Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action

Abstract

BACKGROUND: Financial toxicity negatively affects the well-being of cancer survivors. We examined the incidence, cost drivers, and factors associated with financial toxicity after cancer in an upper-middle-income country with universal health coverage. METHODS: Through the Association of Southeast Asian Nations Costs in Oncology study, 1,294 newly diagnosed patients with cancer (Ministry of Health [MOH] hospitals [n = 577], a public university hospital [n = 642], private hospitals [n = 75]) were observed in Malaysia. Cost diaries and questionnaires were used to measure incidence of financial toxicity, encompassing financial catastrophe (FC; out-of-pocket costs ≥ 30% of annual household income), medical impoverishment (decrease in household income from above the national poverty line to below that line after subtraction of cancer-related costs), and economic hardship (inability to make necessary household payments). Predictors of financial toxicity were determined using multivariable analyses. RESULTS: One fifth of patients had private health insurance. Incidence of FC at 1 year was 51% (MOH hospitals, 33%; public university hospital, 65%; private hospitals, 72%). Thirty-three percent of households were impoverished at 1 year. Economic hardship was reported by 47% of families. Risk of FC attributed to conventional medical care alone was 18% (MOH hospitals, 5%; public university hospital, 24%; private hospitals, 67%). Inclusion of expenditures on nonmedical goods and services inflated the risk of financial toxicity in public hospitals. Low-income status, type of hospital, and lack of health insurance were strong predictors of FC. CONCLUSION: Patients with cancer may not be fully protected against financial hardships, even in settings with universal health coverage. Nonmedical costs also contribute as important drivers of financial toxicity in these settings.

Understanding the Financial Needs Following Diagnosis of Breast Cancer in a Setting with Universal Health Coverage

“…In the present study, patients seeking cancer care in Ministry of Health hospitals did not appear to incur substantial out‐of‐pocket costs for cancer treatment and health care, corroborating the findings of the ACTION study . This finding is not surprising, given that cancer care is heavily subsidized in Ministry of Health facilities, even when compared with public academic hospitals.…”

“…As the financial toxicity of cancer is not just limited to the active treatment phase but extends into the long‐term survivorship period post‐treatment, cancer‐related expenses may have dire effects on household budgets and, subsequently, the ability to pay for basic necessities , such as food, as was reported in the present study. Furthermore, participants from low‐ and middle‐income groups had repeatedly highlighted that transportation and parking costs posed a financial burden on their household expenditures.…”

“…Financial toxicity affects a substantial proportion of patients with cancer irrespective of health care systems , including in settings with universal health coverage . Besides treatment and health care‐related costs, financial toxicity may also include financial distress associated with loss of wages, savings, or household assets .…”

Assessing the Relationship between Socio-demographic, Clinical Profile and Financial Toxicity: Evidence from Cancer Survivors in Sarawak

“…Whilst FT is an important issue, little is known about the predictors of FT (Fathollahzade et al, 2015;Bhoo-Pathy et al, 2019). Most prior studies that had been conducted focused on the association between financial distress and quality of life in developing countries (Chino et al, 2014;Lathan et al, 2016;Perrone et al, 2016;Chen et al, 2018;Park and Look, 2018).…”

“…Most prior studies that had been conducted focused on the association between financial distress and quality of life in developing countries (Chino et al, 2014;Lathan et al, 2016;Perrone et al, 2016;Chen et al, 2018;Park and Look, 2018). In Malaysia, the study conducted by Bhoo-Pathy et al, (2019) examined the factor associated with FT in various types of cancer, whereas Ting et al,. (2020) focused on urological cancer.…”