 0.14. Additionally, breast cancer survivors and individuals who were unemployed at the time of diagnosis had a higher likelihood of experiencing unmet supportive care needs, with adjusted odds ratios of 1.68 (95% confidence interval: 1.088-2.603) and 1.80 (95% CI: 1.125-2.891), respectively. Conclusions Cancer survivors with moderate to severe financial distress were more likely to be at risk of experiencing a high level of unmet supportive care needs. Coping and emotional needs are the most important concerns among the unmet needs of cancer survivors regardless of the time since cancer diagnosis. Key messages • Cancer survivors in South Korea with moderate to severe financial distress are twice as likely to face a high level of unmet supportive care needs. • The most significant unmet supportive care needs among South Korean cancer survivors relate to coping and emotional support, highlighting the need for enhanced mental health services.

Financial distress and medical financial hardship among young adult survivors of blood cancer.

The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility-namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. NCT05620979.

Who Can Tell Which Banks Will Fail?

Abstract We study the run on the German banking system in 1931 to understand whether depositors anticipate which banks will fail in a major financial crisis. We find that deposits decline by around 20% during the run. There is an equal outflow of retail and nonfinancial wholesale deposits from both failing and surviving banks. In contrast, we find that interbank deposits almost exclusively decline for failing banks. Our evidence suggests that banks are better informed about which fellow banks will fail. In turn, banks being informed allows the interbank market to continue providing liquidity even during times of severe financial distress.

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.

Patient-reported burden associated with pheochromocytoma/paraganglioma diagnosis.

Pheochromocytoma and paragangliomas (PPGLs) originate from the chromaffin cells of the adrenal medulla or neural crest progenitors outside the adrenal gland, respectively. The estimated annual incidence of PPGL is between 2.0 and 8.0/million adults. Minimal data exist on the impact of PPGL from the patient's perspective. Therefore, a survey was adapted from a previously published study on gastroenteropancreatic neuroendocrine tumors to explore the voice of patients with PPGL and learn ways to improve clinical care while understanding the current gaps to direct future research. A self-reported online survey was available to patients with PPGL and those with genetic predisposition even without PPGL from June to July 2022. Survey questions captured sociodemographic and clinical characteristics, the diagnostic workup, treatment and monitoring, quality and access to care, and financial impact. Here, we report the most relevant findings on patient experience of disease burden following diagnosis. A total of 270 people responded, the majority of whom were from the USA (79%), Caucasian (88%), and female (81%). The results of this survey highlight the burden of disease on a patient's daily life, resulting in moderate to severe financial distress, increased travel time to specialized facilities resulting in loss of work and wages, and significant delays in care. Respondents reported being unheard and unacknowledged. With a median time to diagnosis just over 2 years, the physical, mental, and emotional toll are substantial. Increasing access to PPGL specialists and centers could lead to faster diagnoses and better management, which may reduce the burden on both patients and healthcare centers.

DETOURS AND DELAYS: NAVIGATING THE PANDEMIC'S IMPACT ON INDIA'S TRANSPORT SECTOR AND TOURISM

The COVID-19 pandemic has had a profound impact on the Indian transport industry, affecting various sectors such as aviation, railways, road transport, and maritime. The nationwide lockdowns and travel restrictions imposed to curb the spread of the virus led to a significant decline in passenger traffic and freight movement, causing severe financial distress to the industry. This almost standstill in the movement of the people severely affected the Indian tourism industry which provides 7 per cent of GDP and 9 per cent of employment by 2019. The aviation sector witnessed a sharp decline in passenger traffic, leading to financial losses for airlines and airports. Many airlines were forced to suspend operations or reduce their workforce to survive. Similarly, the Indian Railways faced challenges due to the suspension of passenger trains, impacting revenue generation. The road transport sector also suffered due to the lockdowns, with restrictions on inter-state and intra-state movement affecting the movement of goods and passengers. The maritime sector faced challenges due to disruptions in global trade and port operations. To mitigate the impact of the pandemic, the Indian government announced various relief measures, including financial assistance, waivers, and restructuring of loans for the transport industry. The government also launched initiatives such as the Vande Bharat Mission to repatriate stranded Indians and the One Nation, One Card scheme for seamless travel across different modes of transport. By recognising the importance of the revival of tourism in India Indian Government announced many sops and reliefs to the tour operators, travel agents and transport organisations. Despite these measures, the road to recovery for the Indian transport industry remains challenging. The industry will need to adapt to the new normal by implementing safety measures, embracing digital technologies, and diversifying its operations to ensure resilience in future crises. KEYWORDS: Covid -19, Road transport, Railways, Civil aviation, Tourism

