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Table of Contents
LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 173-174

Cancer – Too costly to cure?


1 Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
2 Department of Hospital Administration, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission05-Feb-2021
Date of Decision26-Feb-2021
Date of Acceptance01-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Vidya Jha
Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_30_21

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How to cite this article:
Jha V, Dinesh T A, Nair P. Cancer – Too costly to cure?. Cancer Res Stat Treat 2021;4:173-4

How to cite this URL:
Jha V, Dinesh T A, Nair P. Cancer – Too costly to cure?. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:173-4. Available from: https://www.crstonline.com/text.asp?2021/4/1/173/312079



The scientific community has witnessed technical as well as clinical advances at a remarkable pace. As health-care providers, we are often more concerned about the therapeutic outcomes for any disease. In doing so, we tend to overlook the impact of the treatment cost on the patients' overall well-being. The treatment cost is generally higher for cancer compared to other conditions.[1],[2] In a country like India, one of the challenges faced by patients with cancer and their caregivers is the out-of-pocket expenses that account for more than 75% of the treatment cost for cancer.[3] This can be viewed as treatment-related toxicity and is referred to as “financial toxicity.”

Financial toxicity impacts the treatment as patients tend to take fewer drugs than prescribed, replace prescription medications with cheaper over-the-counter drugs, or default on treatment either by skipping appointments or declining procedures due to the lack of affordability. This leads to low medication compliance which is an important factor in the treatment of any cancer.[4],[5] The 2011 Medical Expenditure Panel Survey showed that 28.7% of the 19.6 million cancer survivors in the United States of America (USA) reported at least one financial problem.[6] In addition, 7.6% of the survivors borrowed money for cancer cure, 11.5% could not afford the cost of medical care visits, and 20.9% were concerned about payment of their medical bills. Financial toxicity is also associated with poor survival. According to the Western Washington SEER registry (1995–2009) linked to the federal bankruptcy records, patients who were younger, female, and non-Caucasian, had disease with locoregional spread at diagnosis, and had received treatment were more likely to file for bankruptcy.[7]

As a consequence of the growing medical expenditure, even patients who have health insurance may need financial assistance to be able to access the complete course of therapy and to alleviate the financial toxicity associated with cancer care.[8],[9]

Dusetzina et al. reported in their study that a significant number of patients in the USA do not adhere to their treatment regimens, even for drugs such as imatinib that are life-saving and can be administered orally, because of their high cost.[10] Ramsey et al. in their study observed that out of 231,596 patients, 4728 (2%) suffered bankruptcy and were more likely to die earlier due to the financial toxicity.[7]

Kalra et al. also reported severe financial toxicity in their study on Indian patients receiving systemic therapy for brain tumors.[11] We would like to highlight two points from this study. First, there are notable differences between the health-care delivery systems in the USA and India. Therefore, we believe that using a grading system different from the one used by D'Rummo et al. for estimating the Comprehensive Score for Financial Toxicity (COST) would have given a more realistic picture in the Indian context. However, Honda et al. found the COST measure to be feasible in measuring financial toxicity in the Japanese healthcare setting.[12] Second, careful consideration should be given to the temporal frame of the evaluation of factors related to financial toxicity including quality of life. This could give a complete and accurate picture if the patient's experience throughout the treatment process is taken into account and not just at a single point of time.

We believe that the cost of cancer care is not adequately discussed between the patients and their physicians in India. Therefore, we need a health-care delivery model that addresses the patients' concerns related to the out-of-pocket expenses when deciding the treatment. This will help in engaging the patients in the treatment decision-making process. A more detailed study on the various factors leading to financial toxicity at the micro level will help us understand the interventions needed to mitigate them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bernard DS, Farr SL, Fang Z. National estimates of out-of-pocket health care expenditure burdens among nonelderly adults with cancer: 2001 to 2008. J Clin Oncol 2011;29:2821-6.  Back to cited text no. 1
    
2.
Langa KM, Fendrick AM, Chernew ME, Kabeto MU, Paisley KL, Hayman JA. Out-of-pocket health-care expenditures among older Americans with cancer. Value Health 2004;7:186-94.  Back to cited text no. 2
    
3.
Jain M, Mukherjee K. Economic burden of breast cancer to the households in Punjab, India. Int J Med Public Health 2016;6:13-8.  Back to cited text no. 3
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4.
Markman M, Luce R. Impact of the cost of cancer treatment: An internet-based survey. J Oncol Pract 2010;6:69-73.  Back to cited text no. 4
    
5.
Neugut AI, Subar M, Wilde ET, Stratton S, Brouse CH, Hillyer GC, et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 2011;29:2534-42.  Back to cited text no. 5
    
6.
Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 2016;122:283-9.  Back to cited text no. 6
    
7.
Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 2016;34:980-6.  Back to cited text no. 7
    
8.
Rajurkar SP, Presant CA, Bosserman LD, McNatt WJ. A Copay Foundation Assistance Support Program for patients receiving intravenous cancer therapy. J Oncol Pract 2011;7:100-2.  Back to cited text no. 8
    
9.
Philip CC, Mathew A, John MJ. Cancer care: Challenges in the developing world. Cancer Res Stat Treat 2018;1:58-62.  Back to cited text no. 9
  [Full text]  
10.
Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol 2014;32:306-11.  Back to cited text no. 10
    
11.
Kalra D, Menon N, Singh GK, Dale O, Adak S, Das S, et al. Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study. Cancer Res Stat Treat 2020;3:724-9.  Back to cited text no. 11
  [Full text]  
12.
Honda K, Gyawali B, Ando M, Sugiyama K, Mitani S, Masuishi T, et al. A prospective survey of comprehensive score for financial toxicity in Japanese cancer patients: Report on a pilot study. Ecancermedicalscience 2018;12:847.  Back to cited text no. 12
    




 

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