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

Abstract

PROFFIT (Patient Reported Outcome for Fighting FInancial Toxicity of cancer) questionnaire has been developed in Italy, within a universal healthcare system, for measuring financial toxicity (FT) in patients with cancer and understanding its determinants. Our aim was to describe the amount of FT in patients with cancer, by using the PROFFIT questionnaire, in subjects treated in a public Italian institution. Between May and July 2021 we administered, on one-off basis with a cross-sectional approach, the PROFFIT questionnaire to 167 outpatients receiving active anticancer treatment at the Oncology Day Hospital of Ordine Mauriziano Hospital, Turin, Italy. Answers were matched with relevant clinical and demographic characteristics. Median FT score in the overall population was 23.81 ). FT score was significantly higher in younger patients, in those with worse educational level, in private employees and unemployed, and in subjects with economically dependent familiars.

Confirmatory validation analysis of the PROFFIT questionnaire to assess financial toxicity in cancer patients

“…The present study reports data of the third series of patients prospectively enrolled into the PROFFIT project; although none of these series was planned to be representative of a specific or general context, it is interesting to observe similarities regarding subgroups that have higher risk of financial toxicity in Italy. 12 , 22 These include patients who reside in South Italy, those younger than 65 years of age, those with a lower education level; consistently, FT is lower for those who work in the public sector (thanks to several protection rules) and for those who are retired, whose income is not affected by their incapacity to work. Also, there is consistency regarding the higher PROFFIT-score among those who reported further financial impact due to COVID-19.…”

“…Also, there is consistency regarding the higher PROFFIT-score among those who reported further financial impact due to COVID-19. 22 …”

“…We suspect that a sort of deference toward the health-staff might affect patients during treatment; a similar trend, indeed, with few patients reporting problems of interaction with the health-staff was also found among the 184 patients involved in previous factor analysis (the one leading from pre-final to final questionnaire - data not reported) and among 167 patients interviewed in a single-centre study of PROFFIT. 12 , 22 For the future, the opportunity to investigate these determinants among patients who are in a phase of active treatment might be reviewed or anonymity should be warranted. These items, however, might still be important in cross-sectional studies enrolling patients not undergoing active anticancer treatment, considering that 45 patients involved in the importance analysis during the development of PROFFIT ranked items 14 to 16 among the most important within the pre-final questionnaire.…”