Corporate information preference and stock return volatility

ABSTRACT This paper models the effect of corporate information preference on stock return volatility based on optimization problems of information decisions for firms and investors. Our model hypothesizes a positive correlation between corporate information preference and volatility. Utilizing the ideal institutional background of the Chinese stock market, we empirically confirm that corporate information preference has a positive impact on volatility, particularly for firms facing more severe financial distress, limited investor attention, and less analyst coverage. Our study provides a new perspective for analyzing the interaction between information supply and asset price dynamics.

Protecting Whom, Why, and from What? The Dutch Government’s Politics of Abjection of Sex Workers in Times of the COVID-19 Pandemic

Sex workers in the Netherlands experienced severe financial and social distress during the COVID-19 health crisis. Notwithstanding them paying taxes over the earnings, they were excluded from government financial support, faced discriminatory treatment concerning safe reopening, and experienced increased repression and stigmatization. In this contribution, I explore whether the concept of “vulnerability” contributes to understanding (and addressing) that situation. Data acquired through participatory action research, partly taking place online during lock-down measures, and literature and content analysis show that labeling sex workers “vulnerable” deflects attention away from the (in)actions of Dutch authorities responsible for sex workers’ precarious conditions during the pandemic. Government denial and strategies of abjection explain these conditions better than “vulnerability” does, as they return the gaze to actors and processes accountable for sex workers’ exclusion and criminalization during the COVID-19 health crisis and thereby put responsibility where it belongs.

Configuring lean manufacturing and supply chain risk management: a cluster analysis

Among many fallouts of the global pandemic, firms’ supply chains have been severely impacted at the global scale. Such global impact can be mainly attributed to companies’ current heavy focus on lean manufacturing, resulting in a lack of preparedness and flexibility, and therefore weakening their supply chain links. At the same time, firms face severe financial distress and constraints if their investments in future risks turn out to be of no value. Facing such dilemmas, many firms are unsure of how to appropriately configure lean and risk management at their operational and supply chain levels. This study aims to understand the various configurations of lean manufacturing and supply chain risk management. Also, this study pays attention to buffer capacity associated with lean and risk management. In a dataset collected from 198 US companies, cluster analyses discover the manufacturers’ configurations of the varying emphases on lean management and supply chain management. Our results indicate that firms achieve the highest levels of buffer capacity and firm performance if they implement lean practices and risk management at a higher level than others.

Association of financial toxicity with quality of life in testicular cancer survivors.

Most testicular cancer (TC) survivors have long-term survival. However, the association between financial toxicity (FT), which is an economic side effect of cancer treatment, and the quality of life (QOL) of TC survivors is still unclear. Thus, the impact of FT on the QOL of TC survivors was examined in a multi-institutional cross-sectional study. We recruited TC survivors from eight high-volume institutions in Japan between January 2018 and March 2019. A total of 562 participants completed the EORTC QLQ-C30, EORTC QLQ-TC26 and the questionnaires on demographics, including annual income. Financial difficulty in the EORTC QLQ-C30 and low income were used to assess financial distress (FD) and financial burden (FB), respectively. FT was defined as FD and FB. The QOL scores were compared, and a multivariate logistic regression analysis for FT was performed. With severe FD, TC survivors had more treatment side effects, physical limitations, and anxiety concerning employment and future. The TC survivors who reported low income were worried about their jobs and the future. The QOL of the survivors with FT exhibited high impairment, except for sexual activity. In particular, the TC survivors with FT were physically limited and anxious concerning the future. The multivariate logistic regression analysis revealed that four or more chemotherapy cycles were substantial risk factors for FT (4 cycles, odds ratio (OR) = 4.17; ≥5 cycles, OR = 6.96). TC survivors who received multi-cycle chemotherapy were prone to experience FT, resulting in a decline in their health-related QOL.

