so for this study in particular we
wanted to know
what was the financial toxicity that was
associated with people with a specific kind
of heart disease which is atherosclerotic of
ask a disease meaning heart attacks angina
and stroke
compared to that with the finest toxicity
associated with ah with a cancer diagnosis
and the reason for this was that
we've known for almost a decade now
that individuals with cancer
have high rates of finest toxicity
in fact that term for financial it
was first introduced by oncology researchers and
i believe two thousand and eleven
and i don't i think it was
officially coined in two thousand thirty but
most of the research done in the
space is done and cancer
and we've done
now a few studies on finest or
to city on heart disease
but there was always a question
of how to these two diagnoses and
patient populations actually contrast with each other
they're both the number one number two
causes of mortality in the u s
they also carry a lot of morbidity
with them and they are a big
strain other them financially but of course
including financially on both the patients and
their families
but to our knowledge there had not
been one study that actually compared
ah that's a head to head
individuals with cancer
only with a a cbd only which
is heart disease or people with both
and of course comparing it to to
individuals who had neither one of those
diseases
and this is what we went ahead
and did we we used a nationally
representative survey from the u s many
that our results could be expanded to
the entire country
and we created these for mutually exclusive
groups meaning you either don't have any
one of those diseases or you have
cancer but not heart disease heart disease
but not cancer where you have both
and this this this was the primary
am
the primary focus of our stay and
our findings were although a little heartbreaking
we're a little surprising which was that
for many of the measurements that we
had for financial is city including any
final complexity measure we found that individuals
with heart disease
are often have a little bit higher
rates and or higher odds of reporting
financial toxicity when compared with individuals with
cancer only
now it says reason as as it
was also shown in our results that
individuals with both diagnoses often have the
worse outcomes
so most of the questions actually years
revolve ah
or could be summarized in two two
main questions that we get the first
one is
what are we gonna do about this
or what can be done
and the second one is
does this
affects both cancer and heart disease equally
meaning not all cancers are the same
some cancers are operable and basically curable
others are long lasting some start in
adolescence or infancy and other start laden
and adulthood and the same for ago
the same thing goes for heart disease
not all heart cc is the same
of course we studied the once said
that are say born out of
atherosclerosis as a problem or a some
main as the main route of the
problem but there's other kinds of heart
disease for example arrhythmias or problems and
in the electric system of the heart
or we have for example heart failure
to and we have other things like
congenital to he says etc
so there's foster that is is quite
simple the first one is that we
just rounded
all kinds of cancer seem to one
and we studied only those types of
heart disease which happen in
a around the middle of adulthood which
are the ones that have a very
catastrophic ah
potential if you will
well within the paper though ah one
thing that we didn't do was we
did a bunch of sensitivity analyses this
means that we took subset of each
one of those groups and compared to
see the results in the same so
for example first we compared heart disease
to only the most import
didn't or the most prevalent cancer diagnosis
ah another thing that we did was
we took out some diagnoses and of
cancer that usually don't represent a lot
of or don't have a lot of
financial impact such as a small skin
cancer for temple on
so in that regard we were able
to show that are true results remained
this is not mean that heart disease
has the potential to always have a
higher financial toxicity towards patients and their
families it just shows that
the financial ecstasy experienced by individuals with
this kind of heart disease which is
the vast majority is at the very
least the same or maybe in some
cases greater than those experience with cancer
and this was a good a good
finding us to percent not because it's
not because it's
good on it's own or by itself
but because so much research has been
done cancer that if we were able
to show that we are seeing the
same kind of issues in heart disease
then there's the potential to do a
lot more for us to either alleviate
or take out finance
such as he out of the question
so i started with the second question
and the first question which is what
we do
going forward
the is
it's a rather complex question i'm there's
definitely things that we all can do
at different levels of care so for
example
cardiologists often are often asked what do
we do what can we do after
a we read the paper what can
we do on on clinic that same
day
and one of the most astonishing findings
again from the ecology research is that
most physicians actually don't talk to their
patients about their financial issues
so one thing that you can do
today as a physician is just to
talk to your to your patience
and it may be and oversimplistic answer
but the true the fact is that
the the case is all good more
complex than it would seem for example
speaking it as well know that speaking
about financial issues not necessarily financial topics
but specifically financial problems is subbed
eric too strong social desire real bias
which means that people don't really like
to tell other people expressing that physicians
if they're having money problems and the
other thing is that
a lot of people do what we
call cost reducing behaviors which is they
might say that everything is is fine
or on the face of it not
have a lot of
ah comments about whether or not they're
having financial issues but down the road
they might start
our practicing some of these cars producing
behaviors for example not taking their medications
when they're supposed to are taking less
medication to save on cost or not
refilling because of cost or delaying going
to the physician said they don't have
to pay
have a lot of visits or follow
of visits or if a test a
syndicated maybe they'll they'll postpone it or
they'll buy medicines from out the country
so that's just at a physician level
in terms of research though there's a
lot that we can also do to
better understand how to tackle this problem
for example in cardiology lg we have
basically no knowledge about what physicians actually
one know and to think about the
financial issues that their patients might be
having most physicians are we that we
know of think that if the physician
if the sorry if the patient is
insured the insurance would take care of
it but one thing that we've seen
in our work and in in the
ecology research in terms of
initial to city is that a phenomenon
with that we call under insurance is
is actually very prevalent this means that
people still have insurance and still have
difficulty paying the medical bills or
fantastic city as a whole so under
insurance can be a big blinding component
