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Table of Contents
LETTERS TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 174-175

Authors' reply to Patel, Gupta et al., and Jha et al.


Department of Neuro Oncology, Tata Memorial Centre, HBNI, Mumbai, Maharashtra, India

Date of Submission03-Mar-2021
Date of Decision03-Mar-2021
Date of Acceptance05-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Vijay M Patil
Tata Memorial Centre, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_55_21

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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

How to cite this URL:
Kalra D, Menon N, Patil VM. Authors' reply to Patel, Gupta et al., and Jha et al. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 22];4:174-5. Available from: https://www.crstonline.com/text.asp?2021/4/1/174/312115



We would like to thank Patel,[1] Gupta and Gyawali,[2] and Jha et al.[3] for their valuable comments on our article titled, “Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study.”[4]

Cancer treatment has made remarkable strides, yielding improvements in patient outcomes, but these improvements have come at increasing costs.[5] 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.[6]

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.[7] 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,[7] 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.[8] 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.[8] 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.[9] 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.[4] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patel N. One foot in the door-Financial toxicity among patients receiving active chemotherapy. Cancer Res Stat Treat 2021;4:170-1.  Back to cited text no. 1
  [Full text]  
2.
Gupta A, Gyawali B. Digging deeper into cancer-associated financial toxicity in low-and middle-income countries. Cancer Res Stat Treat 2021;4:172-3.  Back to cited text no. 2
  [Full text]  
3.
Jha V, Dinesh AT, Nair P. Cancer– Too costly to cure? Cancer Res Stat Treat 2021;4:173-4.  Back to cited text no. 3
  [Full text]  
4.
Kalra D, Menon N, Singh G, 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. 4
  [Full text]  
5.
Zafar SY, Abernethy AP. Financial toxicity, Part I: A new name for a growing problem. Oncology (Williston Park) 2013;27:80-1, 149.  Back to cited text no. 5
    
6.
Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T, et al. Impact of financial burden of cancer on survivors' quality of life. J Oncol Pract 2014;10:332-8.  Back to cited text no. 6
    
7.
Kastor A, Mohanty SK. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing? PLoS One 2018;13:e0196106.  Back to cited text no. 7
    
8.
Patil VM, Pande N, Chandrasekharan A, Chandrakanth M, Tonse R, Krishnatry R, et al. Shadow study: Randomized comparison of clinic with video follow-up in glioma undergoing adjuvant temozolomide therapy. CNS Oncol 2018;7:CNS14.  Back to cited text no. 8
    
9.
Hall DE, Prochazka AV, Fink AS. Informed consent for clinical treatment. CMAJ 2012;184:533-40.  Back to cited text no. 9
    




 

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