nach oben

Supportive Care in Cancer

Erschienen in:

15.08.2021 | Original Article

Predictors of financial toxicity and its associations with health-related quality of life and treatment non-adherence in Turkish cancer patients

verfasst von: Duygu Ürek, Özgür Uğurluoğlu

Erschienen in: Supportive Care in Cancer | Ausgabe 1/2022

Einloggen, um Zugang zu erhalten

Abstract

Purpose

This study aims to determine the financial toxicity (FT) level in cancer patients, identify the risk factors associated with this level, and reveal the effect of this level on patient outcomes (health-related quality of life (HRQoL) and treatment non-adherence).

Methods

The data of 316 cancer patients, who were receiving inpatient treatment in an oncology hospital affiliated to a public university in Ankara, Turkey, were ≥ 18 years old, and were receiving chemotherapy for at least 3 months, were evaluated. The data were collected through a face-to-face interview. FT was measured with the COmprehensive Score for financial Toxicity (COST) Measure (v2), HRQoL was measured with the Functional Assessment of Cancer Therapy-General (FACT-G) Scale (v4), and treatment adherence was measured using a questionnaire created by conducting a literature review.

Results

Patients were found to experience FT above the moderate level (mean ± SD, 21.85 ± 12.02; median value, 24.0). Younger age, being married, low education level, low monthly household income, and receiving social/economic support for treatment were revealed to be the determinants of high FT. Moreover, as the FT score decreased (as the FT level felt increased), the HRQoL was observed to decrease, and treatment non-adherence increased.

Conclusion

The results indicate that FT problem is also valid for cancer patients in Turkey despite the system of general health insurance. The FT was found to result from socio-economic characteristics rather than the disease and treatment-related characteristics. The significant associations revealed between FT and patient outcomes emphasize the importance of reducing the FT in cancer patients.

Carrera P, Zafar SY (2018) Financial toxicity. In: Olver I (ed) The MASCC textbook of cancer supportive care and survivorship, 2nd edn. Springer International Publishing AG, Switzerland, pp 127–143CrossRef

Nipp RD, Sonet EM, Guy GP Jr (2018) Communicating the financial burden of treatment with patients. Am Soc Clin Oncol Educ Book 38:524–531. https://doi.org/10.1200/EDBK_201051CrossRefPubMed

Zafar SY, Abernethy AP (2013) Financial toxicity, Part II: how can we help with the burden of treatment-related costs? Oncology 27(4):253–256PubMed

Gordon LG, Merollini KMD, Lowe A, Chan RJ (2017) Financial toxicity – what it is and how to measure it. Cancer Forum 41(2):30–35

Philips F, Kvale E, Jones B, Currin-Mcculloch J, Byelousova A (2019) The construct of financial toxicity and association with quality of life in poor populations (TH341A). J Pain Symptom Manage 57(2):386CrossRef

Gordon LG, Elliott TM, Wakelin K, Leyden S, Leyden J, Michael M, Pavlakis N, Mumford J, Segelov E, Wyld DK (2020) The economic impact on Australian patients with neuroendocrine tumors. Patient-Patient-Centered Outcomes Res 13:363–373. https://doi.org/10.1007/s40271-020-00412-zCrossRef

Ting CY, Teh GC, Yu KL, Alias H, Tan HM, Wong LP (2020) 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. https://doi.org/10.1007/s00520-019-04975-yCrossRefPubMed

Knight TG, Deal AM, Dusetzina SB, Muss HB, Choi SK, Bensen JT, Williams GR (2018) Financial toxicity in adults with cancer: adverse outcomes and noncompliance. J Oncol Pract 14(11):e665–e673. https://doi.org/10.1200/JOP.18.00120CrossRef

Bouberhan S, Shea M, Kennedy A, Erlinger A, Stack-Dunnbier H, Buss MK, Moss L, Nolan K, Awtrey C, Dalrymple JL, Garrett L, Liu FW, Hacker MR, Esselen KM (2019) Financial toxicity in gynecologic oncology. Gynecol Oncol 154:8–12. https://doi.org/10.1016/j.ygyno.2019.04.003CrossRefPubMedPubMedCentral

10.

Beeler WH, Bellile EL, Casper KA, Jaworski E, Burger NJ, Malloy KM, Spector ME, Shuman AG, Rosko A, Stucken CL, Chinn SB, Dragovic AF, Chapman CH, Owen D, Jolly S, Bradford CR, Prince MEP, Worden FP, Jagsi R, Mierza ML, Swiecicki PL (2020) Patient-reported financial toxicity and adverse medical consequences in head and neck cancer. Oral Oncol 101:104521. https://doi.org/10.1016/j.oraloncology.2019.104521CrossRefPubMed

11.

Longo CJ, Fitch MI, Banfield L, Hanly P, Yabroff KR, Sharp L (2020) Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 28:4645–4665. https://doi.org/10.1007/s00520-020-05620-9CrossRefPubMed

12.

