Financial Toxicity Among Older Mexican Adults With Cancer and Their Families: A Mixed-Methods Study

Abstract

PURPOSE The financial toxicity (FT) of cancer is common among older adults in high-income countries, but little is known about the financial hardships faced by older patients with cancer living in developing countries. The aim of this study was to explore the financial burden of cancer among older Mexican adults and their relatives, as well as factors that might mitigate such burden. METHODS This mixed-methods study included patients age 65 years and older with the 10 most common malignancies in Mexico and 3-24 months from diagnosis at two cancer centers in Mexico City and their relatives. For the quantitative component, patients and relatives answered the Spanish version of the Consumer Financial Protection Bureau Financial Well-Being Scale. Patients completed the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale and a 3-month, self-reported cost diary. For the qualitative component, focused interviews were used to explore the individual experiences of patients and their relatives. RESULTS Ninety-six patients and their relatives were included, of whom 45% had stage IV disease. On the COST-FACIT scale, 9% reported no FT, 52% mild FT, 39% moderate FT, and 0% severe FT. The mean Consumer Financial Protection Bureau Financial Well-Being Scale score was 45.2, with 78% reporting poor financial well-being (score ≤ 50). On cost diaries, most expenses were associated with purchasing medications, including chemotherapy. Focused interviews showed that most patients and relatives had to acquire debt to face costs of cancer care. CONCLUSION A high proportion of Mexican older adults with cancer reported FT and poor financial well-being. Understanding experiences associated with FT and strategies to mitigate it represents an essential first step to design public policies aimed at protecting older adults with cancer and their families from catastrophic spending.

Low dose nivolumab in metastatic mucosal melanoma: a case report

“…In a survey in 112 patients with newly diagnosed acute leukemia, in Nepal, who completed consolidation chemotherapy, all patients suffered financial toxicity, the most common financial hardship involved asking for donations, followed by borrowing loans from friends or relatives 12 . In another study that included patients 65 years or older with the 10 most common malignancies in Mexico and their family members, up to 90% of participants reported some form of financial toxicity 13 . The study also found that participants had limited knowledge about financial assistance programs, and that there is a need for more comprehensive financial counseling services to support patients and families in managing the financial impact of cancer.…”

Local Sociocultural Practice Specific Financial Toxicity Assessment Tool for Cancer: An Emerging Need

“…Therefore, a tool for assessing FT needs to look beyond debt and loss of assets because of and needs to assess common region-specific experiences. 9 An ideal tool should be easy to interpret and understand by the patient and should be able to correctly identify the people affected most by the financial destruction due to the disease.…”

A multi‐dimensional assessment of financial hardship of cancer patients using existing health system data

“…Material conditions refer to patient's direct (e.g., OOP) 5 and indirect costs (e.g., productivity loss, employment interruption, and related bankruptcies) 7–9 . Psychological responses refers to patient's treatment‐related mental distresses (e.g., fear of financial burden, worry about side effects, fear of cancer recurrence) 10 .…”

“…Currently available multidimensional measures of financial hardship in cancer patients 8–10 have limitations that hinder their scalability, sustainability, and effectiveness. First, these measures require data beyond the information regularly housed in the health system, which poses a significant implementation barrier due to increased patient response burden and could disrupt clinic workflow 7,11 .…”