Abstract
Purpose
This study examined the prevalence of financial toxicity (FT) and associated factors among urologic cancer patients. The association between FT and health-related quality of life (HRQoL) was also investigated.
Methods
A total of 429 respondents diagnosed with urologic cancers (prostate cancer, bladder and renal cancer) from Sarawak General Hospital and Subang Jaya Medical Centre in Malaysia were interviewed using a structured questionnaire. Objective and subjective FT were measured by catastrophic health expenditure (healthcare-cost-to-income ratio greater than 40%) and the Personal Financial Well-being Scale, respectively. HRQoL was measured with the Functional Assessment of Cancer Therapy – General 7 Items scale.
Results
Objective and subjective FT were experienced by 16.1 and 47.3% of the respondents, respectively. Respondents who sought treatment at a private hospital and had out-of-pocket health expenditures were more likely to experience objective FT, after adjustment for covariates. Respondents who were female and had a monthly household income less than MYR 5000 were more likely to experience average to high subjective FT. Greater objective FT (OR = 2.75, 95% CI 1.09–6.95) and subjective FT (OR = 4.68, 95% CI 2.63–8.30) were associated with poor HRQoL.
Conclusions
The significant association between both objective and subjective FT and HRQoL highlights the importance of reducing FT among urologic cancer patients. Subjective FT was found to have a greater negative impact on HRQoL.
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References
Joung JY, Lim J, Oh CM, Jung KW, Cho H, Kim SH, Seo HK, Park WS, Chung J, Lee KH, Won YJ (2017) Current trends in the incidence and survival rate of urological cancers in Korea. Cancer Res Treat 49(3):607–615
Silverberg E (1987) Statistical and epidemiologic data on urologic cancer. Cancer 60(S3):692–717
Ploussard G, Albrand G, Rozet F, Lang H, Paillaud E, Mongiat-Artus P (2014) Challenging treatment decision-making in older urologic cancer patients. World J Urol 32(2):299–308
Omar ZA, Ibrahim Tamin NS (2011) National cancer registry report: Malaysia cancer statistics-data and figure. Malaysia: National Cancer Registry 85–7
Carrera PM, Kantarjian HM, Blinder VS (2018) The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin 68(2):153–165
Peppercorn J (2014) The financial burden of cancer care: do patients in the US know what to expect? Expert Rev Pharmacoecon Outcomes Res 14(6):835–842
Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors: a systematic review. JNCI: J Natl Cancer Inst 109(2):djw205
Catt S, Starkings R, Shilling V, Fallowfield L (2017) Patient-reported outcome measures of the impact of cancer on patients’ everyday lives: a systematic review. J Cancer Surviv 11(2):211–232
Gordon LG, Merollini KM, Lowe A, Chan RJ (2017) A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient 10(3):295–309
Chen JE, Lou VW, Jian H, Zhou Z, Yan M, Zhu J, Li G, He Y (2018) Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients. Support Care Cancer 26(4):1265–1272
Arastu A, Ciminelli J, Culakova E, Lei L, Xu H, Dougherty DW, Mohamed MR, Wells M, Duberstein P, Flannery MA, Morrow GR, Kamen CS, Pandya C, Berenberg JL, Aarne V, Mohile SG (2018) Association of financial toxicity (FT) with depression, anxiety, and quality of life (QoL) in older patients with advanced cancer: an analysis of 544 patients from 31 practices in the University of Rochester NCI Community Oncology Research Program (UR NCORP). J Clin Oncol 36(15):e22037. https://doi.org/10.1200/JCO.2018.36.15_suppl.e22037
Park J, Look KA (2018) Relationship between objective financial burden and the health-related quality of life and mental health of patients with cancer. J Oncol Pract JOP-2017
Kang SH, Ju YJ, Yoon HJ, Lee SA, Kim W, Park EC (2018) The relationship between catastrophic health expenditure and health-related quality of life. Int J Equity Health 17(1):166
Kent EE, Forsythe LP, Yabroff KR, Weaver KE, Moor JS, Rodriguez JL, Rowland JH (2013) Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 119(20):3710–3717
Bhanvadia SK (2018) Bladder cancer survivorship. Curr Urol Rep 19(12):111
Mossanen M, Smith AB (2018) Addressing financial toxicity: the role of the urologist. J Urol 200(1):43–45
Pisu M, Azuero A, Benz R, McNees P, Meneses K (2017) Out-of-pocket costs and burden among rural breast cancer survivors. Cancer Med 6(3):572–581
Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B (2008) Economic stress among low-income women with cancer: effects on quality of life. Cancer 112(3):616–625
Irwin B, Kimmick G, Altomare I, Marcom PK, Houck K, Zafar SY, Peppercorn J (2014) Patient experience and attitudes toward addressing the cost of breast cancer care. Oncologist 19(11):1135–1140
Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I, Tulsky J, Ubel P, Schrag D, Nicolla J, Abernethy AP, Peppercorn J, Zafar SY (2014) Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract 10(3):162–167
Chino F, Peppercorn J, Taylor DH, Lu Y, Samsa G, Abernethy AP, Zafar SY (2014) Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist 19(4):414–420
Kodama Y, Morozumi R, Matsumura T, Kishi Y, Murashige N, Tanaka Y, Takita M, Hatanaka N, Kusumi E, Kami M, Matsui A (2012) Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey. BMC Cancer 12(1):152
Yabroff KR, Dowling EC, Guy GP Jr et al (2015) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267
Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18(4):381–390
Longo CJ, Deber R, Fitch M, Williams AP, D’souza D (2007) An examination of cancer patients’ monthly ‘out-of-pocket’costs in Ontario, Canada. Eur J Cancer Care 16(6):500–507