Social Security Institution (SSI) (2020a) SSI monthly bulletin insured statistics, January 2020. http://www.sgk.gov.tr. Accessed 1 Aug 2020

13.

Atun R, Aydın S, Chakraborty S, Sümer S, Aran M, Gürol I, Nazlıoğlu S, Özgülcü Ş, Aydoğan Ü, Ayar B, Dilmen U, Akdağ R (2013) Universal health coverage in Turkey: enhancement of equity. Lancet 382:65–99. https://doi.org/10.1016/S0140-6736(13)61051-XCrossRefPubMed

14.

Social Security Institution (SSI) (2020b) The number of medicines in the reimbursement list reached to 8,880. SSI Agenda 3/November. http://www.sgk.gov.tr/. Accessed 29 Nov 2020

15.

Uğurluoğlu Ö, Ürek D, Demir İB (2019) Evaluation of individuals’ satisfaction with health care services in Turkey. Health Policy Technol 8(1):24–29. https://doi.org/10.1016/j.hlpt.2019.02.003CrossRef

16.

Health Application Notification (2020). Current Health Application Notification dated 16.06.2020. http://www.sgk.gov.tr. Accessed 1 Sep 2020

17.

de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, Daugherty CK (2014) The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer 120(20):3245–3253. https://doi.org/10.1002/cncr.28814CrossRefPubMed

18.

de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araújo FS, Hlubocky FJ, Nicholas LH, O’Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D (2017) Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the comprehensive score for financial toxicity (COST). Cancer 123(3):476–484. https://doi.org/10.1002/cncr.30369CrossRefPubMed

19.

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 18:381–390. https://doi.org/10.1634/theoncologist.2012-0279CrossRefPubMedPubMedCentral

20.

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. https://doi.org/10.1200/JOP.2014.001406CrossRefPubMed

21.

Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, Doshi JA, Stadtmauer EA (2015) Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol 2:e408–e416. https://doi.org/10.1016/S2352-3026(15)00151-9CrossRefPubMed

22.

Kaul S, Avila JC, Mehta HB, Rodriguez AM, Kuo Y, Kirchoff AC (2017) Cost-related medication nonadherence among adolescent and young adult cancer survivors. Cancer 123:2726–2734. https://doi.org/10.1002/cncr.30648CrossRefPubMed

23.

Cella DF, Tulsky DS, Gray G, Saraflan B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, Eckberg K, Lloyd S, Purl S, Blendowski C, Goodman M, Barnicle M, Stewart I, McHale M, Bonomi P, Kaplan E, Taylor S IV, Thomas CR, Harris J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579. https://doi.org/10.1200/JCO.1993.11.3.570CrossRefPubMed

24.

Cella D (1997) Manual of the functional assessment of chronic illness therapy (FACIT scales). Center on Outcomes, Research and Education (CORE), Evanston Northwestern Healthcare and Northwestern University. Version 4, Evanston

25.

Webster K, Odom L, Peterman A, Lent L, Cella D (1999) The functional assessment of chronic illness therapy (FACIT) measurement system: validation of version 4 of the core questionnaire. Qual Life Res 8(7):604. https://doi.org/10.1186/1477-7525-1-79CrossRef

26.

Çetiner M, Kalaça S, Birtaş E, Kalayoğlu Beşışık S, Sosyal T, Saygın D, Ferhanoğlu B, Fıratlı Tuğlular T, Bayık M (2004) Evaluation of quality of life in patients undergoing hematopoietic stem cell transplantation (Istanbul experience, pilot study). XXXI National Congress Hematology 21(3 Supplement):6–7

27.

Eremenco SL, Cella D, Arnold BJ (2005) A comprehensive method for the translation and cross-cultural validation of health status questionnaires. Eval Health Prof 28(2):212–232CrossRefPubMed

28.

Fathollahzade A, Rahmani A, Dadashzadeh A, Gahramanian A, Esfahani A, Javanganji L, Nabiolahi L (2015) Financial distress and its predicting factors among Iranian cancer patients. Asian Pac J Cancer Prev 16(4):1621–1625. https://doi.org/10.7314/apjcp.2015.16.4.1621CrossRefPubMed

29.

Ezeife DA, Morganstein BJ, Lau S, Law JH, Le LW, Bredle J, Cella D, Doherty MK, Bradbury P, Liu G, Sacher A, Shepherd FA, Leighl NB (2019) Financial burden among patients with lung cancer in a publically funded health care system. Clin Lung Cancer 20(4):231–236. https://doi.org/10.1016/j.cllc.2018.12.010CrossRefPubMed

30.

Jing J, Feng R, Zhang X, Li M, Gao J (2020) Financial toxicity and its associated patient and cancer factors among women with breast cancer: a single-center analysis of low-middle income region in China. Breast Cancer Res Treat 181(2):435–443. https://doi.org/10.1007/s10549-020-05632-3CrossRefPubMed

31.

