Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients

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The purpose of this study is to examine the effect of financial burden, using objective and subjective indicators, on the health-related quality of life (HRQOL) in lung cancer patients.


A total of 227 patients diagnosed with lung cancer (from the inpatient unit of the department of internal medicine-chest oncology, in Shanghai Chest Hospital, China) participated in the study. Financial information was measured by direct medical costs, direct nonmedical costs, healthcare-cost-to-income ratio, and perceived financial difficulty. HRQOL was measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale.


Catastrophic health spending, defined as a healthcare-cost-to-income ratio of more than 40%, was reported in 72.7% of the participants, whereas 37.0% reported that healthcare costs exceeded annual household income. Financial difficulty was perceived in 83.7% of the participants. Patients whose healthcare costs exceeded their annual household income and who perceived financial difficulty reported a clinically meaningful difference in overall HRQOL (> 6 points on the FACT-L) compared with participants without catastrophic health spending or perceived financial difficulty. Healthcare costs did not show a significant effect on HRQOL.


Healthcare costs exceeding total annual household income and perceived financial difficulty are associated with poorer HRQOL in lung cancer patients. Subjective indicator of financial burden has a stronger effect on quality of life than objective indicators.


Health-cost-to-income ratio and perceived financial difficulty can be implied as objective and subjective indicators of financial burden to identify the patients who may need additional assistance. Communication on deciding on cost-effective treatments can be facilitated.

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Author information

Correspondence to Yaping He.

Ethics declarations

All the participants provided written informed consent. The study was approved by the ethics committee of Shanghai Chest Hospital, Shanghai Jiao Tong University (No. KS1353).

Conflict of interest

The authors declare that they have no competing interests.

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Chen, J.E., Lou, V.W., Jian, H. et al. Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients. Support Care Cancer 26, 1265–1272 (2018) doi:10.1007/s00520-017-3949-4

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  • Financial burden
  • Quality of life
  • Lung cancer
  • Perceived financial difficulty
  • Catastrophic health spending