ACTION Study Group (2015) Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: results from a longitudinal study in eight countries. BMC Med 13(1):190
Azzani M, Yahya A, Roslani AC, Su TT (2017) Catastrophic health expenditure among colorectal cancer patients and families: a case of Malaysia. Asia Pac J Public Health 29(6):485–494
Greenberg D, Earle C, Fang CH, Eldar-Lissai A, Neumann PJ (2010) When is cancer care cost-effective? A systematic overview of cost–utility analyses in oncology. J Natl Cancer Inst 102(2):82–88
Schoen C, Hayes SL, Riley P (2013) The Affordable Care Act’s new tools and resources to improve health and care for low-income families across the country. Issue Brief (Commonwealth Fund) 26:1–14
Department of Statistics Malaysia (2011) Population Distribution and Basic Demographic Characteristic Report 2010 (Updated: 05/08/2011). https://www.dosm.gov.my/v1/index.php?r=column/cthemeByCat&cat=117&bul_id=MDMxdHZjWTk1SjFzTzNkRXYzcVZjdz09&menu_id=L0pheU43NWJwRWVSZklWdzQ4TlhUUT09. Accessed 24 Jan 2019
Naing L, Winn T, Rusli BN (2006) Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci 1:9–14
Zaidi AA, Ansari TZ, Khan A (2012) The financial burden of cancer: estimates from patients undergoing cancer care in a tertiary care hospital. Int J Equity Health 11(1):60
Xu K, World Health Organization (2005) Distribution of health payments and catastrophic expenditures methodology (No. EIP/FER/DP. 05.2). Publishing World Health Organization. https://apps.who.int/iris/bitstream/handle/10665/69030/EIP_HSF_DP_05.2.pdf?sequence=1&isAllowed=y. Accessed 12 December 2018
Xu T, Wu J (2018) Financial toxicity of cancer in China. J Glob Oncol 4(2). https://doi.org/10.1200/jgo.18.17600
Nielsen RB (2010) Assessing financial wellness via computer-assisted telephone interviews. J Finan Counsel Plan 21(2):16–29
Prawitz AD, Garman ET, Sorhaindo B, O'Neill B, Kim J, Drentea P (2006) InCharge financial distress/financial well-being scale: development, administration, and score interpretation. J Finan Counsel Plan 17(1):34–50
Yanez B, Pearman T, Lis CG, Beaumont JL, Cella D (2012) The FACT-G7: a rapid version of the functional assessment of cancer therapy-general (FACT-G) for monitoring symptoms and concerns in oncology practice and research. Ann Oncol 24(4):1073–1078
Pearman T, Yanez B, Peipert J, Wortman K, Beaumont J, Cella D (2014) Ambulatory cancer and US general population reference values and cutoff scores for the functional assessment of cancer therapy. Cancer 120(18):2902–2909
Alexopoulos EC (2010) Introduction to multivariate regression analysis. Hippokratia 14(Suppl 1):23–28
Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source code Biol Med 3(1):17
Hosmer DW Jr, Lemeshow S, Sturdivant RX (2013) Applied logistic regression (Vol. 398). John Wiley & Sons, Hoboken, NJ
Chan RJ, Gordon LG, Tan CJ, Bradford NK, Yates P, Agbejule QA, Miaskowski C (2019) Relationship between financial toxicity and symptom burden in cancer survivors. A systematic review. J Pain Symptom Manag 57(3):646–660
Babyak MA (2004) What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosom Med 66(3):411–421
Schaffer C (1993) Overfitting avoidance as bias. Mach Learn 10(2):153–178
Acknowledgements
The authors would like to express their gratitude to the Director General of Health Malaysia for his permission to publish this manuscript. The authors are obliged to thank the Director of Sarawak General Hospital for his approval of the data collection for this study and his unconditional support of this study. The authors also thank Ms. Lim Chien Joo of Tan Tock Seng Hospital for her guidance with statistical analysis. Permission to use and translate the Personal Financial Well-being Scale© was granted by Dr. E. Thomas Garman, Virginia Tech University, and Dr. John Hoffmire, Chairman of Personal Finance Employee Education Fund Inc. ©Copyright by InCharge Education Foundation and E. Thomas Garman, 2004, 2005, 2006. All rights reserved.
License to use the English and Malay version of FACT-G7 was granted by Licensor (FACIT.org). The Functional Assessment of Chronic Illness Therapy system of Quality of Life questionnaires and all related subscales, translations and adaptations (“FACIT System”) are owned and copyrighted by David Cella, Ph.D. The ownership and copyright of the FACIT System resides strictly with Dr. Cella; Dr. Cella has granted FACIT.org (Licensor) the right to license usage of the FACIT System to other parties.
Funding
This study received funding from the Malaysian Society of Andrology and the Study of the Aging Male to cover the costs of the enumerators’ employment and overhead costs.
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The study was reviewed and approved by the Ministry of Health Malaysia Medical Research Ethics Committee (MREC) on 8 March 2018 with registration number NMRR-18-86-39533. Informed consent was obtained from all the individual participants included in the study. All the data are restricted to the principal investigators and were solely used for research purposes. All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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The authors declare that they have no conflicts of interest. The principal investigators have full control of all primary data and agree to allow the journal to review the data upon request.
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Ting, C.Y., Teh, G.C., Yu, K.L. et al. Financial toxicity and its associations with health-related quality of life among urologic cancer patients in an upper middle-income country. Support Care Cancer 28, 1703–1715 (2020). https://doi.org/10.1007/s00520-019-04975-y
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DOI: https://doi.org/10.1007/s00520-019-04975-y