Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
권호 표지
DOI QR코드

DOI QR Code

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer

  • Binh Thang Tran (Faculty of Public Health, University of Medicine and Pharmacy, Hue University) ;
  • Thanh Gia Nguyen (Faculty of Public Health, University of Medicine and Pharmacy, Hue University) ;
  • Dinh Duong Le (Faculty of Public Health, University of Medicine and Pharmacy, Hue University) ;
  • Minh Tu Nguyen (Undergraduate Training Office, University of Medicine and Pharmacy, Hue University) ;
  • Nhan P. T. Nguyen (Da Nang Oncology Hospital) ;
  • Minh Hanh Nguyen (Oncology Centre, Hue Central Hospital) ;
  • The Due Ong (Health Strategy & Policy Institute, Ministry of Health)
  • Received : 2024.02.21
  • Accepted : 2024.06.12
  • Published : 2024.07.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients. Methods: This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking. Results: The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT. Conclusions: FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

Keywords

Acknowledgement

The authors would like to thank Prof. Hoang Lan Nguyen, Dr. Thanh Xuan Nguyen, Dr. The Thanh Nguyen, Dr. Quynh Anh Nguyen Dac, two hospital board of directors, doctors, nurses, volunteers and participants for their support and contributions to this study. The funder played no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.

References

  1. Hoang VM, Pham CP, Vu QM, Ngo TT, Tran DH, Bui D, et al. Household financial burden and poverty impacts of cancer treatment in Vietnam. Biomed Res Int 2017;2017:9350147. https://doi.org/10.1155/2017/9350147
  2. ACTION Study Group. Policy and priorities for national cancer control planning in low- and middle-income countries: lessons from the Association of Southeast Asian Nations (ASEAN) Costs in Oncology prospective cohort study. Eur J Cancer 2017;74:26-37. https://doi.org/10.1016/j.ejca.2016.12.014
  3. Ngan TT, Van Minh H, Donnelly M, O'Neill C. Financial toxicity due to breast cancer treatment in low- and middle-income countries: evidence from Vietnam. Support Care Cancer 2021; 29(11):6325-6333. https://doi.org/10.1007/s00520-021-06210-z
  4. de Moor JS, Williams CP, Blinder VS. Cancer-related care costs and employment disruption: recommendations to reduce patient economic burden as part of cancer care delivery. J Natl Cancer Inst Monogr 2022;2022(59):79-84. https://doi.org/10.1093/jncimonographs/lgac006
  5. Carrera PM, Kantarjian HM, Blinder VS. 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 2018;68(2):153-165. https://doi.org/10.3322/caac.21443
  6. Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol 2021;22(12):e541-e549. https://doi.org/10.1016/S1470-2045(21)00468-X
  7. Witte J, Mehlis K, Surmann B, Lingnau R, Damm O, Greiner W, et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. Ann Oncol 2019;30(7):1061-1070. https://doi.org/10.1093/annonc/mdz140
  8. Donkor A, Atuwo-Ampoh VD, Yakanu F, Torgbenu E, Ameyaw EK, Kitson-Mills D, et al. Financial toxicity of cancer care in low-and middle-income countries: a systematic review and meta-analysis. Support Care Cancer 2022;30(9):7159-7190. https://doi.org/10.1007/s00520-022-07044-z
  9. Xu B, Hu L, Cheng Q, K W So W. A systematic review of financial toxicity among cancer patients in China. Asia Pac J Oncol Nurs 2022;9(8):100071. https://doi.org/10.1016/j.apjon.2022.04.010
  10. Liu M, Huang D, Liu Y. Financial toxicity of patients with lung cancer in China: results from a National Survey Study. Cancer Med 2023;12(4):4751-4760. https://doi.org/10.1002/cam4.5244
  11. Qiu Z, Yao L, Jiang J. Financial toxicity assessment and associated factors analysis of patients with cancer in China. Support Care Cancer 2023;31(5):264. https://doi.org/10.1007/s00520-023-07714-6
  12. Eala MA, Dee EC, Ginsburg O, Chua ML, Bhoo-Pathy N. Financial toxicities of cancer in low- and middle-income countries: perspectives from Southeast Asia. Cancer 2022;128(16):3013-3015. https://doi.org/10.1002/cncr.34353
  13. Chen J, Rizzo JA, Rodriguez HP. The health effects of cost-related treatment delays. Am J Med Qual 2011;26(4):261-271. https://doi.org/10.1177/1062860610390352
  14. Hueniken K, Douglas CM, Jethwa AR, Mirshams M, Eng L, Hope A, et al. Measuring financial toxicity incurred after treatment of head and neck cancer: development and validation of the Financial Index of Toxicity questionnaire. Cancer 2020;126(17):4042-4050. https://doi.org/10.1002/cncr.33032
  15. Hue Central Hospital. Oncology centre introduction [cited 2023 Nov 11]. Available from: https://bvtwhue.com.vn/Danhmuc/Baiviet/?lang=vi&ID=86 (Vietnamese).
