Financial Toxicity of Cancer Treatment and Care

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 11436

Special Issue Editors


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Guest Editor
DeGroote School of Business, Centre for Health Economics and Policy Analysis, McMaster University, Toronto, ON, Canada
Interests: financial burden of cancer; health technology assessment; health policy
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Guest Editor
Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada
Interests: supportive care; cancer care; palliative care; psychosocial oncology; oncology nursing; survivorship; clinical nursing research
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Special Issue Information

Dear Colleagues,

Over the course of many years, significant advances in cancer diagnosis and treatment have led to dramatic improvements in clinical outcomes. However, the cost of cancer care continues to rise, with more expensive anti-cancer drugs and higher treatment costs for chemotherapy or immunotherapy, as well as an impact on income streams. These costs place a significant financial burden on patients and their caregivers.

Financial toxicity (FT), which indicates the unexpected and unanticipated financial burden experienced by cancer patients receiving cancer treatment or follow-up care, is associated with an increased risk of negative outcomes and death. The risk of financial toxicity is influenced by the cancer type and severity, treatment received, age, income and type of health insurance. The impact of financial distress on cancer patients can include impaired health-related quality of life, not taking medications as prescribed to save money, and substandard quality of care. There are still some aspects of financial toxicity that have very limited data, or data that is out of date. We hope this Special Issue will allow researchers to more fully explore the current issues facing patients and their caregivers related to financial stresses.

In this Special Issue, original research articles, including both quantitative and qualitative designs, and reviews are welcome. Research areas may include (but are not limited to) the following:

  • Patient/family-level impact of financial toxicity;
  • Potential interventions to mitigate financial toxicity.

We look forward to receiving your contributions.

Dr. Christopher J. Longo
Prof. Dr. Margaret Fitch
Guest Editors

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Keywords

  • financial toxicity
  • financial burden
  • cancer care
  • cost
  • financial distress

Published Papers (6 papers)