Academics as Independent Directors: Do They Contribute to Environmental Innovation

Building on agency theory and the literature on independent directors, this research investigates the effects of independent directors with academic backgrounds on environmental innovation. We make the argument that the independent academic directors as an internal mechanism, can make contributions to corporate environmental technological innovation performance through monitoring, advising, and networking functions. We further suggest the positive effects of independent academic directors are contingent on financial constraints. Our findings report that the positive effects are amplified when firms have severe financial distress. Using a sample of Chinese listed companies, we find supportive evidence to our hypotheses.

Wealth management products, banking competition, and stability: Evidence from China

Shadow financing through off-balance sheet wealth management products (WMPs) has become increasingly important besides deposits in China. We quantify the economic magnitude of the effect of WMPs on banking stability in an equilibrium model calibrated to Chinese banking sector data. Alternative equilibria emerge which deviate substantially from the observed banking system and lead to severe financial distress and large welfare losses. Rollover costs from the WMP market and negative shocks to the asset market underlying WMPs can exacerbate banking instability. Moreover, we show that smaller and medium sized banks are comparably relevant for financial stability as the systemically important big 4 banks in China.

Government lending in a crisis

The economic disruption from the COVID-19 pandemic prompted governments around the world to initiate an unprecedented number of temporary lending and tax deferment programs. Which firms will benefit from these programs? What are the implications for firm balance sheets and post-crisis survival? We provide some novel insights on these questions by studying one of the first government programs of this type, which Sweden launched at the height of the 2008–2009 financial crisis. The Swedish program allowed firms to temporarily suspend payment of all labor-related taxes and fees, treating these deferred amounts as a short-term loan from the government. Firms participating in the program are younger, less profitable, hold fewer cash reserves, are more leveraged, and have less unused slack in their credit lines when the crisis hits. Given the structure of the Swedish program, it provided more liquidity to firms with relatively larger ex ante wage bills. Exploiting this feature of the policy, we find that firms use the program to increase overall debt levels rather than to substitute for other borrowing. The leverage increase is due entirely to higher levels of non-bank debt. Firms use the funds to avoid making even deeper cuts to current assets. Despite the increase in leverage, access to the lending program is unrelated to the likelihood a firm files for bankruptcy and is negatively related to the likelihood a firm encounters severe financial distress in the years immediately following the crisis.

Pediatric outpatient care during the COVID-19 pandemic: Results of a qualitative interview study

