How cancer programs identify and address the financial burdens of rural cancer patients

Victoria Petermann; Whitney E. Zahnd; Robin C. Vanderpool; Jan M. Eberth; Catherine Rohweder; Randall Teal; Maihan Vu; Lindsay Stradtman; Elizabeth Frost; Erika Trapl; Sarah Koopman Gonzalez; Thuy Vu; Linda K. Ko; Allison Cole; Paige E. Farris; Jackilen Shannon; Jessica Lee; Natoshia Askelson; Laura Seegmiller; Arica White; Jean Edward; Melinda Davis; Stephanie B. Wheeler

doi:10.1007/s00520-021-06577-z

How cancer programs identify and address the financial burdens of rural cancer patients

Victoria Petermann, Whitney E. Zahnd, Robin C. Vanderpool, Jan M. Eberth, Catherine Rohweder, Randall Teal, Maihan Vu, Lindsay Stradtman, Elizabeth Frost, Erika Trapl, Sarah Koopman Gonzalez, Thuy Vu, Linda K. Ko, Allison Cole, Paige E. Farris, Jackilen Shannon, Jessica Lee, Natoshia Askelson, Laura Seegmiller, Arica WhiteJean Edward, Melinda Davis, Stephanie B. Wheeler

College of Nursing

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Purpose: Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. Methods: Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. Results: We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns. Conclusions: Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

Original language	English
Pages (from-to)	2047-2058
Number of pages	12
Journal	Supportive Care in Cancer
Volume	30
Issue number	3
DOIs	https://doi.org/10.1007/s00520-021-06577-z
State	Published - Mar 2022

Bibliographical note

Funding Information:
Stephanie B. Wheeler has received grant funding paid to her institution from Pfizer Foundation in the past 3 years. All other authors report no conflict of interests.

Funding Information:
This study was funded by the Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Numbers (U48-DP005017, U48-DP005053, U48-DP005014, U48-DP005030, U48-DP005013, U48-DP005006, U48-DP005021) from the Centers for Disease Control and Prevention. CHAI Core is funded by the UNC Gillings School of Global Public Health Nutrition Obesity Research Center through NIH (DK056350) and the UNC Lineberger Comprehensive Cancer Center through NCI (P30-CA16086). Victoria Petermann is supported by the Rita and Alex Hillman Foundation and the UNC Lineberger Cancer Control Education Program T32 (T32CA057726-27). Dr. Melinda Davis’s time was supported in part by a Cancer Prevention, Control, Behavioral Sciences, and Populations Sciences Career Development Award from the National Cancer Institute (K07CA211971). The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Hillman Foundation, or the National Institutes of Health.

Funding Information:
Participants also discussed external resources they were aware of outside their cancer program. External resources described by participants across the rural–urban continuum included the American Cancer Society, transportation services, pharmaceutical assistance programs, foundations (public/private, local/state/national), local agencies, community-based cancer associations, outreach services, and support groups. Compared to their rural counterparts, participants from urban cancer programs more often mentioned connecting patients with resources through national societies and organizations (e.g., Leukemia and Lymphoma Society) and external resources to assist with non-medical costs such as utility bills, rent or mortgage payments, food, and gas. Participants from rural cancer programs more frequently mentioned utilizing financial assistance programs through churches, pharmaceutical patient assistance programs, and the Department of Social Services.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

Cancer
Financial assistance
Financial toxicity
Navigation
Oncology
Rural

ASJC Scopus subject areas

Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s00520-021-06577-z

Cite this

Petermann, V., Zahnd, W. E., Vanderpool, R. C., Eberth, J. M., Rohweder, C., Teal, R., Vu, M., Stradtman, L., Frost, E., Trapl, E., Koopman Gonzalez, S., Vu, T., Ko, L. K., Cole, A., Farris, P. E., Shannon, J., Lee, J., Askelson, N., Seegmiller, L., ... Wheeler, S. B. (2022). How cancer programs identify and address the financial burdens of rural cancer patients. Supportive Care in Cancer, 30(3), 2047-2058. https://doi.org/10.1007/s00520-021-06577-z

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title = "How cancer programs identify and address the financial burdens of rural cancer patients",

abstract = "Purpose: Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs{\textquoteright} perceptions of rural–urban differences in cancer patients{\textquoteright} experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. Methods: Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. Results: We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients{\textquoteright} experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients{\textquoteright} financial concerns. Conclusions: Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.",

keywords = "Cancer, Financial assistance, Financial toxicity, Navigation, Oncology, Rural",

author = "Victoria Petermann and Zahnd, {Whitney E.} and Vanderpool, {Robin C.} and Eberth, {Jan M.} and Catherine Rohweder and Randall Teal and Maihan Vu and Lindsay Stradtman and Elizabeth Frost and Erika Trapl and {Koopman Gonzalez}, Sarah and Thuy Vu and Ko, {Linda K.} and Allison Cole and Farris, {Paige E.} and Jackilen Shannon and Jessica Lee and Natoshia Askelson and Laura Seegmiller and Arica White and Jean Edward and Melinda Davis and Wheeler, {Stephanie B.}",

