Financial toxicity and mental well‐being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic – A cross‐sectional study

Abstract

Objectives The primary outcome measures evaluated the financial toxicity and mental well‐being of the oral cancer survivors. Methods A cross‐sectional study of oral cancer survivors who were disease‐free for more than 6 months after treatment and visited the hospital for a routine follow‐up is included in the study. Mental well‐being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale ‐ 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST‐ Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre‐pandemic era. Results A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full‐time employment dropped from 83.5% in the pre‐treatment period to 21.5% post‐treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3–5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3–21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3–6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors ( M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression ( M = 16.4 ± 7.1, p = 0.06) and stress ( M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment ( p = 0.04) and treatment modality ( p = 0.05) were significant factors impacting the financial toxicity. Conclusion There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre‐COVID era. There is significant financial toxicity among either unemployed or part‐time workers. This calls for urgent public/government intervention to prevent the long‐term impact of financial toxicity on survival and quality of life.

Influence of financial toxicity on quality of life in lung cancer patients undergoing immunotherapy: the mediating effect of self-perceived burden

“…And secondly, a systematic review demonstrated relatively clear associations exist between FT and stress, spiritual suffering, fear of recurrence, and overall psychological symptoms [48]. Numerous studies also found positive associations between increases in FT and higher levels of depression and anxiety [49,50]. It is not controversial to say that this in turn affect physical symptoms such as sleep disturbance and fatigue, and ultimately result in inferior life quality.…”

“…And each item was given on a Likert-type format with 5 options (1 = none of the time, 5 = all of the time). The total score ranges from 10 to 50, with the following stages: none (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), mild (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), moderate (30)(31)(32)(33)(34)(35)(36)(37)(38)(39), and severe (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). Wu and Jiang translated it into Chinese with satisfactory internal consistency coe cient (Cronbach's α = 0.91) [38].…”

Global psycho‐oncology in low middle‐income countries: Challenges and opportunities

“…Papers in this Special Issue also draw important attention to the interconnections among mental, physical and social determinants of health. Thaduria et al 16 report on the association between financial toxicity, employment and well-being in oral cancer survivors in a sub-Himalayan city in North India in the era of Covid-19. In a systematic review of the duration of time from symptom onset to the first consultation with a health professional in breast cancer patients, Petrova et al 17 demonstrated the role that literacy and education, stigma, low socioeconomic status and social support play in delaying help-seeking in this population.…”

“…Papers in this Special Issue also draw important attention to the interconnections among mental, physical and social determinants of health. Thaduria et al 16 . report on the association between financial toxicity, employment and well‐being in oral cancer survivors in a sub‐Himalayan city in North India in the era of Covid‐19.…”

“…Thaduria et al. 16 report on the association between financial toxicity, employment and well‐being in oral cancer survivors in a sub‐Himalayan city in North India in the era of Covid‐19. In a systematic review of the duration of time from symptom onset to the first consultation with a health professional in breast cancer patients, Petrova et al.…”