Financial toxicity among cancer patients, survivors and their families in the United Kingdom: a scoping review.

BACKGROUND: The aim of this scoping review was to identify key research gaps and priorities in order to advance policy and practice for people living with cancer in the UK. METHODS: The review adhered to PRISMA guidelines for scoping review. We searched MEDLINE, EMBASE, Scopus, Web of Science and Google Scholar on 16 July 2022. There were no restrictions in terms of study design and publication time; gray literature was included. The key words, 'financial' or 'economic', were combined with each of the following words 'hardship/stress/burden/distress/strain/toxicity/catastrophe/consequence/impact.' RESULTS: 29/629 studies/reports published during 1982-2022 were eligible to be included in the review. No study conducted a comprehensive inquiry and reported all aspects of financial toxicity (FT) or used a validated measure of FT. The most three commonly reported outcomes related to financial hardship were financial well-being (24/29), benefit/welfare (17/29) and mental health status (16/29). CONCLUSIONS: It is evident that FT is experienced by UK cancer patients/survivors and that the issue is under-researched. There is an urgent need for further research including rigorous studies which contribute to a comprehensive understanding about the nature and extent of FT, disparities in experience, the impacts of FT on outcomes and potential solutions to alleviate FT and related problems.

Cost-effectiveness of clinical breast examination screening programme among HER2-positive breast cancer patients: a modelling study.

PURPOSE: For many low- and middle-income countries (LMICs), breast cancer (BC) screening based on mammography is not a viable option. Clinical breast examination (CBE) may represent a pragmatic and cost-effective alternative. This paper examines the cost-effectiveness of CBE screening programme among a patient group for whom its cost-effectiveness is likely to be least evident (HER2-positive patients) and discuss the wider implications for BC screening in LMICs. METHODS: A Markov model was used to examine clinical and economic outcomes over a life-time horizon from the patient, public payer, and healthcare sector perspective. HER2-positive patients entered the model at either disease-free survival or metastatic BC state. The downstaging effect of CBE determined the starting probabilities in the no-screening and screening scenarios. The model used a monthly cycle length, with half-cycle correction. Costs and outcomes were discounted at 1.5% annually. RESULTS: Compared with no-screening, the cost-effectiveness ratio (ICER) per quality-adjusted life-year gained for the CBE screening programme was $1801, $2381, and $4179 from three mentioned perspectives, respectively. The finding of cost-effectiveness remained robust to a range of sensitivity analyses. The parameters to which ICERs are most sensitive are average age of cohorts, reduction in proportion of metastatic patients at diagnosis, cost of CBE, and BC detection rate of the programme. CONCLUSION: For HER2-positive patients and compared with no-screening, CBE screening programme in Vietnam is cost-effective from all investigated perspectives. CBE is a 'good value' intervention and should be considered for implementation throughout Vietnam as well as in LMICs where mammography is not feasible.

Establishing a tobacco control fund in Vietnam: some learnings for other countries.

In response to the need for stable and adequate funding for tobacco control and the shortage of personnel working in the field, the Vietnam Tobacco Control Fund (VNTCF) was established through the Law on Prevention and Control of Tobacco Harms in 2012. In September 2014, VNTCF awarded its first set of grants. Built on the local evidence-based context and needs as well as lessons learnt from other countries, VNTCF adapted best practices with adjustments that fit the country's political, economic and social environment. The key strengths of the VNTCF are the evidence-based model; multisectoral management; clearly dedicated funding mechanism, defined vision, objectives and function; outcomes based mechanism and a multisectoral approach to releasing grants. Although several challenges remain such as insufficient human resources to undertake the workload, complex and cumbersome administrative processes, and limited capacity for tobacco control in the country, VNTCF has achieved several successes. The establishment of VNTCF in Vietnam is a critical milestone within the country's fight against the tobacco epidemic. It showed not only the commitment of the local authorities to the fight but also their determination to ensure sustainable funding for tobacco control activities in Vietnam. Analysing VNTCF's critical success elements, key strengths and challenges is helpful for other countries which want to establish or modify a tobacco control fund.