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Research

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15 pages, 257 KiB  
Article
Perspectives of Cancer Survivors with Low Income: A Content Analysis Exploring Concerns, Positive Experiences, and Suggestions for Improvement in Survivorship Care
by Irene Nicoll, Gina Lockwood and Margaret I. Fitch
Curr. Oncol. 2023, 30(9), 8134-8148; https://doi.org/10.3390/curroncol30090590 - 1 Sep 2023
Viewed by 1014
Abstract
The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors’ perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income [...] Read more.
The number of cancer survivors in Canada has reached 1.5 million and is expected to grow. It is important to understand cancer survivors’ perspectives about the challenges they face after treatment is completed. Many factors create barriers to accessing assistance, and limited income may be a significant one. This study is a secondary analysis of data from a publicly available databank (Cancer Survivor Transitions Study) regarding the experiences of Canadian cancer survivors. The goal was to explore major challenges, positive experiences, and suggestions for improvement in survivorship care for low-income Canadian cancer survivors one to three years following treatment. A total of 1708 survey respondents indicated a low annual household income (<$25,000 CD). A content analysis was performed utilizing written comments to open-ended questions. The major challenges respondents described focused on physical capacity limits and treatment side effects; positive experiences emphasized support and attentive care; and suggestions for improvements highlighted the need for better support, information about self-care and side effect management, and timely follow-up care. The relationships between household income and the management of survivors’ physical, emotional, and practical concerns require consideration. The design of follow-up care plans, programs, services, and financial assessments of patients may prepare survivors for predictable issues and costs in their transition to survivorship. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
8 pages, 441 KiB  
Article
The Role of Financial Difficulties as a Mediator between Physical Symptoms and Depression in Advanced Cancer Patients
by Eun Mi Lee, Paula Jiménez-Fonseca, Raquel Hernández, Patricia Cruz-Castellanos, Ana Fernández-Montes, Jacobo Rogado, Mireia Gil-Raga, Mónica Antoñanzas, Helena López-Ceballos and Caterina Calderon
Curr. Oncol. 2023, 30(6), 5719-5726; https://doi.org/10.3390/curroncol30060429 - 12 Jun 2023
Viewed by 1267
Abstract
Financial difficulties experienced by cancer patients negatively impact the mental health of the patients. The objective of this study was to examine the mediating role of financial difficulties between physical symptoms and depression in patients with advanced cancer. A prospective, cross-sectional design was [...] Read more.
Financial difficulties experienced by cancer patients negatively impact the mental health of the patients. The objective of this study was to examine the mediating role of financial difficulties between physical symptoms and depression in patients with advanced cancer. A prospective, cross-sectional design was adopted in the study. The data were collected from 861 participants with advanced cancer in 15 different tertiary hospitals in Spain. The participants’ socio-demographic characteristics were collected using a standardized self-report form. Hierarchical linear regression models were used to explore the mediating role of financial difficulties. In the results, 24% of patients reported a high level of financial difficulties. Physical symptoms were positively associated with financial difficulties and depression (β = 0.46 and β = 0.43, respectively), and financial difficulties was positively associated with depression (β = 0.26). Additionally, financial difficulties played a role in explaining the relationship between physical symptoms and depression, showing a standardized regression coefficient of 0.43 which decreased to 0.39 after the financial difficulties were controlled. Healthcare professionals should consider the importance of providing financial resources and emotional support to help patients and their families cope with the financial burden associated with cancer treatment and its symptoms. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
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14 pages, 862 KiB  
Article
Financial Toxicity and Out-of-Pocket Costs for Patients with Head and Neck Cancer
by Justin Smith, Justin Yu, Louisa G. Gordon and Madhavi Chilkuri
Curr. Oncol. 2023, 30(5), 4922-4935; https://doi.org/10.3390/curroncol30050371 - 10 May 2023
Cited by 2 | Viewed by 2421
Abstract
Aim: To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL). Methods: A cross-sectional survey was administered to patients with HNC 1–3 years after radiotherapy at a regional hospital in [...] Read more.
Aim: To quantify financial toxicity and out-of-pocket costs for patients with HNC in Australia and explore their relationship with health-related quality of life (HRQoL). Methods: A cross-sectional survey was administered to patients with HNC 1–3 years after radiotherapy at a regional hospital in Australia. The survey included questions on sociodemographics, out-of-pocket expenses, HRQoL, and the Financial Index of Toxicity (FIT) tool. The relationship between high financial toxicity scores (top quartile) and HRQoL was explored. Results: Of the 57 participants included in the study, 41 (72%) reported out-of-pocket expenses at a median of AUD 1796 (IQR AUD 2700) and a maximum of AUD 25,050. The median FIT score was 13.9 (IQR 19.5) and patients with high financial toxicity (n = 14) reported poorer HRQoL (76.5 vs. 114.5, p < 0.001). Patients who were not married had higher FIT scores (23.1 vs. 11.1, p = 0.01), as did those with lower education (19.3 vs. 11.1, p = 0.06). Participants with private health insurance had lower financial toxicity scores (8.3 vs. 17.6, p = 0.01). Medications (41%, median AUD 400), dietary supplements (41%, median AUD 600), travel (36%, median AUD 525), and dental (29%, AUD 388) were the most common out-of-pocket expenses. Participants living in rural locations (≥100 km from the hospital) had higher out-of-pocket expenses (AUD 2655 vs. AUD 730, p = 0.01). Conclusion: Financial toxicity is associated with poorer HRQoL for many patients with HNC following treatment. Further research is needed to investigate interventions aimed at reducing financial toxicity and how these can best be incorporated into routine clinical care. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
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13 pages, 649 KiB  
Article
Clinical Management of Financial Toxicity–Identifying Opportunities through Experiential Insights of Cancer Survivors, Caregivers, and Social Workers
by Christopher J. Longo, Louisa G. Gordon, Rebecca L. Nund, Nicolas H. Hart, Laisa Teleni, Carla Thamm, Olivia Hollingdrake, Fiona Crawford-Williams, Bogda Koczwara, Tamara Ownsworth, Stephen Born, Sue Schoonbeek, Leanne Stone, Christie Barrett and Raymond J. Chan
Curr. Oncol. 2022, 29(10), 7705-7717; https://doi.org/10.3390/curroncol29100609 - 14 Oct 2022
Cited by 3 | Viewed by 2096
Abstract
Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive [...] Read more.
Perspectives of cancer survivors, caregivers, and social workers as key stakeholders on the clinical management of financial toxicity (FT) are critical to identify opportunities for better FT management. Semi-structured interviews (cancer survivors, caregivers) and a focus group (social workers) were undertaken using purposive sampling at a quaternary public hospital in Australia. People with any cancer diagnosis attending the hospital were eligible. Data were analysed using inductive-deductive content analysis techniques. Twenty-two stakeholders (n = 10 cancer survivors of mixed-cancer types, n = 5 caregivers, and n = 7 social workers) participated. Key findings included: (i) genuine concern for FT of cancer survivors and caregivers shown through practical support by health care and social workers; (ii) need for clarity of role and services; (iii) importance of timely information flow; and (iv) proactive navigation as a priority. While cancer survivors and caregivers received financial assistance and support from the hospital, the lack of synchronised, shared understanding of roles and services in relation to finance between cancer survivors, caregivers, and health professionals undermined the effectiveness and consistency of these services. A proactive approach to anticipate cancer survivors’ and caregivers’ needs is recommended. Future research may develop and evaluate initiatives to manage cancer survivors and families FT experiences and outcomes. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
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Review

