The hospital-based socioeconomic study to assess the financial toxicity among cancer survivors

Pandey, Awadhesh Kumar; Vias, Poorva; Mangwana, Suraj Kumar; Kaur, Snehpreet; Dimri, Kislay; Walia, Dinesh Kumar

doi:10.4103/ccij.ccij_26_20

Cited by 3 publications

(3 citation statements)

References 12 publications

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“…Globally, several studies have attempted to estimate the economic burden of cancer. However, a recent systematic review from India found only 22 studies reporting financial hardship among cancer patients ( 7 , 14 , 16–19 , 43 , 44 ). Most of these studies were single-centric with sample as small as 11, making the findings not generalizable for the country.…”

Section: Discussionmentioning

confidence: 99%

“…Most of these studies were single-centric with sample as small as 11, making the findings not generalizable for the country. Among the included studies, only 5 studies measured CHE and 11 studies assessed distress financing among cancer patients in India ( 7 , 14 , 16–19 , 44 ). The estimated reported in these studies on OOPE, CHE, and impoverishment varied significantly.…”

Section: Discussionmentioning

confidence: 99%

“…The OOPE incurred on cancer treatment ranged from ₹ 34,816 on head & neck, breast, and cervical cancer to ₹ 3,35,800 on palliative care ( 17 , 20 ). This wide range of OOPE is due to heterogeneity within the studies owing to difference in study settings (single or multi-centric studies in one or more states of India), varied sample size ranging from 50 to 3,012, non-representative nature of included studies (varying expenditures on different cancers), type of OOPE reported (medical or non-medical or both), category of health services covered (outpatient or inpatient or both), and so on ( 16–19 , 44 ). A thorough review of these studies revealed high heterogeneity in the methodological robustness and outcomes estimated ( 16–19 , 44 ).…”

Section: Discussionmentioning

confidence: 99%

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Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Prinja

Dixit

Gupta

et al. 2023

Front. Public Health

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BackgroundThe rising economic burden of cancer on patients is an important determinant of access to treatment initiation and adherence in India. Several publicly financed health insurance (PFHI) schemes have been launched in India, with treatment for cancer as an explicit inclusion in the health benefit packages (HBPs). Although, financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and determinants among the Indian population. There is a need to determine the optimal strategy for clinicians and cancer care centers to address the issue of high costs of care in order to minimize the financial toxicity, promote access to high value care and reduce health disparities.MethodsA total of 12,148 cancer patients were recruited at seven purposively selected cancer centres in India, to assess the out-of-pocket expenditure (OOPE) and financial toxicity among cancer patients. Mean OOPE incurred for outpatient treatment and hospitalization, was estimated by cancer site, stage, type of treatment and socio-demographic characteristics. Economic impact of cancer care on household financial risk protection was assessed using standard indicators of catastrophic health expenditures (CHE) and impoverishment, along with the determinants using logistic regression.ResultsMean direct OOPE per outpatient consultation and per episode of hospitalization was estimated as ₹8,053 (US$ 101) and ₹39,085 (US$ 492) respectively. Per patient annual direct OOPE incurred on cancer treatment was estimated as ₹331,177 (US$ 4,171). Diagnostics (36.4%) and medicines (45%) are major contributors of OOPE for outpatient treatment and hospitalization, respectively. The overall prevalence of CHE and impoverishment was higher among patients seeking outpatient treatment (80.4% and 67%, respectively) than hospitalization (29.8% and 17.2%, respectively). The odds of incurring CHE was 7.4 times higher among poorer patients [Adjusted Odds Ratio (AOR): 7.414] than richest. Enrolment in PM-JAY (CHE AOR = 0.426, and impoverishment AOR = 0.395) or a state sponsored scheme (CHE AOR = 0.304 and impoverishment AOR = 0.371) resulted in a significant reduction in CHE and impoverishment for an episode of hospitalization. The prevalence of CHE and impoverishment was significantly higher with hospitalization in private hospitals and longer duration of hospital stay (p < 0.001). The extent of CHE and impoverishment due to direct costs incurred on outpatient treatment increased from 83% to 99.7% and, 63.9% to 97.1% after considering both direct and indirect costs borne by the patient and caregivers, respectively. In case of hospitalization, the extent of CHE increased from 23.6% (direct cost) to 59.4% (direct+ indirect costs) and impoverishment increased from 14.1% (direct cost) to 27% due to both direct and indirect cost of cancer treatment.ConclusionThere is high economic burden on patients and their families due to cancer treatment. The increase in population and cancer services coverage of PFHI schemes, creating prepayment mechanisms like E-RUPI for outpatient diagnostic and staging services, and strengthening public hospitals can potentially reduce the financial burden among cancer patients in India. The disaggregated OOPE estimates could be useful input for future health technology analyses to determine cost-effective treatment strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Prinja

Dixit

Gupta

et al. 2023

Front. Public Health

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Financial toxicity in cancer care in India: a systematic review

Boby

Rajappa

Mathew

2021

The Lancet Oncology

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Identification of Barriers in Onco-Physiotherapy: Patient’s Perspective; A Cross-Sectional Observational Study

Raikundlia

Ghodge

2021

Int J Health Sci Res

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Cancer is a debilitating and complex disease that affects millions of people around the world, it has been identified that cancer rehabilitation including physiotherapy can be important factor in management of cancer patients and survivors. There are disquisitions that showcase and prove the presence of certain problems with respect to referral and delivery of the physiotherapy treatment given to oncology patients. It is noticed that in spite of available facilities a large number of our population including the cancer patients are unaware of the presence of onco-physiotherapy and its potential benefits. This cross sectional study conducted among cancer patients aims to identify these barriers to help gain a complete understanding of them and the benefits of rehabilitation will help us gain valuable insight to optimise the beneficial services and its deliverance at these centres. It showed that only half of the samples were aware of onco-physiotherapy. There are multiple barriers faced especially with respect to the referral system present in our country. Though they do not lack motivation, family and community support, ability to follow exercise regime and home programme, this study showed that in spite of this being conducted in an urban setting most were unaware of such services. This tells us that there is a dire need of awareness among patients, doctors and general population. There is also a need for more awareness about NGOs, government schemes and specialised branch of onco-physiotherapy to aid the rehabilitation process. Key words: Oncology, cancer rehabilitation, onco-physiotherpy, barriers, awareness.

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The hospital-based socioeconomic study to assess the financial toxicity among cancer survivors

Cited by 3 publications

References 12 publications

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Financial toxicity of cancer treatment in India: towards closing the cancer care gap

Financial toxicity in cancer care in India: a systematic review

Identification of Barriers in Onco-Physiotherapy: Patient’s Perspective; A Cross-Sectional Observational Study

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