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Financial Toxicity and Its Associated Factors in Cancer Patients: A Cross-sectional Study in Indonesia

Dewi Handayani  -  Faculty of Nursing, Universitas Indonesia, Indonesia
*Yati Afiyanti scopus  -  Faculty of Nursing, Universitas Indonesia, Indonesia
Open Access Copyright (c) 2023 Nurse Media Journal of Nursing
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Financial toxicity has been shown to negatively affect cancer patients’ quality of life, depression, anxiety, and even mortality rates. However, there is only limited data on financial toxicity and its associated factors, which are needed to address this problem in Indonesia.

Purpose: This study aimed to identify factors associated with financial toxicity in cancer patients in Indonesia.

Methods: This study was a cross-sectional study that recruited respondents at a cancer health center in Indonesia using a convenience sampling method. A total of 110 adult cancer patients undergoing treatment took part in the study. The questionnaires comprised sociodemographic data, clinical characteristics, and the Comprehensive Score for Financial Toxicity (COST). Logistic regression was performed to achieve the study's aim.

Results: The median value of the financial toxicity index was 3.01 (min-max=1-5), indicating a medium level of financial toxicity. Occupational status was the only factor found to be associated with financial toxicity in this study. The participants who were unemployed were 2.389 more likely to have a higher financial toxicity level compared to those who were employed (OR=2.389; p=0.048).

Conclusion: Unemployment was identified to be associated with financial toxicity among cancer patients. Nurses should assess and assist patients in utilizing financial resources and develop strategies to manage extra costs that burden them financially. Future nationwide studies are essential to provide more robust evidence on multifaceted factors influencing financial toxicity and inform policy-making aimed at effectively addressing financial toxicity.

 

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Keywords: Cancer; employment; financial toxicity; treatment
Funding: Internationally Indexed Publication Grant (PUTI) of the Postgraduate Program, Fiscal Year 2023-2024, Universitas Indonesia (No. NKB-084/UN2.RST/HKP.05.00/2023)

Article Metrics:

  1. Abrams, H. R., Durbin, S., Huang, C. X., Johnson, S. F., Nayak, R. K., Zahner, G. J. & Peppercorn, J. (2021). Financial toxicity in cancer care: Origins, impact, and solutions. Translational Behavioral Medicine, 11(11), 2043–2054. https://doi.org/10.1093/tbm/ibab091
  2. Afiyanti, Y., Gayatri, D., Besral & Haryani. (2019). Unmet supportive care needs of Indonesian gynecological cancer survivors. Enfermeria Clinica, 29(Insc 2018), 869–873. https://doi.org/10.1016/j.enfcli.2019.04.131
  3. Altice, C. K., Banegas, M. P., Tucker-Seeley, R. D. & Yabroff, K. R. (2017). Financial hardships experienced by cancer survivors: A systematic review. Journal of the National Cancer Institute, 109(2), 1–17. https://doi.org/10.1093/jnci/djw205
  4. Beeler, W. H., Bellile, E. L., Casper, K. A., Jaworski, E., Burger, N. J., Malloy, K. M., Spector, M. E., Shuman, A. G., Rosko, A., Stucken, C. L., Chinn, S. B., Dragovic. A. F., Chapman, C. H., Owen, D., Jolly, S., Bradford, C. R., Prince, M. E. P., Worden, F. P., Jagsi, R., Mierzwa, M. L., & Swiecicki, P. L. (2020). Patient-reported financial toxicity and adverse medical consequences in head and neck cancer. Oral Oncology, 101, 104521. https://doi.org/10.1016/j.oraloncology.2019.104521
  5. Chan, R. J., Gordon, L. G., Tan, C. J., Hons, B., Chan, A., Pharm, D., Bradford, N. K., Yates, P., Agbejule, O. A. & Miaskowski, C. (2019). Relationships between financial toxicity and symptom burden in cancer survivors : A systematic review. Journal of Pain and Symptom Management, 57(3), 646–659. https://doi.org/10.1016/j.jpainsymman.2018.12.003
  6. de Souza, J. A., Yap, B. J., Hlubocky, F. J., Wroblewski, K., Ratain, M. J., Cella, D. & Daugherty, C. K. (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.28814
  7. de Souza, J. A., Yap, B. J., Wroblewski, K., Blinder, V., Araújo, F. S., Hlubocky, F. J., Nicholas, L. H., O'Connor, J. M., Brockstein, B., Ratain, M. J., Daugherty, C. K. & 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.30369
  8. Desai, A. & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine, 20, 100269. https://doi.org/10.1016/j.eclinm.2020.100269
  9. Donkor, A., