Cancer care

Financial toxicity for cancer patients in public system


Financial hardship is experienced by many cancer patients treated in the public healthcare system and has a significant impact on quality of life, a pilot study from Victoria has shown.

And the impact of financial toxicity is particularly bad for younger people with cancer, according to a survey of patients attending the Department of Medical Oncology at St Vincent’s Hospital, Melbourne.

The study, which elicited responses from 53 patients receiving treatment for cancer found that the median score for financial hardship was 18/42 based on  comprehensive score for financial toxicity (COST) criteria.

The US-derived COST measure is an 11-point questionnaire covering financial stress and worry and whether patients felt this was directly attributable to the management of their oncological diagnosis.

When applied in an Australian setting it showed a significant relationship between increasing financial toxicity and reduced quality of life . There was also a significant inverse relationship between financial toxicity scores and age, but no relationship was found with sex, regional location or income.

The study, led by Associate Professor Sue-Anne McLachlan, also found that only 13 (24%) of patients were currently employed, of whom patients reported working despite feeling unwell. All of those working reported taking at least one sick day in the previous month.

More than half (55%) of cancer patients were retired and 19% were unemployed, and as expected these patients had significantly lower income than those who were working.

The study authors said the findings showed that financial toxicity for cancer patients also occurs in a setting of universal healthcare where treatments are subsidised by the PBS and Medicare.

They noted that other recent Australian studies had reported median out of pocket costs of $4192 for breast cancer patients and $3175 for prostate cancer patients.

However they cautioned that their findings were preliminary and did not take into consideration factors such as duration of treatment, with patients likely to face a higher financial burden over time.

“We have identified that the COST self-reporting questionnaire could be used to identify a proportion of patients experiencing meaningful financial toxicity in an Australian malignant cohort, however, results need to be confirmed in larger studies,” they wrote.

They added that recognition of financial toxicity was important for encouraging financial consent, and this was already being recognised in the private health sector in Australia “with cost communication in patient interactions having been proven to be associated with improved patient satisfaction.”

The findings are published in the Asia Pacific Journal of Clinical Oncology.

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