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. 2021 Jun 15;3(2):236-246.
doi: 10.1016/j.jaccao.2021.02.006. eCollection 2021 Jun.

Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States

Javier Valero-Elizondo  1   2 , Fouad Chouairi  3 , Rohan Khera  3   4 , Gowtham R Grandhi  5 , Anshul Saxena  6 , Haider J Warraich  7   8 , Salim S Virani  9   10 , Nihar R Desai  3   4 , Farzan Sasangohar  2   11 , Harlan M Krumholz  3   4   12 , Nestor F Esnaola  13   14 , Khurram Nasir  1   2
Affiliations

Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States

Javier Valero-Elizondo et al. JACC CardioOncol. .

Abstract

Background: Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences.

Objectives: This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer.

Methods: From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost.

Results: The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population.

Conclusions: Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.

Keywords: ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CI, confidence interval; COST, Comprehensive Score for Financial Toxicity; CRF, cardiovascular risk factor; FT, financial toxicity; OOP, out-of-pocket; OR, odds ratios; atherosclerotic cardiovascular disease; cancer; financial toxicity; health economics.

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Conflict of interest statement

Dr. Virani has received grant funding from the Department of Veterans Affairs, World Heart Federation and the Jooma and Taher Family; has received an honorarium from the American College of Cardiology (Associate Editor for Innovations, acc.org); and is the member of a steering committee for the Patient and Provider Assessment of Lipid Management (PALM) registry at the Duke Clinical Research Institute (no financial remuneration). Dr. Krumholz has received research agreements from Medtronic and Johnson & Johnson (Janssen), through Yale, to develop methods of clinical trial data sharing; has received a grant from Medtronic and the Food and Drug Administration, through Yale, to develop methods for postmarket surveillance of medical devices and work under contract with the Centers for Medicare and Medicaid Services to develop and maintain performance measures that are publicly reported; is chair of a cardiac scientific advisory board for United Health; is a participant/participant representative of the IBM Watson Health Life Sciences Board; is a member of the Advisory Board for Element Science and the Physician Advisory Board for Aetna; and is the founder of Hugo, a personal health information platform. Dr. Nasir is on the advisory board of Amgen, Novartis, Medicine Company; and his research is partly supported by the Jerold B. Katz Academy of Translational Research. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Prevalence of Financial Toxicity Measures by Cancer and/or ASCVD Status, Among Non-Elderly Adults, From the National Health Interview Survey, 2013 to 2018 Any financial toxicity: any difficulty paying medical bills ± unable to pay bills at all ± high financial distress ± cost-related medication non-adherence ± food insecurity ± delayed/foregone care due to cost. The p value for linear trends was <0.001 for all financial toxicity prevalence measures when comparing disease groups. Data in this figure represents weighted prevalence (bars) with 95% confidence interval (error bars). ASCVD = atherosclerotic cardiovascular disease; NHIS = National Health Interview Survey.
Figure 1
Figure 1
Distribution of Total Burden From Financial Toxicity Measures, by ASCVD and/or Cancer Status, Among Non-Elderly Adults, From the National Health Interview Survey, 2013 to 2018 FT measures: any difficulty paying medical bills ± high financial distress ± cost-related medication non-adherence ± food insecurity ± delayed/foregone care due to cost. ASCVD = atherosclerotic cardiovascular disease; FT = financial toxicity; NHIS = National Health Interview Survey.
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References

    1. Lentz R., Benson A.B., 3rd, Kircher S. Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies. J Surg Oncol. 2019;120:85–92. - PubMed
    1. Financial toxicity (financial distress) and cancer treatment (PDQ®)–patient version. https://www.cancer.gov/about-cancer/managing-care/track-care-costs/finan... Available at: - PubMed
    1. Gordon L.G., Merollini K.M.D., Lowe A., Chan R.J. A systematic review of financial toxicity among cancer survivors: we can't pay the co-pay. Patient. 2017;10:295–309. - PubMed
    1. Altice C.K., Banegas M.P., Tucker-Seeley R.D., Yabroff K.R. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2017;109:djw205. - PMC - PubMed
    1. Yabroff K.R., Dowling E.C., Guy G.P., Jr. Financial hardship associated with cancer in the united states: findings from a population-based sample of adult cancer survivors. J Clin Oncol. 2016;34:259–267. - PMC - PubMed

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