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Influence of financial burden on withdrawal or change of cancer treatment in Japan: results of a bereavement survey

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Abstract

Purpose

This study aimed to examine the effect of financial burden of cancer treatment from diagnosis to end-of-life on treatment withdrawal or change in Japan.

Methods

This study was part of a nationwide survey of bereaved family members of cancer patients in Japan (J-HOPE2016 study). Questions regarding withdrawal or change of cancer treatment (stratified according to whether the treatment was recommended by physicians or based on the patients’ request), financial difficulties in coping with cancer treatment expenses, and the participants’ socioeconomic background were asked. Descriptive analyses were performed, and logistic regression was used to examine the factors related to withdrawal or change of cancer treatment.

Results

In total, 510 (60%) questionnaires were returned. Approximately 7.5% of participants reported withdrawal or change of cancer treatment for financial reasons. Financial difficulties in coping with cancer treatment expenses such as using up all or a portion of one’s savings (OR = 2.14, 95% CI = 1.14–4.04, p = 0.018/ OR = 3.45, 95% CI = 1.52–7.81, p = 0.003) and subjective financial burden (OR = 2.54, 95% CI = 1.25–5.14, p = 0.010/OR = 3.89, 95% CI = 1.68–9.00, p = 0.002) were significantly related to withdrawal or change of cancer treatment (recommended by physicians/based on patient request).

Conclusion

Fewer participants reported withdrawal or change of cancer treatment than in previous studies, which might reflect the characteristics of the Japanese healthcare system. However, there are patients in Japan who withdraw or change cancer treatment for financial reasons. Medical staff should consider financial toxicity as a serious side effect and assist patients in their decision-making regarding treatment while taking into account their socioeconomic backgrounds.

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Data availability

The data that support the findings of this study are available from the corresponding author (M.A.) upon reasonable request.

Code availability

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Acknowledgements

The authors would like to thank all of the participants and institutions that participated in the study. English language editorial support was provided by FORTE Science Communications (https://www.fortescience.com/).

Funding

This work was supported by the JSPS KAKENHI (Grant No. JP 18K17480) and by Hospice Palliative Care Japan.

Author information

Authors and Affiliations

  1. Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan

    Taichi Sasaki, Maho Aoyama & Mitsunori Miyashita

  2. Department of Adult and Geriatric Nursing, Health Sciences, Shinshu University Graduate School Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Naoko Igarashi

  3. Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

  4. Tsukuba Medical Center Foundation, Director, Home Care Service, Department of Palliative Medicine, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan

    Yasuo Shima

Authors
  1. Taichi Sasaki
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  2. Maho Aoyama
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  3. Naoko Igarashi
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  4. Tatsuya Morita
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  5. Yasuo Shima
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  6. Mitsunori Miyashita
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Contributions

The study was conceived by Taichi Sasaki and Maho Aoyama. The study was designed by Maho Aoyama and Mitsunori Miyashita. Data were collected by Naoko Igarashi. Data were analyzed by Taichi Sasaki and Maho Aoyama. All authors contributed to the data interpretation. The first draft of the manuscript was written by Taichi Sasaki and Maho Aoyama. All authors contributed to the revision of the manuscript and reviewed the final version for submission.

Corresponding author

Correspondence to Maho Aoyama.

Ethics declarations

Ethics approval

Ethical approval for the study was granted by the institutional review boards of Tohoku University Hospital and all participating institutions (Approval No. 2016–1–015).

Consent to participate

A document explaining the aims and procedures of the study was sent along with the questionnaire, stating that return of a completed questionnaire would be considered to indicate consent to participate in the study.

Consent for publication

A document was sent along with the questionnaire, stating that return of a completed questionnaire would be considered to indicate full consent for publication.

Conflict of interest

The authors declare no competing interests.

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Sasaki, T., Aoyama, M., Igarashi, N. et al. Influence of financial burden on withdrawal or change of cancer treatment in Japan: results of a bereavement survey. Support Care Cancer 30, 5115–5123 (2022). https://doi.org/10.1007/s00520-022-06933-7

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  • DOI: https://doi.org/10.1007/s00520-022-06933-7

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