The Impact of Cancer Treatment “Out-of-Pocket” Costs on the Mental Health of Chemotherapy Patients: A Comparative Study

Abstract

Introduction: Anxiety and depression are prevalent comorbidities in cancer patients. Although cancer treatment is funded by the Brazilian Unified Health System (SUS), economic burden is also borne by patients through out-of-pocket costs. Our study sought to evaluate the impact of out-of-pocket costs of cancer treatment on depression, anxiety and stress levels in cancer patients.Methods: Observational, cross-sectional and analytical study conducted in 2021. Patients undergoing chemotherapy were being treated at tertiary hospital affiliated with the SUS and enrolled in research protocols at research center. To evaluate out-of-pocket costs, we used a socioeconomic questionnaire to identify costs and time spent by patients. Primary outcomes were prevalence of depression and anxiety, as determined by the Hospital Anxiety and Depression Scale (HADS), and prevalence of stress, as determined using a stress thermometer.Results: 195 patients were included. Among included patients, 61% were female, and mean age was 57 years. Patients' median overall out-of-pocket costs was R$ 453.80 (US$ 78.92). Based on the HADS, 62.1% of patients had possible or probable depression/anxiety. There was no correlation between overall out-of-pocket spending and levels of depression/anxiety. However, when stratified by cost-time variables, there was a negative correlation between spending on telephones and HADS (rho = -0.140; P = 0.049) and positive correlations between spending on medications (rho = 0.140; P = 0.05) and time spent purchasing medications (rho = 0.157; P = 0.029) with HADS.Conclusion: Although overall spending was not directly correlated with mental health, specific costs impacted levels of anxiety, depression and stress.