Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

Lentz, Robert W.; Benson, Al B.; Kircher, Sheetal Mehta

doi:10.1002/jso.25374

Cited by 224 publications

(240 citation statements)

References 68 publications

(91 reference statements)

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“…The high expense of cancer care creates a financial burden not only to the healthcare system, but also to patients themselves. Between 48% and 73% of patients with cancer experience tremendous financial difficulties over the course of treatment with patients with cancer being at a higher than average risk to file for bankruptcy . In fact, Ramsay et al reported that patients with a cancer diagnosis had an almost 3‐fold higher risk to declare bankruptcy, and patients who declared bankruptcy were more likely to die than patients who did not become bankrupt .…”

Section: Introductionmentioning

confidence: 99%

“…Between 48% and 73% of patients with cancer experience tremendous financial difficulties over the course of treatment with patients with cancer being at a higher than average risk to file for bankruptcy. 2 In fact, Ramsay et al reported that patients with a cancer diagnosis had an almost 3-fold higher risk to declare bankruptcy, and patients who declared bankruptcy were more likely to die than patients who did not become bankrupt. 3 The financial hardship experienced by patients with cancer has been termed "financial toxicity" and can be considered akin to other more traditional treatment-related "toxicities" associated with cancer care.…”

Section: Introductionmentioning

confidence: 99%

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Financial toxicity risk among adult patients undergoing cancer surgery in the United States: An analysis of the National Inpatient Sample

Farooq

Merath

Hyer

et al. 2019

Journal of Surgical Oncology

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Background and Objective Financial hardship occurring as a result of cancer treatment has been termed financial toxicity and is an established side effect of the cancer treatment. We investigated the risk of financial toxicity among patients undergoing surgery for gastrointestinal cancers. Methods All uninsured and privately insured patients who underwent surgery for a gastrointestinal cancer were identified from the National Inpatient Sample. Publicly available government data were used estimate income, food expenditure, and average maximum out‐of‐pocket expenditure. Risk of financial toxicity was defined as health expenditure ≥ 40% of postsubsistence income. Results Among the 78 545 patients in the analytic cohort, 73 305 individuals had private insurance while 5240 patients were uninsured. Overall median hospital charges were $58 651 (IQR: $37 912‐$95 379). Approximately 90% of uninsured and 10% of privately insured patients were at risk of financial toxicity. At the subpopulation level, patients in the lowest income quartile, undergoing emergency surgery, black or hispanic individuals, and those undergoing surgery for esophageal or colon cancer were more likely to experience catastrophic costs following surgery (P < .001). Conclusion Approximately 9 in 10 uninsured and 1 in 10 privately insured patients with cancer were at risk of financial toxicity after the surgery. Targeted interventions are needed to provide financial protection to patients undergoing the cancer treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Financial toxicity risk among adult patients undergoing cancer surgery in the United States: An analysis of the National Inpatient Sample

Farooq

Merath

Hyer

et al. 2019

Journal of Surgical Oncology

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“…Even if cancer survivors have no signs of cancer after initial treatment, FT will be further increased due to the impact of cancer on work performance and income and difficulty in returning to work and with family support . Previous studies noted that psychological and social distress caused by cancer are easily undetected by healthcare professionals and may result in more than 22.3 missed workdays per year and reductions in income . Job loss, low income, and public health insurance were the major factors contributing to 34% of cancer survivors being in debt .…”

Section: Discussionmentioning

confidence: 99%

Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies

Zhu

Xing

et al. 2020

Psycho-Oncology

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Objective The aim of this study was to synthesize qualitative research evidence on cancer survivors' experiences with financial toxicity (FT). Methods We carried out a systematic review of qualitative studies using a meta‐aggregation approach. Papers published prior to 31 August 2019, were collected from electronic databases, including PubMed/MEDLINE, MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), Web of Science, ProQuest Dissertations and Theses, and Cochrane Library (Wiley). Results Six synthesized findings were derived from 14 studies covering cancer patients' awareness of FT, cancer‐related expenditures, and the risk factors, impacts, coping strategies, and unmet needs related to FT. Conclusions Cancer survivors incur FT; however, their awareness of FT is limited. Cancer‐related FT has multiple impacts on survivors' lives. Although cancer survivors try to cope with FT through adjustments, they still have unmet needs for the management of FT. Nurses and social workers can play a critical role in helping survivors manage FT by increasing pre‐awareness of FT, strengthening emotional empowerment, and providing personalized informative support.

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“…A cancer diagnosis and its treatment influence the psychological well-being of the person diagnosed and may also have an effect on the relatives’ well-being 1–5. Moreover, evidence exists that a cancer diagnosis can also lead to occupational and financial hazards 6–8…”

Section: Introductionmentioning

confidence: 99%

Observational non-randomised controlled evaluation of the effectiveness of cancer counselling centres: a study protocol

et al. 2019

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IntroductionIn recent years, medical treatment for cancer has improved, thereby increasing the life expectancy of patients with cancer. Hence, the focus in healthcare shifted towards analysing treatments that offer to decrease distress and improve the quality of life of patients with cancer. The psychological burden of patients with cancer originates from all kinds of psychosocial challenges related to diagnosis and treatment. Cancer counselling centres (CCounCs) try to address these concerns. However, the current literature lacks research on the effectiveness of CCounCs. This study aims to assess the effectiveness of CCounCs with regard to distress and other relevant psychosocial variables (quality of life, anxietyand so on).Methods and analysisThis prospective observational study with a non-randomised control group has three measurement points: before the first counselling session (baseline, t0) and at 2 weeks and 3 months after baseline (t1, t2). Patients and their relatives who seek counselling between December 2018 and November 2020 and have sufficient German language skills will be included. The control group will be recruited at clinics and oncological outpatient centres in Hamburg. Propensity scoring will be applied to adjust for differences between the control and intervention groups at baseline. Sociodemographic data, medical data and counselling concerns are measured at baseline. Distress (distress thermometer), quality of life (Short Form-8 Health Survey, European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire-Core 30), anxiety (Generalized AnxietyDisorder-7), depression (Patient HealthQuestionnaire-9) and further psychosocial variables are assessed at all time points. With a total of 787 participants, differences between the intervention and control groups of a small effect size (f=0.10) can be detected with a power of 80%.Ethics and disseminationThe study was registered prior to data collection with the German Registration of Clinical Trials in September 2018. Ethical approval was received by the local psychological ethical committee of the Center for Psychosocial Medicine at the University Medical Centre Hamburg-Eppendorf in August 2018. The results will be published in peer-reviewed journals.Trial registration numberDRKS00015516; Pre-results.

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Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

Cited by 224 publications

References 68 publications

Financial toxicity risk among adult patients undergoing cancer surgery in the United States: An analysis of the National Inpatient Sample

Financial toxicity risk among adult patients undergoing cancer surgery in the United States: An analysis of the National Inpatient Sample

Cancer survivors' experiences with financial toxicity: A systematic review and meta‐synthesis of qualitative studies

Observational non-randomised controlled evaluation of the effectiveness of cancer counselling centres: a study protocol

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