PubMed · 10169996
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T L Chin. 1997. Breaking new ground.. https://pubmed.ncbi.nlm.nih.gov/10169996/
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BACKGROUND: The oral complications and morbidity resulting from overall cancer therapy utilizing radiation, chemotherapy, and/or stem cell transplantation can have significant impact on a patient's health, quality of life, cost of care, and cancer management. There has been minimal health services research focusing on the status of medically necessary, oral supportive services at US cancer centers. METHODS: A pre-tested, survey questionnaire was distributed to the directors of National Cancer Institute (NCI)-designated comprehensive cancer centers to assess each institution's resource availability and clinical practices, as it relates to the prevention and management of oral complications during cancer treatment. RESULTS: Sixteen of the 39 comprehensive cancer centers responded to the survey. Of the respondents, 56% of the centers did not have a dental department. The sites of delivery of oral supportive care services range from the provision of in-house dental care to community-based, private practice sites. No standard protocols were in place for either oral preventive care or for supportive services for oral complications during or after cancer therapy. Fifty percent of the responding comprehensive cancer centers reported orally focused research and/or clinical trial activities. CONCLUSIONS: Comprehensive cancer care must include an oral care component, particularly for those cancer patients who are at high risk for oral complications. This requires a functional team of oral care providers collaborating closely within the oncology team. Considering the number of cancer patients receiving aggressive oncologic treatment that may result in oral toxicity, the impact of oral conditions on a compromised host, and the potential lack of appropriate resources and healthcare personnel to manage these complications, future research efforts are needed to identify the strengths and weaknesses of present oral supportive care delivery systems at both NCI-designated cancer centers and community-based oncology practices.
BACKGROUND: Limited evidence exists regarding the relationship between literacy and health-related quality of life (HRQL). Research is needed to develop measurement techniques for low literacy populations and to evaluate potential literacy-related measurement bias. METHODS: A Talking Touchscreen (TT) was developed for an HRQL study. Low (n = 214) and high literacy (n = 201) adult cancer outpatients participated, 70% of whom were from racial/ethnic minorities. Patients completed three questionnaires by TT: FACT-G (cancer-specific), SF-36 (generic health status), and a standard gamble utility questionnaire. Measurement bias was evaluated using item response theory (IRT). Effects of literacy on HRQL were evaluated using regression models. RESULTS: Most (97%) patients rated the TT easy to use. In IRT analysis, 6/27 FACT-G and 12/31 SF-36 items demonstrated literacy bias; this was relatively balanced (10 items 'biased against' low literacy; 8 'biased against' high literacy). Mean literacy group differences were statistically and clinically non-significant for 9/14 HRQL outcomes. Adjustment for bias and/or covariates eliminated most remaining differences. CONCLUSIONS: The TT is valid and useful for HRQL assessment in low literacy populations. There appears to be no systematic literacy bias in reporting HRQL, and low literacy is not an independent risk factor for poorer HRQL.
PURPOSE: The role of patient assistance programs and patient advocacy foundations as a safety net for Americans without health insurance or with inadequate insurance, the financial impact of 14 years of experience promoting enrollment in such programs at a cancer treatment center, and resources and strategies that pharmacists can use to increase patient enrollment and access to needed medications are discussed. SUMMARY: Various patient assistance programs and patient advocacy foundations offer financial and other support for patients who need help obtaining prescription medications because they lack health insurance or their insurance fails to meet their needs. Patients must complete an application and provide personal financial information. Efforts by a pharmacist at a cancer treatment center to enroll patients in such programs produced a marked reduction in write-offs over a 14-year period. Pharmacists can promote patient enrollment in assistance programs by screening for costly drugs and patients who are likely to have difficulty obtaining these drugs. These patients include those who exceed Medicaid coverage or for whom Medicaid coverage is pending, patients without any health insurance, patients without a prescription drug benefit, patients for whom the planned drug therapy is not covered by insurance, and patients enrolled in charity programs. CONCLUSION: Patient assistance programs and patient advocacy foundations provide a valuable safety net to ensure that Americans without health insurance or with inadequate coverage receive needed prescription medications.