note = "Funding Information: Stephanie B. Wheeler has received grant funding paid to her institution from Pfizer Foundation in the past 3 years. All other authors report no conflict of interests. Funding Information: This study was funded by the Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Numbers (U48-DP005017, U48-DP005053, U48-DP005014, U48-DP005030, U48-DP005013, U48-DP005006, U48-DP005021) from the Centers for Disease Control and Prevention. CHAI Core is funded by the UNC Gillings School of Global Public Health Nutrition Obesity Research Center through NIH (DK056350) and the UNC Lineberger Comprehensive Cancer Center through NCI (P30-CA16086). Victoria Petermann is supported by the Rita and Alex Hillman Foundation and the UNC Lineberger Cancer Control Education Program T32 (T32CA057726-27). Dr. Melinda Davis{\textquoteright}s time was supported in part by a Cancer Prevention, Control, Behavioral Sciences, and Populations Sciences Career Development Award from the National Cancer Institute (K07CA211971). The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Hillman Foundation, or the National Institutes of Health. Funding Information: Participants also discussed external resources they were aware of outside their cancer program. External resources described by participants across the rural–urban continuum included the American Cancer Society, transportation services, pharmaceutical assistance programs, foundations (public/private, local/state/national), local agencies, community-based cancer associations, outreach services, and support groups. Compared to their rural counterparts, participants from urban cancer programs more often mentioned connecting patients with resources through national societies and organizations (e.g., Leukemia and Lymphoma Society) and external resources to assist with non-medical costs such as utility bills, rent or mortgage payments, food, and gas. Participants from rural cancer programs more frequently mentioned utilizing financial assistance programs through churches, pharmaceutical patient assistance programs, and the Department of Social Services. Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2022",

month = mar,

doi = "10.1007/s00520-021-06577-z",

language = "English",

volume = "30",

pages = "2047--2058",

number = "3",

}

Petermann, V, Zahnd, WE, Vanderpool, RC, Eberth, JM, Rohweder, C, Teal, R, Vu, M, Stradtman, L, Frost, E, Trapl, E, Koopman Gonzalez, S, Vu, T, Ko, LK, Cole, A, Farris, PE, Shannon, J, Lee, J, Askelson, N, Seegmiller, L, White, A, Edward, J, Davis, M & Wheeler, SB 2022, 'How cancer programs identify and address the financial burdens of rural cancer patients', Supportive Care in Cancer, vol. 30, no. 3, pp. 2047-2058. https://doi.org/10.1007/s00520-021-06577-z

TY - JOUR

T1 - How cancer programs identify and address the financial burdens of rural cancer patients

AU - Petermann, Victoria

AU - Zahnd, Whitney E.

AU - Vanderpool, Robin C.

AU - Eberth, Jan M.

AU - Rohweder, Catherine

AU - Teal, Randall

AU - Vu, Maihan

AU - Stradtman, Lindsay

AU - Frost, Elizabeth

AU - Trapl, Erika

AU - Koopman Gonzalez, Sarah

AU - Vu, Thuy

AU - Ko, Linda K.

AU - Cole, Allison

AU - Farris, Paige E.

AU - Shannon, Jackilen

AU - Lee, Jessica

AU - Askelson, Natoshia

AU - Seegmiller, Laura

AU - White, Arica

AU - Edward, Jean

AU - Davis, Melinda

AU - Wheeler, Stephanie B.

N1 - Funding Information: Stephanie B. Wheeler has received grant funding paid to her institution from Pfizer Foundation in the past 3 years. All other authors report no conflict of interests. Funding Information: This study was funded by the Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Numbers (U48-DP005017, U48-DP005053, U48-DP005014, U48-DP005030, U48-DP005013, U48-DP005006, U48-DP005021) from the Centers for Disease Control and Prevention. CHAI Core is funded by the UNC Gillings School of Global Public Health Nutrition Obesity Research Center through NIH (DK056350) and the UNC Lineberger Comprehensive Cancer Center through NCI (P30-CA16086). Victoria Petermann is supported by the Rita and Alex Hillman Foundation and the UNC Lineberger Cancer Control Education Program T32 (T32CA057726-27). Dr. Melinda Davis’s time was supported in part by a Cancer Prevention, Control, Behavioral Sciences, and Populations Sciences Career Development Award from the National Cancer Institute (K07CA211971). The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Hillman Foundation, or the National Institutes of Health. Funding Information: Participants also discussed external resources they were aware of outside their cancer program. External resources described by participants across the rural–urban continuum included the American Cancer Society, transportation services, pharmaceutical assistance programs, foundations (public/private, local/state/national), local agencies, community-based cancer associations, outreach services, and support groups. Compared to their rural counterparts, participants from urban cancer programs more often mentioned connecting patients with resources through national societies and organizations (e.g., Leukemia and Lymphoma Society) and external resources to assist with non-medical costs such as utility bills, rent or mortgage payments, food, and gas. Participants from rural cancer programs more frequently mentioned utilizing financial assistance programs through churches, pharmaceutical patient assistance programs, and the Department of Social Services. Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2022/3

Y1 - 2022/3

N2 - Purpose: Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. Methods: Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. Results: We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns. Conclusions: Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

AB - Purpose: Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. Methods: Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. Results: We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns. Conclusions: Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

KW - Cancer

KW - Financial assistance

KW - Financial toxicity

KW - Navigation

KW - Oncology

KW - Rural

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JO - Supportive Care in Cancer

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How cancer programs identify and address the financial burdens of rural cancer patients

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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