physicians who think that maybe if the
for is the patient is insured
i'm on the insurance will take care
of everything this sexually highlighted in our
paper because we also saw that individuals
the of the age of sixty five
meaning most of them being under the
care of medicare also have issues paying
medical bills at a far lower rate
than individuals less than sixty five but
rest assured the problem still there
i'm now
the other things are we could do
is try to developed tools to better
understand both who will in the future
be likely to develop final check to
see so we can act before it
happens and also tools which can be
the same or different tools to alleviate
the problem what's his there
and we're able to were able to
actually detected
and the third is
changes at the policy level i think
that the most important and strongest actions
are we can take a guess finest
or to city which in oncology research
is has been suggested to be
for us to to consider it as
if it was a side effect of
treatment just us as we would think
of side effects for humor therapy or
other treatments
i'm
the strongest
changes will come from policy changes but
those policy changes might be the ones
that take the long as taxi taken
to affect are going to affect so
as physicians as public health researchers or
healthcare professionals or roll they're still other
a we can do and our clinics
and towards our patients
to either prevent or diminish running toxicity
and specifically in quartermaster disease although it
also applies to algae and other fields
the other thing that we can do
to prevent france or to city is
prevention to try to live a healthier
lifestyle with know for example smoking ah
lack of exercise obesity having hypertension diabetes
obesity or obese it and high cholesterol
all these have a strong component
when it comes to lifestyle and the
choices of me ah tobacco use has
also been associated with at least favorite
shipped to percent of cash de da
she's so
when we talk directly to patients
is it's also a responsibility of the
patient that they take care of themselves
so that in preventing disease there with
a will be
an obvious decline in finance for to
city if that's the road that that
were able to persuade them to it
clinicians today can take action into talking
to their patients because there's a lot
that we can do as positions to
be more
conscious of what we tell patients to
do or what be prescribed them either
and as medications or tests or follow
ups
the where we can help a lot
for example of eso si sub is
a wonderful example because lot of the
medications that we give with a couple
of exceptions are relatively cheap so
in speaking with patients we can quickly
maybe take out some medication some ramifications
and replace him with generic for it's
apple
two
to alleviate some of the burden that
they may be experiencing
there there are also in some health
systems
other people who may not be health
professional themselves that can help there are
social services there are
asif
late i guess there are also financial
navigators within health systems that physicians can
refer to or or can ask help
from they can help patients navigate the
system without having so many so many
issues that could at the end of
the day translate into
what could be furnished access your a
high financial burden
hum but the main thing is to
talk to their patients
there are several different venues that we're
pursuing so right now we're trying to
understand ah i believe i said little
bit about this before
we are trying to understand from a
patient perspective what it is that what
attributes patients have before they have heart
disease that could later turn those patients
into patients who have them and their
families develop or half finished the city
the other thing is that we need
to understand also
further facetious perspective what are their thoughts
and comments and usual practices one it
and when it comes into sorry it
when it comes to talking about health
finances were their patients
this is a bit of her of
a tricky situation because it's one thing
to do this with patients in your
clinic whereas it's a different ballgame when
you see a pigeon for example at
the hospital with a recent heart attack
for example
i haven't we have yet to also
understand again in court of as for
medicine how does this affect families as
a whole most of our research is
done both at the individual and at
the family level but there are also
other things that we need to dive
deeper into the can give us with
a better claire
already have one what the issue or
what the issues are and to how
to go about that for example
we have no idea and about your
disease what the caregiver burden is for
those who take care of people who
have heart disease and who need help
or needed a caretaker
i'm
in terms of the tools that we
were mentioning before were actively working towards
developing tools for
for prevention of find success city meaning
trying to identify the components that would
likely take someone into violence or to
city and then stop it right there
and then and the other is
a big branch where we're trying to
identify fantastic city where
where it might already be settled or
when we know that it's practically or
virtually there but maybe sometimes even the
patient doesn't really know i'm
so these are the venues and the
third one i guess would be for
us to work to somehow
i'm
work alongside health systems and health institute
to start getting this at a broader
level implemented so that we can potentially
get this too
two policy levels
ah
so what i believe oncologist and cardiologist
should know from this data doesn't really
it doesn't really come from this one
paper the literature is filled with the
the very
unfortunate events that we see that have
that people with for netflix city have
both in oncology research and cardiology which
seen that the prevalence is sometimes you
than half or more than half of
people who have finance which city with
either one of these two broad diagnoses
and so
sometimes you expand the a subsidy definition
to include delayed care for gone care
costs related not adherence of medications
these are things that are truly pervasive
and we believe that they've been actually
growing over time
so
more than this one paper i believe
that in general
we're still at a phase where we've
made a lot of
advance in this particular area of of
health and health economics but at at
the same level or at same time
i believe we are still trying to
demonstrate what the depth and with of
the problem is and
i believe every physician who reads these
kind of papers should go regardless of
what the up for this the special
but he has heard the patient appreciably
the take care of they should really
take away
that these are issues that a lot
of people have if not most in
carbon the casserole then at least have
in in the cardiovascular disease area
and that this is even more pervasive
then we think it is largely because
this is a family issue
income is usually distributed a family level
so this potentially could be affecting a
lot more people than we think so
it is on us to develop the
research to try to tackle this problem
as a whole but it is also
on us as caretakers or healthcare professionals
to look after patients
to identify either if the problems there
or to try to mitigate and as
a whole