ABSTRACT
Purpose: Describe associations between changes in employment during the COVID-19 pandemic and financial toxicity among adolescent and young adult (AYA) cancer patients and survivors. Methods: Eligible individuals were diagnosed between 15-39 years of age, currently age ≥18, and recruited through the Huntsman-Intermountain Adolescent and Young Adult Cancer Care Program. We sent the survey to N=709. Survey questions included demographics, employment, and the 11-item COmprehensive Score for financial Toxicity (COST) which captures financial toxicity in the last four weeks. COST is scored from 0 to 44 with lower scores indicating greater financial toxicity. Scores were dichotomized as high (0-21) or low (22-44). Changes in employment since March 2020 were categorized as no change, increase in hours, and decrease in hours/lost job. We calculated descriptive statistics and fit a multivariable logistic regression to examine the association between employment change and financial toxicity controlling for current age, gender, and treatment status. Results: Of 280 respondents (39.5% participation), 198 (70.7%) were employed prior to the pandemic and were thus included in analyses. Employed individuals were a mean of 29.4 years of age (range 18-58), 64.3% were female, and 50.5% had received cancer treatment since March 2020. Nearly a third (31.3%) had lost their job or reported reduced hours;50.3% reported high financial toxicity. Among those previously employed, participants who lost their job or had their hours reduced had nearly six times the odds of high financial toxicity than those who reported no change in hours (Odds Ratio [OR]=5.8, 95% Confidence Interval [CI]: 2.6-12.9). In the same model, the odds of reporting high financial toxicity was over twice as high among females than males (OR=2.3, 95% CI: 1.2-4.5). Treatment status and age were not significant. Conclusions: Employment changes during the COVID-19 pandemic resulted in increased financial toxicity among a population already susceptible to high financial hardship. Societal gender inequity appears to be mirrored in participants' financial toxicity during the pandemic. Employment interventions for patients and survivors of AYA cancers who have experienced job loss or reduction in work hours during the pandemic are needed and may particularly benefit females.
ABSTRACT
Purpose: To describe adolescent and young adult (AYA) cancer patients' and survivors' experiences with telehealth during the COVID-19 pandemic. Methods: Eligible participants were identified through the Huntsman Intermountain Adolescent and Young Adult Cancer Care Program, which provides age-specific programming and patient navigation to AYA cancer patients and survivors in Utah and surrounding Mountain West states. Participants were emailed an online survey if they were currently age 18 or older and had been diagnosed with cancer between the ages of 15-39 years. We applied descriptive statistics to summarize demographics, comfortability with technology, access to reliable internet connection, and perceived quality of care while using telehealth. Results: AYAs (N=280) were an average of 29.4 years old at survey (range 18-58);65.2% were female and 82.4% non-Hispanic white. Over half (54.2%) had received cancer treatment since March 2020. All participants reported owning a computer, tablet, and/or smart phone they could use for telehealth appointments. The majority (93.5%) reported almost always or always having a reliable internet connection. AYAs felt most comfortable having a telehealth appointment in their own home (96.4%);only 12.5% felt comfortable using telehealth at work. Since March 2020, (N=183) 65.4% had a health care visit moved to a telehealth platform due to COVID-19. Of those who recently moved to telehealth, 60.1% had an oncology visit, 33.9% had a primary care visit, and 31.1% had a mental health visit. Additionally over one-third (35.2%) reported the quality of their medical care had decreased since moving to telehealth. This was most commonly due to 1) troubles with audio, video, or connecting through telehealth platforms;2) telehealth visits feeling impersonal;and 3) feeling that providers more easily dismissed or did not fully address their symptoms. Conclusions: Although AYAs are digital natives, over one third of AYAs feel the quality of their medical care has decreased since moving to telehealth for COVID-19. Further research should explore medical provider training in using telehealth systems and encourage telehealth practices that help AYAs feel more supported and understood.
ABSTRACT
Objective: We sought to identify factors that contributed to proceeding with ART following the COVID-19 shutdown. Design: Retrospective cohort study. Materials and Methods: Patients who had planned an IVF cycle or frozen embryo transfer between March 2019 and April 27th, 2020, but had not yet undergone their treatment prior to the COVID-19 shutdown were included in this study. Patient demographics were collected including age, parity, AMH, AFC, history of prior IVF cycles or transfer, and number of frozen blastocysts. Data on gamete source and use of a gestational carrier was included. When IVF was resumed, patient decision to move forward with treatment or delay was recorded. Chi-square tests and Wilcoxon rank sum tests were used to assess the association between proceeding with ART treatment for categorical variables or non-parametrically distributed continuous variables, as appropriate. Results: A total of 145 patients planning FET and 133 patients planning a fresh cycle were offered the option to restart treatment. In total, 62% of all patients desired to initiate treatment. Of the 133 fresh cycles, 69 (52%) patients proceeded immediately, compared to 104 of the 145 FET cycles (72%). Among the fresh cycles, there was a trend toward older age among those who moved forward (37 vs 35;p=0.05). FET cycles using a gestational carrier were more likely to continue to delay treatment (7% vs 1 % p=0.04). Conclusions: The majority of patients whose IVF treatment was delayed with the COVID-19 pandemic shut down desired to resume treatment immediately when able. Those proceeding and delaying were similar with regards to most prognostic factors. Older age, however, showed a trend towards moving forward with a fresh IVF cycle and gestational carrier use was associated with continuing to pause on a transfer. While some patients voiced financial or health related concerns, the majority did not provide concrete reasons why they chose to delay or forgo treatment. Further research is needed to understand the reasons patients choose to proceed with fertility treatment in the setting of a pandemic, including more robust data on financial and personal or family health concerns. [Formula presented]