Syed Mohammed Qasim Hussaini

PURPOSE: Financial toxicity is common after bone marrow transplant (BMT) and is associated with worse quality of life, but longitudinal patterns remain poorly understood. METHODS: We conducted a prospective cohort study of insured adults undergoing allogeneic BMT (2018-2023). Financial toxicity (Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy) and quality of life (Functional Assessment of Cancer Therapy [FACT]–General, FACT-BMT) were assessed at baseline and at days (D) 90, 180, and 365. Longitudinal trends were analyzed using mixed-effects models. Relative risks (RR) for financial toxicity and hazard ratios (HR) for post-BMT mortality were estimated using generalized linear mixed-effects and time-varying Cox models. RESULTS: Among 214 transplanted patients, the median age was 58 years (IQR 46-66 year), 62% were male, and 80% were White; 47% had leukemia, 27% myelodysplastic syndrome, and 9% lymphoma; and 31% died by D365. At baseline, 56% reported none/minimal, 26% mild, and 18% moderate/high financial toxicity. Financial toxicity was associated with more cost-cutting behaviors, including reduced spending on food or clothing, use of savings, and prescription nonadherence. Expected probability of ≥mild financial toxicity reduced over time (39% baseline, 34% D90, 30% D180, 26% D365). Across time points, age >65 years and income >$90,000 in US dollars (USD) had 66% and 67% decreased risk of financial toxicity, respectively, compared with counterparts (n = 148, RR, 0.34, 95% CI [0.19 to 0.59]; RR, 0.33 [0.20 to 0.57]). Quality of life (n = 119 alive and with data by D365) with none/minimal or mild financial toxicity improved after transplant compared with baseline but significantly worsened for those with moderate/high financial toxicity over 1 year. Following adjustment for covariables, financial toxicity was not significantly associated with premature death after transplant (n = 214, HR, 1.10 [0.62-1.96]). CONCLUSION: Financial toxicity improved overtime with BMT, but persistent financial hardship was associated with quality of life. These findings support longitudinal screening and financial interventions across the transplant continuum.

PURPOSE: Precision oncology has contributed to population-level improvements in cancer mortality, but patients in rural areas have not benefited as greatly from survival gains. Delivery of complex precision oncology strategies in resource-limited or rural areas can be challenging, and improvement is a priority to ensure access to these treatments for all patients. This scoping review synthesized existing evidence for precision oncology for solid tumors in the rural United States and identified areas for further research and health policy development. METHODS: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews was performed. We conducted a search of English-language publications from 2014 to 2026 in the PubMed and Scopus databases. RESULTS: In all, 34 of 842 studies identified met the inclusion criteria for analysis. Four primary themes were identified: (1) rural-urban disparities in precision oncology access and utilization, (2) patient experiences and perceptions of precision oncology, (3) provider perceptions of precision oncology, and (4) implementation and integration of precision oncology infrastructure into rural settings. CONCLUSION: This review highlights the need for (1) greater examination of regional and cultural differences in uptake and perceptions of precision oncology in the rural United States, (2) future care delivery studies, and (3) health policy efforts to promote accessible and sustainable precision oncology delivery.

PURPOSE: In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced Principal Illness Navigation (PIN) codes to provide provider reimbursement for patient navigation. However, a potential unintended consequence of these PIN codes is patient cost sharing. This study sought to understand patient perspectives on and willingness to pay for navigation services among patients with cancer. METHODS: This convergent, mixed-methods analysis used cross-sectional survey data from patients with cancer previously served by Patient Advocate Foundation (PAF; collected January 2025) and interview data from navigated patients with cancer at University of Alabama at Birmingham (collected January-July 2025). Surveys elicited respondent experiences with and willingness to pay for navigation services. Interviews explored patient experiences with navigation, including perceptions of funding and expenses. Surveys were analyzed descriptively, interviews were analyzed using a framework method, and quantitative and qualitative results were analyzed convergently. RESULTS: Of 565 survey respondents, 88% were aged ≥56 years, 33% were non-White, and 58% had annual household incomes of <$35,000 in US dollars (USD). Half of respondents (53%, n = 299) were interested in receiving navigation services, including 70% with prior navigation and 48% with no prior navigation. Respondents were most interested in receiving financial navigation (50% ranked as most interested), followed by nurse navigation (29%). Only 5% (n = 31) were willing to pay for navigation services, with a median out-of-pocket cost of $28 USD per month (IQR, $20-$45 USD). Factors influencing willingness to pay included affordability (cited by 30% of respondents), insurance coverage (12%), and perceived benefit/value of navigation (12%). Of 20 interviewed patients (mean age 60 years [IQR, 48-69], 40% non-White, 60% employed), navigation was emphasized as important for addressing health system complexities, decreasing distress or anxiety, and as part of the whole “package” of receiving cancer care, saying, “the mental health aspect of it is as important as the physical.” However, interviewees did not believe patients should be required to pay out of pocket for navigation services, stating, “you don't want to limit people [if] they can't pay.” Of the few patients who were willing to pay for navigation, cited amounts for a preferred “one-time fee/copay” were between $5 and $20 USD. CONCLUSION: Though new PIN codes may allow for sustainable provider reimbursement for navigation, patient cost sharing may affect usage and equity. Inclusion of patient perspectives during development and implementation of value-based payment reform efforts, as well as policy-level changes such as zero-dollar cost sharing, should be considered for successful uptake, equity, and sustainability.

