Financially Toxic Cancer Care

Financial toxicity in gynecologic oncology

https://tinyurl.com/y3u3euna

Financial toxicity is increasingly recognised as an adverse outcome of cancer treatment.  For 240 respondents, financial toxicity was correlated with worse self-reported health. 

Government-sponsored health insurance, lower income, and treatment with chemotherapy were significantly associated with high financial toxicity. Amongst those with excellent insurance coverage and high reported incomes, many respondents reported high levels of financial toxicity.

High financial toxicity was significantly associated with worse self-reported overall health and cost-coping strategies, including delaying or avoiding care. Health insurance does not eliminate financial distress or health disparities for cancer patients.

Recurrent ovarian cancer, how to cope.

A Letter to My Newly Diagnosed Self

https://tinyurl.com/yxhp2x7u

"Women with stage 4 ovarian cancers live with the fear of recurrence. It’s not a question of if, but when. When it does happen, strange as it sounds, it’s almost a relief. Certainly anticlimactic; we’re old hands at this.

If I could go back three and a half years and give advice to my newly diagnosed self, what would I say?

Have hope. But also be realistic. Be prepared to deal with the disappointment and anger

Losing your hair again sucks.

Advocate for yourself. Be an active member of your care team, research the treatments your doctor recommends and ask questions about them.

Don’t endure poor customer service. Stand your ground. Stand up for yourself. This isn’t about being liked. It’s about your health.

Change the conversation in your head from worst-case scenario to a focus on blessings. Think more about others and less about yourself.

In remission don’t waste those days worrying about the next recurrence. Thank God for the blessing of each day. Make each day count. Live and live well".

Incurable. Me? I don’t believe you.

Willingness to Bear Adversity and Beliefs About the Curability of Advanced Cancer in Older Adults

https://tinyurl.com/y6dr9l7u

Telling patients that their cancer is incurable is difficult; many patients refuse to accept this, which makes them vulnerable to inappropriate therapy. 

Reluctance to accept reality seems related to a patient’s beliefs and values, which override scientific data.

500 patients aged 70-96 years, previously informed that they had incurable cancer, were surveyed. 5% thought there was a 100% chance that their cancer would be cured and nearly a quarter of patients estimated their chances of cure as 50% or greater.

Many medical interventions are potentially harmful, but patients seem willing to bear these consequences because they think it will be curative. To help older patients with advanced cancer understand the truth, their preferences, values, emotions, and fears need to be understood.

Intra peritoneal therapy fails RCT

Randomized Trial of Intravenous Versus Intraperitoneal Chemotherapy Plus Bevacizumab in Advanced Ovarian Carcinoma: An NRG Oncology/Gynecologic Oncology Group Study

https://tinyurl.com/y3wcwmby

Intra peritoneal (IP) therapy for high-grade ovarian cancer seemed a good idea. Metastasis to the peritoneum occurs early, direct treatment was thought to improve outcomes.

However, the reality is that IP therapy is intrusive and painful, with high complication rates and toxicity. A randomised trial compared intravenous (IV) chemo alone with two groups, both receiving the same IV therapy as the control; and in addition, one IP chemo weekly and the other IP chemo every 3 weeks.

No benefit, measured as increased progression free survival, was recorded in any of the 3 groups. The quality of life, as measured by functional assessment (FACT-O), was significantly worse in those receiving IP therapy.