Financial Toxicity and Its Association With Prostate and Colon Cancer Screening.

BACKGROUND: The term "financial toxicity" or "hardship" is a patient-reported outcome that results from the material costs of cancer care, the psychological impacts of these costs, and the coping strategies that patients use to deal with the strain that includes delaying or forgoing care. However, little is known about the impact of financial toxicity on cancer screening. We examined the effects of financial toxicity on the use of screening tests for prostate and colon cancer. We hypothesized that greater financial hardship would show an association with decreased prevalence of cancer screening. METHODS: This cross-sectional survey-based US study included men and women aged ≥50 years from the National Health Interview Survey database from January through December 2018. A financial hardship score (FHS) between 0 and 10 was formulated by summarizing the responses from 10 financial toxicity dichotomic questions (yes or no), with a higher score associated with greater financial hardship. Primary outcomes were self-reported occurrence of prostate-specific antigen (PSA) blood testing and colonoscopy for prostate and colon cancer screening, respectively. RESULTS: Overall, 13,439 individual responses were collected. A total of 9,277 (69.03%) people had undergone colonoscopies, and 3,455 (70.94%) men had a PSA test. White, married, working men were more likely to undergo PSA testing and colonoscopy. Individuals who had not had a PSA test or colonoscopy had higher mean FHSs than those who underwent these tests (0.70 and 0.79 vs 0.47 and 0.61, respectively; P≤.001 for both). Multivariable logistic regression models demonstrated that a higher FHS was associated with a decreased odds ratio for having a PSA test (0.916; 95% CI, 0.867-0.967; P=.002) and colonoscopy (0.969; 95% CI, 0.941-0.998; P=.039). CONCLUSIONS: Greater financial hardship is suggested to be associated with a decreased probability of having prostate and colon cancer screening. Healthcare professionals should be aware that financial toxicity can impact not only cancer treatment but also cancer screening.

Association of Race With Cancer-Related Financial Toxicity.

PURPOSE: We investigated the association between race and FT among previous patients with cancer. Studies show that patients with cancer experience financial toxicity (FT) because of their cancer treatment. METHODS: Data on individuals with a cancer history were collected in this cross-sectional study during 2012, 2014, and 2017, from the US Health Information National Trends Survey. This survey is conducted by mail with monetary compensation as an incentive. We specifically assessed responses to two questions: Has cancer hurt you financially? Have you been denied health insurance because of cancer? Multivariable logistic regression analyses were used to assess the associations between these questions and race. RESULTS: Of 10,592 individuals participating, 1,328 men and women (12.5%) with a cancer history were assessed. Compared with Blacks, Whites were found to have a higher rate of insurance (95.4% v 90.0%), were more likely to receive cancer treatment (93.9% v 85%), and had a higher rate of surgical treatment than Blacks (77% v 60%), Hispanics (55%), and others (77%, 60%, 55%, and 74.2%, respectively, P < .001). On multivariable analysis, Blacks were more than five times as likely to be denied insurance (odds ratio, 5.003; 95% CI, 2.451 to 10.213; P < .001) and more than twice as likely to report being hurt financially because of cancer (odds ratio, 2.448; 95% CI, 1.520 to 3.941; P < .001) than Whites. Of all cancer groups analyzed (genitourinary, gynecologic, gastrointestinal, and breast), genitourinary malignancies were the only group in which the rate of reporting being hurt financially varied in a statistically significant manner (Whites 36.7%, Hispanics 62.5%, and Blacks 59.3%, P = .004). CONCLUSION: Our data suggest that race is significantly associated with FT because of cancer. Awareness of racial inequality with regards to FT should be raised among health care workers.

Family Welfare Effort, Total Fertility, and In Vitro Fertilization: Explaining the Israeli Anomaly.

The theory of family welfare effort is a leading macro-sociological explanation of variation in human fertility. It holds that states which provide universally available, inexpensive, high-quality day care, generous parental leave, and flexible work schedules lower the opportunity cost of motherhood. They thus enable women, especially those in lower socioeconomic strata, to have the number of babies they want. A considerable body of research supports this theory. However, it is based almost exclusively on analyses of Western European and North American countries. This paper examines the Israeli case because Israel's total fertility rate is anomalously high given its family welfare effort. Based on a review of the relevant literature and a reanalysis of data from various published sources, it explains the country's unusually high total fertility rate as the product of (1) religious and nationalistic sentiment that is heightened by the Jewish population's perception of a demographic threat in the form of a burgeoning Palestinian population and (2) the state's resulting support for pro-natal policies, including the world's most extensive in vitro fertilization (IVF) system. The paper also suggests that Israel's IVF policy may not be in harmony with the interests of many women insofar as even women with an extremely low likelihood of becoming pregnant are encouraged to undergo the often lengthy, emotionally and physically painful, and risky process of IVF.

La théorie de l'effort pour le bien-être familial est une explication macrosociologique majeure de la variation de la fécondité humaine. Cette théorie soutient l'idée que les États offrant des garderies universellement accessibles, peu coûteuses et de grande qualité, des congés parentaux généreux et des horaires variables réduisent le coût d'opportunité de la maternité. Ces États permettent ainsi aux femmes, en particulier celles appartenant à des strates socioéconomiques inférieures, d'avoir le nombre d'enfants qu'elles souhaitent. Un nombre considérable de recherches appuient cette théorie. Cependant, elle repose presque exclusivement sur des analyses des pays d'Europe occidentale et d'Amérique du Nord. Cet article examine le cas israélien parce que l'indice synthétique de fécondité d'Israël est anormalement élevé compte tenu de ses efforts en matière de bien-être familial. Reposant sur un examen de la littérature appropriée et d'une nouvelle analyse des données provenant de diverses sources publiées, il explique l'indice synthétique de fécondité anormalement élevé du pays comme le résultat: (1) d'un sentiment religieux et nationaliste renforcé par la perception par la population juive d'une menace démographique au vu d'une population palestinienne croissante et (2) du soutien que l'État apporte aux politiques natalistes, notamment grâce au système de fécondation in vitro le plus important au monde. Cet article suggère également que la politique israélienne de fécondation in vitro ne correspond peut-être pas aux intérêts de nombreuses femmes dans la mesure où l'on encourage même les femmes ayant une probabilité extrêmement faible de devenir enceintes à avoir recours au processus de la fécondation in vitro souvent long et douloureux sur les plans émotionnel et physique ainsi que risqué.