|LETTERS TO EDITOR
|Year : 2021 | Volume
| Issue : 1 | Page : 174-175
Authors' reply to Patel, Gupta et al., and Jha et al.
Devanshi Kalra, Nandini Menon, Vijay M Patil
Department of Neuro Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra, India
|Date of Submission||03-Mar-2021|
|Date of Decision||03-Mar-2021|
|Date of Acceptance||05-Mar-2021|
|Date of Web Publication||26-Mar-2021|
Vijay M Patil
Tata Memorial Centre, Parel, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kalra D, Menon N, Patil VM. Authors' reply to Patel, Gupta et al., and Jha et al. Cancer Res Stat Treat 2021;4:174-5
We would like to thank Patel, Gupta and Gyawali, and Jha et al. for their valuable comments on our article titled, “Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study.”
Cancer treatment has made remarkable strides, yielding improvements in patient outcomes, but these improvements have come at increasing costs. Apart from the management of disease and adverse events of systemic therapy, the financial burden incurred by the patients undergoing treatment is an additional liability. Financial toxicity is a broad term that needs more exploration among patients with cancer as they not only have to deal with the treatment-related costs, but also the cost of home-based health-care and travel to treatment centers. Financial toxicity also affects the patients' quality of life and access to medical care.
We agree that there is a need for a validated tool to assess financial toxicity in patients with cancer. However, this is true for any treatment, tools, or technological advances, such as robotic surgery or newer radiation techniques. Even the assumptions of cost-effectiveness of a treatment based on the gross domestic product are not validated in India. Regardless, these newer therapeutic modalities are used in India as it is not feasible to validate everything. Moreover, India is a diverse country. Socioeconomic status and cultural acceptability differ widely between the various states, many of which are as large as or larger than some countries like the United Kingdom. We believe that the assessment of financial toxicity should include and classify the burden of the patients as per their situation. As factors such as the cost of transportation and accommodation near the treatment center contribute considerably to the financial burden, they should be taken into account when assessing the financial toxicity. This was highlighted in our randomized study comparing clinical follow-up with video follow-up, where the indirect costs were much greater than the direct treatment costs. Hence, we agree that there is a need to evaluate financial toxicity among patients more extensively.
We disagree that the clinicians should decide the best treatment option for their patients. We believe that the clinicians should discuss all the equi-efficacious treatment options with the patients and inform them about the schedule, benefits, adverse events, and the cost of treatment. Moreover, this should be done in a language that the patient understands. The patients should then be allowed to choose their preferred treatment option. Assessment of the patient's financial situation can be difficult, and hence, we feel this is the best approach. This is also legally and morally binding, and it is the patients' right to have all the available information irrespective of their socioeconomic status. This is one of the most important aspects of taking an informed consent for treatment. Not providing the option of a costly treatment may be acceptable at a policy level where the states sponsor the whole treatment. Unfortunately, in India, this is applicable only to a minuscule number of patients, and most patients spend out of their own pocket. Hence, there is a need for a proper health-care delivery system to address the patient's concerns related to the out-of-pocket expenses of the patient, especially in the oncology setting.
Our study provided only a cross-sectional view of the financial stress that prevails among patients with cancer. Furthermore, we agree that longitudinal assessment of the financial toxicities of the patients undergoing systemic therapy can be beneficial in the future.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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