Abstract Background Pediatric outpatient care in Germany is significantly affected by the COVID-19 pandemic. The study aims at exploring the subjective views of pediatricians on changes in their routine healthcare work during the COVID-19 pandemic. Methods 19 qualitative semi-standardized telephone interviews were conducted with pediatricians in Germany. The interviews were audio-recorded, transcribed verbatim and analyzed based on qualitative content analysis (Kuckartz 2012) using QDA software (Atlas.ti, V8). Results COVID-19 infection protection measures induce substantial changes in the pediatricians' work, e.g. separating infectious and non-infectious patients, re-structuring appointments and practice setting and wearing PPE. Some interviewees emphasize that re-structuring measures have set positive impulses for the future. Wearing face masks is difficult when communicating with infants and children with psychosocial issues. Pediatricians feel well-informed on COVID-19-related health information but find it challenging to constantly re-adjust their professional position based on the rapidly changing official recommendations. This also makes it difficult to communicate COVID-19-related information to their often insecure patients. The pediatricians are concerned about a changed (degree of capacity) utilization: Preventive appointments are utilized almost as before, however, parental fear of visiting the practice and infection protection measures in the children's living environments have led to a significant decline in utilization for mild infections. While some pediatricians appreciate this as a relief of workload, others experience severe financial distress. Conclusions The decline in healthcare utilization for mild infections and the resulting financial distress call for health policy measures in order to ensure comprehensive pediatric care in the future. Positive experiences regarding the pediatric practice should be spread as “best practices”. Key messages Pediatricians in outpatient care in Germany experience substantial changes in their routine work due to the COVID-19 pandemic, e.g. practice organization and infection protection measures. They are especially affected by rapidly changing official recommendations and a changed (degree of capacity) utilization.

Wealth Management Products, Banking Competition, and Stability: Evidence from China

Shadow financing through off-balance sheet wealth management products (WMPs) has become increasingly important besides deposits in China. We quantify the economic magnitude of the effect of WMPs on banking stability in an equilibrium model calibrated to Chinese banking sector data. Alternative equilibria emerge, which deviate substantially from the observed banking system and lead to severe financial distress and large welfare losses. Rollover costs from the WMP market and negative shocks to the asset market underlying WMPs can exacerbate banking instability. Moreover, we show that smaller and medium sized banks are comparably relevant for financial stability as the systemically important big 4 banks in China.

Performance of German Family Firms During the Global Financial Crisis

Research on family firm performance has led to inconclusive results which is why scholars called for a differentiated consideration of family firms during exogenous shocks, where costs and benefits of the inherent ownership structure are assumed to be magnified. Following these calls, I use the Global Financial Crisis of 2007 – 2009 as a unique natural experiment where firms have been moved out of their equilibrium while ownership structure maintained constant in the near term. I differentiate between true family firms and lone founder firms and hypothesize that the firm performance of both ownership structures during the Global Financial Crisis is higher than for non-family firms. In a study of 178 firms listed in the German Prime Standard, I found that lone founder ownership was significantly associated with higher firm performance during the GFC, while showing no differences in performance during the period of stable economic conditions prior to the crisis. For true family ownership, in contrast, the results suggest a general tendency of superior performance during the steady-state pre-crisis period, but it could not be established that these firms outperformed other firms during the GFC. Analogously, I found that the presence of a family CEO in true family firms is beneficial for firm performance during stable economic conditions, but the advantageousness seems to vanish in times of severe financial distress. Keywords: Family firm; ownership; governance; performance; crisis.

Cervical Cancer-Associated Suffering: Estimating the Palliative Care Needs of a Highly Vulnerable Population.

PURPOSETo enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.METHODSWe first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying the suffering prevalence and duration estimates to the number of decedents, nondecedents, and family caregivers in 2017, we were able to estimate their palliative care needs and the intensity of palliative care needed to respond adequately to this suffering.RESULTSThere is a high prevalence among decedents of moderate or severe pain (84%), vaginal discharge (66%), vaginal bleeding (61%), and loss of faith (31%). Among both decedents and nondecedents, there is a high prevalence of clinically significant anxiety (63% and 50%, respectively), depressed mood (52% and 38%, respectively), and sexual dysfunction (87% and 83%, respectively). Moderate or severe financial distress is prevalent among decedents, nondecedents, and family caregivers (84%, 74%, and 66%, respectively). More than 40% of decedents and nondecedents are abandoned by their intimate partners. Most patients experience some combination of moderate or severe physical, psychological, social, and spiritual suffering. In total, 258,649 decedents and 2,558,857 nondecedents needed palliative care in 2017, approximately 85% of whom were in low- and middle-income countries where palliative care is rarely accessible.CONCLUSIONAmong women with advanced cervical cancer, suffering is highly prevalent and often severe and multifaceted.