  16. Da Nang Oncology Hospital. Introduction on Da Nang Oncology Hospital [cited 2024 Mar 11]. Available from: https://benhvienungbuoudanang.com.vn/tong-quan-ve-benh-vien-ungbuou-da-nang-2/ (Vietnamese).
  17. de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, et al. The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer 2014;120(20):3245-3253. https://doi.org/10.1002/cncr.28814
  18. de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araujo FS, Hlubocky FJ, et al. Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 2017;123(3):476-484. https://doi.org/10.1002/cncr.30369
  19. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16(3):297-334. https://doi.org/10.1007/BF02310555
  20. Smith GL, Lopez-Olivo MA, Advani PG, Ning MS, Geng Y, Giordano SH, et al. Financial burdens of cancer treatment: a systematic review of risk factors and outcomes. J Natl Compr Canc Netw 2019;17(10):1184-1192. https://doi.org/10.6004/jnccn.2019.7305
  21. Wang S, Wang J, Kang H, Zeng L, Liu G, Qiu Y, et al. Assessment of the prevalence and related factors of financial toxicity in cancer patients based on the COST scale: a systematic review and meta-analysis. Eur J Oncol Nurs 2024;68:102489. https://doi.org/10.1016/j.ejon.2023.102489
  22. Xu B, So WK, Choi KC, Huang Y, Liu M, Qiu L, et al. Financial toxicity and its risk factors among patients with cancer in China: a nationwide multisite study. Asia Pac J Oncol Nurs 2024;11(5):100443. https://doi.org/10.1016/j.apjon.2024.100443
  23. Nikte V, Patil S, Chaudhari H, Patil C, Pawar R, Patil P, et al. Financial toxicity and its implication on quality of life in patients attending the palliative care department in a regional cancer centre: an observational study. J Cancer Policy 2024;39:100460. https://doi.org/10.1016/j.jcpo.2023.100460
  24. Ng MS, Choi KC, Chan DN, Wong CL, Xing W, Ho PS, et al. Identifying a cut-off score for the COST measure to indicate high financial toxicity and low quality of life among cancer patients. Support Care Cancer 2021;29(10):6109-6117. https://doi.org/10.1007/s00520-020-05962-4
  25. ACTION Study Group; Jan S, Kimman M, Peters SA, Woodward M. Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: results from the ACTION Study. Surgery 2015;157(6):971-982. https://doi.org/10.1016/j.surg.2015.02.012
  26. Susilowati M, Afiyanti Y. The socio-demographic factors correlated with financial toxicity among patients with breast cancer in Indonesia. J Public Health Res 2021;10(s1):jphr.2021.2403. https://doi.org/10.4081/jphr.2021.2403
  27. Lee HY, Oh J, Hoang VM, Moon JR, Subramanian SV. Use of high-level health facilities and catastrophic expenditure in Vietnam: can health insurance moderate this relationship? BMC Health Serv Res 2019;19(1):318. https://doi.org/10.1186/s12913-019-4115-0
  28. Kong YC, Kimman M, Subramaniam S, Yip CH, Jan S, Aung S, et al. Out-of-pocket payments for complementary medicine following cancer and the effect on financial outcomes in middle-income countries in southeast Asia: a prospective cohort study. Lancet Glob Health 2022;10(3):e416-e428. https://doi.org/10.1016/S2214-109X(21)00595-7
  29. Tran BT, Pham NH, Nguyen TX, Choi KS, Sohn DK, Kim SY, et al. Measurement of health-related quality of life among colorectal cancer patients using the Vietnamese value set of the EQ5D-5L. Patient Prefer Adherence 2020;14:2427-2437. https://doi.org/10.2147/PPA.S281500
  30. Tran BT, Choi KS, Nguyen TX, Sohn DK, Kim SY, Suh JK, et al. The direct and indirect costs of colorectal cancer in Vietnam: an economic analysis from a social perspective. Int J Environ Res Public Health 2020;18(1):12. https://doi.org/10.3390/ijerph18010012
  31. Joyce DD, Schulte PJ, Kwon ED, Dusetzina SB, Moses KA, Sharma V, et al. Coping mechanisms for financial toxicity among patients with metastatic prostate cancer: a survey-based assessment. J Urol 2023;210(2):290-298. https://doi.org/10.1097/JU.0000000000003506
  32. Zheng Z, Han X, Guy GP Jr, Davidoff AJ, Li C, Banegas MP, et al. Do cancer survivors change their prescription drug use for financial reasons? Findings from a nationally representative sample in the United States. Cancer 2017;123(8):1453-1463. https://doi.org/10.1002/cncr.30560
  33. Itani Y, Obama K, Fujimori M, Saito J, Uchitomi Y. Cancer treatment-related financial toxicity in Japan: a scoping review. Front Psychol 2023;14:1205016. https://doi.org/10.3389/fpsyg.2023.1205016
  34. Giang NH, Oanh TT, Anh Tuan K, Hong Van P, Jayasuriya R. Is health insurance associated with health service utilization and economic burden of non-communicable diseases on households in Vietnam? Health Syst Reform 2020;6(1):1-15. https://doi.org/10.1080/23288604.2019.1619065
  35. Shah K, Zafar SY, Chino F. Role of financial toxicity in perpetuating health disparities. Trends Cancer 2022;8(4):266-268. https://doi.org/10.1016/j.trecan.2021.12.007