Tess Thompson

Background: Financial toxicity, or the negative economic effect of cancer treatment, has been cross‐sectionally associated with poorer psychosocial outcomes in patients with breast cancer. Few studies have examined financial toxicity longitudinally or in Black women with cancer in particular. Methods: Black women with non‐metastatic breast cancer enrolled in this prospective study within 2 months of diagnosis. Participants completed the Comprehensive Score for Financial Toxicity (COST) and the Center for Epidemiologic Studies Depression (CES‐D) at baseline, 2 months, 4 months, and 18 months. We used a random‐intercept cross‐lagged panel model to examine two components of the relationship between financial toxicity and depressive symptoms: the overall association (correlation of the intercepts) and the association over time. We hypothesized that financial toxicity would be associated with greater depressive symptoms (i.e., intercepts would be correlated). We further hypothesized that financial toxicity and depressive symptoms would predict each other over time (i.e., greater financial toxicity at one timepoint would be associated with greater depressive symptoms at the next timepoint, and vice versa). Results: In 107 participants, mean baseline COST score was 24.1 (SD = 9.9); mean baseline CES‐D score was 15.0 (SD = 10.9). We found a strong overall association between depressive symptoms and financial toxicity ( r = −0.63, p < 0.001), but the constructs did not predict each other over time. Conclusions: Financial toxicity and depressive symptoms were strongly correlated, but we did not find prospective effects. Findings speak to the importance of longitudinal financial toxicity research in understanding patterns over time.

Objective: To examine day-to-day experiences of social support and peer partner influence during a tailored physical activity (PA) intervention. Methods: The parent intervention was designed for women in midlife (ages 40-65) with elevated risk for cardiovascular disease (CVD), for whom lack of social support is a barrier to cardioprotective levels of PA. Women in midlife with ≥1 CVD risk factor (e.g., hypertension; N =62, M _Age =53, M _BMI =32.6 kg/m ² , 44% from underrepresented groups) enrolled in an 8-week PA intervention combining PA coaching with formation of partner dyads for between-session support ( n =31).Women who enrolled were paired in partner dyads and did not have a relationship prior to enrolling. They wore a digital PA monitor and completed daily end-of-day surveys throughout the program (94% compliance). Multilevel models tested for within-person associations between daily satisfaction with partner support (individual and dyad levels), including preliminary tests of partner influence. Results: Partners communicated on 58% of days, primarily via texting (used on 92% of communication days). Perceived support varied within-person and within-dyad (ICCs=0.37-0.48); women reported greater PA motivation and took more steps on days when they experienced greater partner support ( P ssr s=0.19-0.32). Partners’ daily PA motivation and steps showed weak correlations ( r s=0.008-0.24); associations between partners’ perceptions and each others’ PA outcomes were slightly stronger ( sr s=0.20-0.28) and reflected different experiences of support. Conclusions: Among women with elevated risk for CVD, support in health-focused partnerships has potential to influence daily PA motivation and behavior. Additional investigation will improve partner-based PA intervention toward reduction in CVD risk for this group.

Background: Caregivers of older adults in rural settings face distinct challenges shaped by environmental factors, including longer travel distances, limited support networks, and fewer resources. Addressing these unmet needs is critical to reducing burnout and negative health outcomes. Methods: We surveyed care managers to compare rural caregivers’ needs with urban caregivers. A convenience sample of care managers completed a survey developed by geriatrics professionals. The survey included multiple-choice and seven optional open-ended questions. Participants were recruited via email and word of mouth (March–June 2025). Inclusion criteria required completion of more than half the survey, providing a practice ZIP code, and employment in North Carolina. Quantitative data were analyzed descriptively; qualitative responses were analyzed by a hybrid deductive-inductive thematic approach. Results: The participation rate was 16% (62/387) before exclusions. The final sample included 36 participants, 89% of whom completed the entire survey. Most were aged 25–34 (38.9%), held a master’s degree (55.6%), had 1–5 years of experience (52.8%), and practiced in rural settings (50%). A total of 89 open-ended responses were analyzed; six responses were reported as “Unsure” and not included in the theme development. Two themes emerged: (1) there are fewer resources for caregivers in rural compared with urban communities, and (2) care managers in rural communities face additional barriers beyond limited resources. Conclusion: Rural caregivers, and the care managers who support them, face distinct challenges. This exploratory work informs future research to expand to other regions, standardize rural definitions in research, and develop and evaluate system-level interventions to better support both caregivers and care managers.

Introduction: Patients with chronic disease often face administrative burden (eg, dealing with insurance paperwork) that affects their health and their care. Informal caregivers (family and close friends) provide important support to patients, but little is known about how they help patients address administrative burden. Methods: To address this gap, we conducted a scoping review about caregivers' experiences of healthcare-related administrative burden using Herd and Moynihan's Administrative Burden Framework, which describes learning, compliance, and psychological costs. We reviewed US-based studies about caregivers' experiences of healthcare-related administrative burden when caring for adults with a range of health conditions. Results: Eighteen articles met criteria. More than half were qualitative, and most involved caregivers for cancer patients/survivors. A minority were informed by a theory or conceptual framework. Learning, compliance, and psychological costs tended to overlap. Caregivers often reported that compliance activities such as navigating insurance caused distress and affected their own health. Conclusion: This review—the first, to our knowledge, to characterize the literature about caregivers' experiences of administrative burden—shows caregivers report overlapping burdens in a range of caregiving contexts. As this work matures, theoretically informed research is needed to develop and test interventions to mitigate administrative burden for patients and caregivers.