Estimating volatility clustering and variance risk premium effects on bank default indicators

Default risk increases substantially during financial stress times due to mainly the two reasons: volatility clustering and investors’ desire to protect themselves from such increases in volatility. It manifested in the aftermath of the Global Financial Crisis of 2008–2009 with unpleasant outcomes of many bankruptcies and severe financial distress. To account for these features, we adapted the structural credit risk approach to include both time-varying (return) volatility and risk premium about the return volatility itself. By applying the model to US banks, we obtain better bank default indicators in comparison to the benchmark models.

Measuring Financial Distress and Quality of Life Over Time in Patients With Gynecologic Cancer-Making the Case to Screen Early in the Treatment Course.

Our objective was to measure the trajectory of financial distress and to determine its relationship with quality of life (QOL) among patients with cancer. We conducted a longitudinal survey of patients with gynecologic cancer starting a new line of systemic therapy at baseline, 3 months, and 6 months. Financial distress was measured using a Comprehensive Score for Financial Toxicity (COST) < 26, and QOL was measured using Functional Assessment of Cancer Therapy-General (FACT-G) with lower scores indicating worse responses. One-way repeated analysis of variances, generalized estimating equation models, and correlation coefficients were used to evaluate financial distress and QOL over time. There were 90 of 121 (74%) baseline participants with a 6-month follow-up. The average age was 60 years, 29% were African-American, 57% had an annual income < $40,000 in US dollars, and 6% were uninsured. At baseline, 54% of patients screened positive for financial distress, which was unchanged at 3 months (50%, P = .27) but decreased at 6 months (46%, P = .04) compared with baseline. There was no change in average COST (23.6, 25.1, 25.6; P = .33) or FACT-G (70.8, 71.0, 72.8; P = .68) over time. Less financial distress was moderately correlated with better QOL (r = 0.63, 0.61, 0.60) at each time point. The presence of financial distress was associated with a 16-point decrease in FACT-G QOL score over time. Upfront screening with COST identified 90% of patients who experienced financial distress, and COST did not change significantly over time. More severe financial distress was moderately correlated with worse QOL, and its presence was associated with a clinically meaningful 16-point decrease in QOL.

Propensity for premature filing for judicial financial recovery in large-scale agriculture in Brazil

In the Brazilian agricultural space, numerous cases of large farmers have declared themselves in severe financial distress and filed for Judicial Financial Recovery (JFR) in the past few years. Our statistical analysis, although preliminary and based on limited available data, indicates that these operations have shown financial indices at levels that, in general, did not significantly differ from a sample of other larger farmers’. Only ‘liquidity’ presented a more persistent relationship with the cases of Judicial Recovery. Therefore, it seems that farmers may be resorting to the JFR route prematurely. Within a limited subsample of cases of farmers who filed for JFR, data also shows a pattern with indications that farmers may tend to time their filing to coincide with having their main crops ready for commercialization immediately preceding or after harvesting. This suggests that these farmers might be seeking to free their most recent crop from previous financial and commercial commitments by pursuing a favorable court decision to their JFR. Some factors may be driving this behavior: (1) most farmers in Brazil do not produce a complete set of financial statements on accrual bases, which may lead to errors and incomplete information; (2) not all farmers’ debt is registered at the Central Bank, making debt consolidation a challenging discovery process to lenders, who may overleverage clients; (3) farm revenues are concentrated in only a few weeks of the year, allowing farmers that file for Judicial Recovery to carry on with their business, if the courts halt service of previous debt; (4) courts have also allowed these farmers to release assets from collateralized loans. In sum, there may be inaccurate interpretation of the farmers’ financial condition due to incomplete information, and a component of moral hazard motivating large farmers filing prematurely for JFR in Brazil. The number and magnitude of these cases may generate negative consequences to agricultural credit costs and availability in the future.