‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

Abstract

Receiving information about expected costs promptly after a cancer diagnosis through psycho‐oncology care or social counselling is crucial for patients to be prepared for the financial impact. Nevertheless, less is known about financial impacts for cancer patients in countries with statutory health insurance. This study aims to explore the full scope of costs that constitute the financial impact of a cancer diagnosis in Germany and to identify the reasons for high financial decline. Semistructured interviews with 39 cancer patients were conducted between May 2017 and April 2018. Narratives were analysed via qualitative content analysis. Several factors influenced cancer patients’ indirect costs and direct medical and non‐medical costs. For many patients, these changes resulted in higher indirect costs caused by income losses, especially when surcharges for shift work, travel expenses or company benefits ceased and were not reimbursed. Higher direct medical costs were caused by co‐payments and additional non‐refundable costs. Non‐medical costs were reported to increase for some patients and to decrease for others, as for example, leisure activity costs either increasing because of pampering oneself to cope with the diagnosis and undergoing therapy or decreasing because of not being able to participate in leisure activities during therapy. When analysing the financial impacts of individuals' total costs, we found that some patients experienced no financial decline or an overall financial increase. Most patients experienced overall higher costs, and income loss was the main driver of a high financial decline. Nevertheless, decreased non‐medical costs due to lower work‐related and leisure activity costs could compensate for these higher costs. Cancer patients are confronted with a variety of changes in their financial situations, even in countries with statutory health insurance. Screening for cancer patients with a high risk of financial decline should consider any effects on indirect costs and direct medical and nonmedical costs.

Financial toxicity in sarcoma patients and survivors in Germany: results from the multicenter PROSa study

“…Another possible factor for financial difficulties during sick leave might be the reduction of income due to high surcharges not covered by the insurance [40]. If patients are not able to return to work after sick leave, it is mandatory to apply for a disability pension in Germany.…”

“…The effect of this income decline is expressed in a statistically significantly increased chance of financial toxicity for patients receiving disability pension in our analysis, where having a disability pass was associated with higher odds of reporting financial toxicity. This might seem controversial because a disability pass may lead to deductions in certain services or payments (e.g., entrance fees, transportation tickets) [40]. On the other hand, patients with a disability pass might have higher OOPPs due to a need for additional services or medical aids which are not fully covered by their insurance.…”

Impact of cancer on income, wealth and economic outcomes of adult cancer survivors: a scoping review

“…Qualitative studies revealed survivors experienced financial struggles from loss of income due to cancer (n=8) 54–61. Income declined for survivors despite receiving disability benefits or other compensatory payments, according to three studies 54 59 61…”

“…37 Qualitative studies revealed survivors experienced financial struggles from loss of income due to cancer (n=8). [54][55][56][57][58][59][60][61] Income declined for survivors despite receiving disability benefits or other compensatory payments, according to three studies. 54 59 61 Debt Twenty-four (38%) studies assessed debt incurred by survivors or their families due to cancer (online supplemental table 2).…”

Patient-reported financial toxicity within the Italian public healthcare system: a single center cross-sectional analysis in patients with cancer

“…Financial toxicity (FT) experienced by patients after a diagnosis of cancer has been increasingly discussed and reported worldwide, within countries with different healthcare systems (1)(2)(3)(4)(5)(6)(7). Initially, FT has been described in the US, as a factor negatively affecting cancer patients (2).…”