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15 pages, 520 KiB  
Review
Interventions to Mitigate Financial Toxicity in Adult Patients with Cancer in the United States: A Scoping Review
by Seiichi Villalona, Brenda S. Castillo, Carlos Chavez Perez, Alana Ferreira, Isoris Nivar, Juan Cisneros and Carmen E. Guerra
Curr. Oncol. 2024, 31(2), 918-932; https://doi.org/10.3390/curroncol31020068 - 6 Feb 2024
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Abstract
Financial toxicity adversely affects quality of life and treatment outcomes for patients with cancer. This scoping review examined interventions aimed at mitigating financial toxicity in adult patients with cancer and their effectiveness. We utilized five bibliographical databases to identify studies that met our [...] Read more.
Financial toxicity adversely affects quality of life and treatment outcomes for patients with cancer. This scoping review examined interventions aimed at mitigating financial toxicity in adult patients with cancer and their effectiveness. We utilized five bibliographical databases to identify studies that met our inclusion criteria. The review included studies conducted among adult patients with cancer in the United States and published in English between January 2011 to March 2023. The review identified eight studies that met the inclusion criteria. Each of the studies discussed the implementation of interventions at the patient/provider and/or health system level. Collectively, the findings from this scoping review highlight both the limited number of published studies that are aimed at mitigating financial toxicity and the need to create and assess interventions that directly impact financial toxicity in demographically diverse populations of adult patients with cancer. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
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Other

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18 pages, 518 KiB  
Systematic Review
Patient Perceived Financial Burden in Haematological Malignancies: A Systematic Review
by Catriona Parker, Danielle Berkovic, Darshini Ayton, Ella Zomer, Danny Liew and Andrew Wei
Curr. Oncol. 2022, 29(6), 3807-3824; https://doi.org/10.3390/curroncol29060305 - 24 May 2022
Cited by 6 | Viewed by 2368
Abstract
Advances in scientific understanding have led to novel therapies and improved supportive care for many patients with haematological malignancies. However, these new drugs are often costly, only available at centralised health care facilities, require regular specialist reviews and lengthy treatment regimens. This leads [...] Read more.
Advances in scientific understanding have led to novel therapies and improved supportive care for many patients with haematological malignancies. However, these new drugs are often costly, only available at centralised health care facilities, require regular specialist reviews and lengthy treatment regimens. This leads to a significant financial burden. Understanding the impact of financial burden on haematological patients is important to appreciate the urgency of alleviating this systemic issue. Method: Eligible studies were identified by systematically searching Medline, PsycINFO, CINAHL and Embase. Self-reported data reported in both quantitative and qualitative studies that described the financial burden for patients with haematological malignancies were included. Quality appraisal of the included studies was undertaken using the Joanna Briggs Institute tools. A narrative synthesis was employed. For quantitative studies, outcomes were extracted, tabulated and categorised to find similarities and differences between the studies. For qualitative studies, quotations, codes and themes were extracted and then clustered. An inductive approach derived qualitative themes. Results: Twenty studies were identified for inclusion. Of the quantitative studies most (83%) employed un-validated researcher-generated measures to assess financial burden. Between 15–59% of patients experienced a financial burden. Out-of-pocket expenditure was frequent for clinical appointments, prescription and non-prescription medication, and travel. Financial burden was associated with a worsening quality of life and living in metropolitan areas, but there was no evidence for impact on survival. Patient-centred experiences from the qualitative inquiry complemented the quantitative findings and five themes were determined: familial or household impact; reliance on others; barriers to care due to cost; and barriers to accessing financial assistance and sources of out-of-pocket expenses. Conclusion: The impacts of financial burden are yet to be fully appreciated in haematological malignancies, exacerbated by the heterogeneous methods employed by researchers. Future work should focus on identifying the long-term ramifications of financial burden for patients and should trial interventions to reduce its prevalence and patient impacts. Full article
(This article belongs to the Special Issue Financial Toxicity of Cancer Treatment and Care)
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