Honda K, Gyawali B, Ando M, Kumanishi R, Kato K, Sugiyama K, Mitani S, Masuishi T, Narita Y, Bando H, Taniguchi H, Kadowaki S, Ura T, Muro K (2019) Prospective survey of financial toxicity measured by the comprehensive score for financial toxicity in Japanese patients with cancer. J Glob Oncol. https://doi.org/10.1200/JGO.19.00003

32.

Ripamonti CI, Chiesi F, Pede PD, Guglielmo M, Toffolatti L, Gangeri L, Allocca E (2020) The validation of the Italian version of the comprehensive score for financial toxicity (COST). Support Care Cancer 28:4477–4485. https://doi.org/10.1007/s00520-019-05286-yCrossRefPubMed

33.

Ramsey SD, Blough DK, Kirchhoff AC, Fedorenko CR, Snell KS, Kreizenbeck KL, Newcomb P, Hollingworth W, Overstreet K (2013) Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancerdiagnosis. Health Aff 32(6):1143–1152. https://doi.org/10.1377/hlthaff.2012.1263CrossRef

34.

Heinesen E, Imai S, Maruyama S (2018) Employment, job skills and occupational mobility of cancer survivors. J Health Econ 58:151–175. https://doi.org/10.1016/j.jhealeco.2018.01.006CrossRefPubMed

35.

Pendergrass JC, Targum SD, Harrison JE (2018) Cognitive impairment associated with cancer: a brief review. Innov Clin Neurosci 15(1–2):36–44PubMedPubMedCentral

36.

Guy GP Jr, Ekwueme DU, Yabroff KR, Dowling EC, Li C, Rodriguez JL, de Moor JS, Virgo KS (2013) Economic burden of cancer survivorship among adults in the United States. J Clin Oncol 31(30):3749–3757. https://doi.org/10.1200/JCO.2013.49.1241CrossRefPubMedPubMedCentral

37.

The 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 13:190. https://doi.org/10.1186/s12916-015-0433-1CrossRefPubMedCentral

38.

Pearce A, Tomalin B, Kaambwa B, Horevoorts N, Dujits S, Mols F, van de Poll-Franse L, Koczwara B (2019) Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors. J Cancer Surviv 13:10–20. https://doi.org/10.1007/s11764-018-0723-7CrossRefPubMed

39.

Egestad H, Nieder C (2015) Undesirable financial effects of head and neck cancer radiotherapy during the ınitial treatment period. Int J Circumpolar Health 74:26686. https://doi.org/10.3402/ijch.v74.26686CrossRefPubMed

40.

Turkish Statistical Institute (2021a). Women by statistics, 2020. https://www.tuik.gov.tr/. Accessed 15 July 2021

41.

Turkish Statistical Institute (2021b). Income and living conditions survey, 2020. https://www.tuik.gov.tr/. Accessed 15 July 2021

42.

Tran G, Zafar SY (2018) Price of cancer care and its tax on quality of life. J Oncol Pract 14(2):69–71. https://doi.org/10.1200/JOP.2017.028498CrossRefPubMed

43.

Baer WH II, Maini A, Jacobs I (2014) Barriers to the access and use of rituximab in patients with non-Hodgkin’s lymphoma and chronic lymphocytic leukemia: a physician survey. Pharmaceuticals 7(5):530–544. https://doi.org/10.3390/ph7050530CrossRefPubMedCentral

44.

Turkish Association for Cancer Research and Control (2017) Turkey Stomach Cancer Report. December 2017

45.

Huyard C, Derijks L, Haak H, Lieverse L (2017) Intentional nonadherence as a means to exert control. Qual Health Res 27(8):1215–1224. https://doi.org/10.1177/1049732316688882CrossRefPubMed

Titel: Predictors of financial toxicity and its associations with health-related quality of life and treatment non-adherence in Turkish cancer patients
verfasst von: Duygu Ürek
Özgür Uğurluoğlu
Publikationsdatum: 15.08.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Supportive Care in Cancer / Ausgabe 1/2022
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-021-06491-4

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Predictors of financial toxicity and its associations with health-related quality of life and treatment non-adherence in Turkish cancer patients

Abstract

Purpose

Methods

Results

Conclusion

Neu im Fachgebiet Onkologie

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

15% bedauern gewählte Blasenkrebs-Therapie

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Update Onkologie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2022

Helping Us Heal: telephone versus in-person marital communication and support counseling for spouse caregivers of wives with breast cancer

Letter to the editor referencing “Body composition changes in patients with head and neck cancer under active treatment: a scoping review”

Feasibility and acceptability of hypnosis-derived communication administered by trained nurses to improve patient well-being during outpatient chemotherapy: a pilot-controlled trial

Needs for information about lifestyle and rehabilitation in long-term young adult cancer survivors

Process, content, and experiences of delivering the Carer Support Needs Assessment Tool Intervention (CSNAT-I) in the Danish specialised palliative care setting

The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital

Neu im Fachgebiet Onkologie

Erhebliches Risiko für Kehlkopfkrebs bei mäßiger Dysplasie

15% bedauern gewählte Blasenkrebs-Therapie

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

Costims – das nächste heiße Ding in der Krebstherapie?

Update Onkologie