Background: Cancer affects not only patients but also their informal caregivers. Dyadic interventions hold promise but are rarely integrated into clinical care, and few have been developed for Black women in particular. Purpose: We centered the voices of Black breast cancer survivors and female caregivers to understand their experiences with cancer and their preferences for psychosocial intervention. Methods: Twenty survivors and their female, nonpartner caregivers (10 dyads) participated in semistructured Zoom interviews. Interviews were transcribed, coded, and analyzed to examine themes related to psychosocial intervention preferences. Results: Five themes emerged: (1) “Being able to have that combination would be awesome”: Desiring an intervention that helps survivors and caregivers both separately and together, (2) “Whatever their preference is”: Tradeoffs to teleconferencing vs in-person interventions, (3) “Therapy scares people sometimes”: Pros and cons to terminology, (4) “I would just like to have more knowledge”: Proposed intervention topics and characteristics, and (5) “Cancer’s not a Black thing” vs “we really see things different”: A range of opinions about a service/program for Black women in particular. One overarching theme involved taking a dyadic perspective on intervention by considering the needs and preferences of both members of a pair. Conclusions: Participants expressed support for dyadic interventions, especially those that would address survivors and caregivers both as individuals and as a pair, and they described how caregivers in particular may have unmet needs for emotional support. Findings provide rich information about participants’ preferences and highlight the value and challenges of taking a dyadic approach to intervention.

Supplementary Table 1 provides descriptive statistics of the characteristics of the sample of individuals without a cancer history.

Supplementary Table 2 shows the results of the analysis exploring the moderating effect of a cancer history on the relationship between medical financial hardship and food security among cancer survivors and individuals without a cancer history.

Introduction: Health and psychosocial outcomes are often interdependent for people with cancer and their informal caregivers. However, few studies have examined interdependence among U.S. Black patients and their caregivers. In this prospective study, we analyzed whether Black women with breast cancer and their caregivers demonstrated interdependence in depressive symptoms and other outcomes over time. Methods: Patient and caregiver data were collected via telephone surveys at three timepoints (baseline, two months, four months). Actor-Partner Interdependence Models (random-intercept cross-panel models in Mplus) were used to analyze depressive symptoms (Center for Epidemiology Studies Depression scale; CES-D), physical and mental health quality of life, perceived social support, and health behaviors. We hypothesized patients and caregivers would demonstrate interdependence for these outcomes both cross-sectionally and over time. Results: We enrolled 210 participants. All patients and 93% of caregivers identified as Black/African American; 70% of caregivers identified as female. Two-thirds (66%) of dyads did not live together. Mean baseline CES-D score was 15.0 ( SD = 10.9) for patients and 11.9 ( SD = 9.0) for caregivers. We did not find prospective interdependence for any outcomes. Dyad members were moderately correlated in overall levels (intercepts) of physical health quality of life ( r = .25), mental health quality of life ( r = .28), social support ( r = .37), and health behavior scores ( r = .33). Conclusion: This study is one of the first longitudinal, dyadic examinations of outcomes for Black breast cancer patients and their informal caregivers. Although our hypothesis of prospective interdependence was not supported, we observed moderate correlations of overall levels of several measures. These results suggest that patients with lower social support, poor health behaviors, and worse quality of life may also have caregivers who could benefit from intervention.

Purpose of Review We conducted a scoping review to determine what is known about the prevalence and consequences of unmet social needs in U.S. cancer survivors, what screening tools are used to assess these needs, and what interventions have been developed to meet the needs of cancer survivors. Recent Findings We identified records from six databases. Inclusion criteria were peer-reviewed journal articles in English with empirical data from U.S.-based samples of people diagnosed with cancer as adults and assessing one of the following modifiable, individual-level needs commonly included in clinical screening: food insecurity, financial hardship, utility assistance, employment, housing, transportation, or personal safety. The search yielded 11,074 abstracts; 543 records underwent full-text review, and 189 were retained for data extraction. Most studies were quantitative and observational (88%), not based on theory (88%), and cross-sectional (87%). The majority addressed financial toxicity, commonly evaluated using the COmprehensive Score for financial Toxicity (COST). Fewer studies focused on food insecurity, transportation barriers, housing concerns, personal safety, or utility assistance. Included studies reported that financial toxicity and other social needs were negatively associated with health-related quality of life, mental health, and adherence to care. Summary Financial toxicity is now a well-established challenge for cancer patients, which suggests financial interventions may be widely beneficial. Future work is needed to develop a fuller picture of cancer survivors’ other social needs, and to understand and address the impact of unmet social needs on clinical, health, and psychosocial outcomes.