Financial toxicity in female patients with breast cancer: a national cross-sectional study in China

Abstract

Purpose To quantify financial toxicity of female patients with breast cancer in China and investigate its factors and patients’ coping strategies. Methods The Comprehensive Score for Financial Toxicity (COST) is defined by using a structured questionnaire containing 12 items measuring perceived affordability of healthcare services, with the range of scoring of which being from 0 to 44 (higher score indicates lower financial toxicity). From January to March 2021, a total of 664 female patients diagnosed with stage 0–IV breast cancer were recruited from 33 public tertiary cancer hospitals located in 31 provinces of China. Multivariate linear regression models were used. Results The median age of patients was 48 years (range: 26–84 years), and 62.04% lived in urban areas. The median COST score was 21.00 (interquartile range: 15–26). Older age, higher household income, and better self-reported health status were associated with lower financial toxicity, while a bigger household size, being retired or unemployed, stage IV cancer, and a history of targeted therapy were associated with higher financial toxicity (all P < 0.05). Nearly half of the patients reported using at least one coping strategy, including considering quitting treatment, delaying treatment, and failing to take medicine or attend medical visits as instructed. The people with increased financial toxicity seem to adopt more coping strategies. Conclusions Financial toxicity and coping strategies are common among Chinese women with breast cancer. An understanding of the factors regarding financial toxicity may help oncologists and policy-makers identify at-risk patients and develop targeted interventions.

Financial toxicity of hidradenitis suppurativa: A single‐center experience at an urban wound‐care clinic

“…Moreover, the average out‐of‐pocket costs for our patients exceeded those of patients diagnosed with breast ($1823), colorectal ($1193), and lung cancer ($1649) 29 . In comparison to patients receiving cancer treatment, the HS population demonstrates FT levels similar to patients with breast, lung, and colorectal cancer 30–36 . While these comparisons do not deem HS a more burdensome disease or requiring more extensive health care coverage than any malignancy, they allude to the notion that the indirect costs of HS may be greater than what is perceived by the health care system.…”

“…29 In comparison to patients receiving cancer treatment, the HS population demonstrates FT levels similar to patients with breast, lung, and colorectal cancer. [30][31][32][33][34][35][36]…”

Cost drivers and financial burden for cancer-affected families in China: a systematic review

“…[47][48][49] Four studies only reported the median of the costs which were not included in the data synthesis. [50][51][52][53] In addition, two studies only reported coping strategies 54,55 and two reported the proportion of catastrophic expenditure without reporting cost data. 56,57 According to the quality assessment for all included studies, 10 studies 26, [37][38][39][40][41]47,51,55,56 were assessed as high quality, 10 studies 27-29,36,42,43,46,52−54 at the middle level and 18 studies 21,23,24,[30][31][32][33][34][35]44,45,48,49,57 as low quality.…”

“…Six studies investigated coping strategies when households with cancer patients shouldered expensive expenditures on cancer care (Table 5). 37,39,44,45,54,55 All studies reported borrowing money from relatives and friends or a loan. In two more recent studies, the reduction of household expenses (66.2%) or the reduction of expenses on basic health services (41.2%) were common strategies for addressing challenges caused by cancer care.…”

“…In two more recent studies, the reduction of household expenses (66.2%) or the reduction of expenses on basic health services (41.2%) were common strategies for addressing challenges caused by cancer care. 54,55 One study recruited parents with children diagnosed with leukemia and found the most common strategy was borrowing money from relatives and friends (97.9%), followed by charity assistance (54.6%) and government subsidy (16.1%). 37 This review demonstrated that costs of inpatient care and patients self-purchasing drugs were major components of medical costs.…”