Background: Survival disparities in prostate cancer are driven in part by social and economic factors, including housing insecurity. Rent subsidies in the form of federal housing assistance are a well-established strategy for alleviating housing insecurity, but their association with prostate cancer care and survival is unknown. Methods: Using linked federal housing assistance data, SEER cancer registry data, and Medicare claims, we assessed workup and treatment receipt and two-year survival among individuals aged 66 to 95 who were diagnosed with prostate cancer in 2007 to 2019. We used logistic and Cox regression models to compare outcomes between individuals receiving housing assistance upon prostate cancer diagnosis and a comparison group without housing assistance, using propensity score matching to balance sociodemographic and clinical characteristics. Results: There were 1,839 individuals with housing assistance (and 5,517 without assistance) included in the workup and treatment analyses and 4,451 individuals with housing assistance (and 13,353 without assistance) in the survival models. Receipt of housing assistance was not associated with guideline-concordant workup (62.7% vs 61.2%, OR 1.02 [95% CI 0.97, 1.07], p = 0.48) or active treatment (63.7% vs 62.2%, OR 1.02 [95% CI: 0.99, 1.06], p = 0.22) but was associated with improved overall survival in the 2 years following diagnosis (hazard ratio for mortality: 0.88 [95% CI: 0.81, 0.96]). Conclusions: Older adults receiving housing assistance at the time of a prostate cancer diagnosis experienced better overall survival than a matched comparison group without housing assistance. Results suggest that expanding access to housing assistance might support greater and more equitable survival in prostate cancer.

PURPOSE: Cancer survivors often experience financial hardship, negatively affecting quality of life, health care use, and survival. Health-related social needs (HRSNs)—such as food/housing insecurity and transportation barriers—are prevalent among survivors and may correlate with financial hardship. Research exploring associations between financial hardship and HRSNs is limited. This study quantifies these associations in a nationally representative US sample. METHODS: We identified adult cancer survivors from the 2013 to 2018 National Health Interview Survey. Medical financial hardship was defined as (1) problems paying medical bills, (2) worry about medical bills, or (3) delaying/forgoing care because of cost. HRSNs were defined as (1) food insecurity, (2) housing insecurity, and (3) transportation barriers to care. Multivariable logistic regression models were used to assess associations between financial hardship and each HRSN, controlling for socioeconomic characteristics. RESULTS: Among 13,626 cancer survivors, 4,623 (34.2%) reported medical financial hardship. Survivors with financial hardship were significantly more likely to report any HRSN compared with those without hardship (53.1% v 8.7%, adjusted odds ratio [aOR], 6.99 [95% CI, 6.06 to 8.07]). This association persisted across household income levels (interaction P = .58). Specifically, survivors with financial hardship were more likely to experience food insecurity (21.9% v 2.2%, aOR, 5.49 [95% CI, 4.38 to 6.87]), housing insecurity (44.6% v 6.4%, aOR, 7.14 [95% CI, 6.1 to 8.35]), and transportation barriers to care (6.6% v 1.1%, aOR, 3.1 [95% CI, 2.27 to 4.22]), than survivors without hardship. CONCLUSION: Medical financial hardship among cancer survivors is strongly associated with HRSNs, such as food, housing, and transportation insecurity, across income levels. These findings highlight the importance of systematic screening of financial hardship and HRSNs, along with providing comprehensive socioeconomic support to address the needs of all cancer survivors, regardless of their household income.

PURPOSE: Although financial toxicity from cancer care is well documented, how cancer and other high-mortality chronic diseases affect credit overuse and high-risk borrowing remains unknown. METHODS: We retrospectively analyzed households in the 2012-2018 Health and Retirement Study. Outcomes included nonhousing financial debt and credit card debt. For homeowning households, outcomes also included access to a home equity line of credit (HELOC) and a loan against HELOC. Linear probability regression models compared changes in financial outcomes among households with new cancer diagnosis or major chronic diseases (diabetes, stroke, or heart disease) with those without health shocks. Analyses were stratified by wealth. RESULTS: Among 14,188 households (age 68 years, 42% male, 21% Black, 13% Hispanic), 33% had financial debt, 26% had credit card debt, and 10% of homeowners used HELOC. Below-median wealth households were more likely to be Black or Hispanic. They were less likely to be headed by a female and to have college-level education. In these households, 22% had negative financial wealth ( v 0% for above-median wealth), and new cancer was associated with a 4.9 percentage point (PPT) increase in rates of financial debt (13.1% effect size; P = .03; 95% CI, 0.005 to 0.094) and a 3.9 PPT increase in HELOC use (65%; P = .04; 95% CI, 0.002 to 0.076) compared with households with no new health changes. Households developing major chronic diseases were 3.6 PPT more likely to develop financial debt (9.6%; P = .015; 95% CI, 0.007 to 0.065) without affecting HELOC use. Such differences disappeared in above-median wealth households. CONCLUSION: Below-median wealth households with cancer incurred higher financial debt and refinanced their home more often compared with those without cancer, highlighting credit overuse and borrowing even in a fully insured population.