Assessment of self-reported financial toxicity among patients with nasopharyngeal carcinoma undergoing radiotherapy: A cross-sectional study in western China

Abstract

Objective Using the Comprehensive Score for Financial Toxicity (COST) tool to measure financial toxicity (FT) among nasopharyngeal cancer (NPC) patients in western China and investigate the association between FT and psychological distress.MethodsWe conducted a cross-sectional study of survivors with NPC in a tertiary oncology hospital in China. FT was assessed using the COST (Chinese version), a validated instrument widely used both at home and abroad. The NCCN Distress Thermometer (DT) was used to measure psychological distress. A multivariate logistic regression model was built to determine factors associated with FT, and the Pearson correlation was used to assess the correlation between COST and DT scores.ResultsOf 210 patients included in this study, the mean FT score was 16.3 (median: 22.5, SD: 9.7), and the prevalence of FT was 66.2% (mild FT: 37.1%, moderate FT: 50.5%, severe FT: 2.4%). Suggested by the logistic regression model, 5 variables were associated with increased FT: unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. The Pearson correlation showed a significantly moderate correlation between financial toxicity and psychological distress (r= -0.587, P < 0.001).ConclusionPatients with nasopharyngeal carcinoma (NPC) in western China demonstrated higher self-reported financial toxicity (FT) associated with factors including unemployed, no commercial insurance, receiving lower annual income, advanced cancer, and receiving targeted therapy. These predictors will help clinicians identify potential patients with FT in advance and conduct effective psychological interventions.

Financial toxicity and its risk factors among patients with cancer in China: A nationwide multisite study

“…Our study confirmed some previously reported risk factors for FT among patients with cancer, 6 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 24 , 25 , 29 including younger age at diagnosis, unmarried status, lower annual household income, negative impact of cancer on participants' and family caregiver's work, advanced cancer stage, longer hospital stay for cancer treatment or treatment-related side-effects, lack of social medical insurance or having URRBMI, and lack of commercial medical insurance.…”

“…The prevalence of FT among Chinese patients with cancer is 61%–84%. 9 Studies conducted in one or a few tertiary hospitals within a province have identified factors associated with FT, 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 including income, age, health insurance status, employment status, post-cancer employment changes, educational level, place of residence, cancer stage, treatment plan, and social support. Another study conducted in two tertiary hospitals across two provinces identified urban–rural differences in FT, 22 and an association between enhanced eHealth literacy and a low risk of FT was reported.…”

Heterogeneity of financial toxicity and associated risk factors for older cancer survivors in China

“…found that the severe FT group accounted for a mere 2.4% of patients with nasopharyngeal carcinoma, while the mild and moderate FT groups accounted for 37.1% and 50.5%, respectively. 33 Focusing on older cancer survivors, the percentage in the high profile in our study is much higher than the figure observed in other studies. One study of 31 communities across the U.S. found that only 20% of older adults with advanced cancer experienced FT. 18 Another survey conducted in Mexico found that 0% of older patients with cancer reported severe FT, 52% reported mild FT, 39% reported moderate FT, and 9% reported no FT. 25 In the current study, the mean COST value among the study sample was 12.6 (SD: 9.8).…”

How National Health Insurance Coverage Policy Affected the Use of Trastuzumab and Rituximab in China: A Bicentric Retrospective Study

“…This might be because peasants have lower incomes and the capacity to pay, making them less willing to receive trastuzumab or rituximab. [35][36][37] Even though trastuzumab and rituximab are already covered by health insurance, the illness burden remains high. In China, different occupations represent different social classes and income levels.…”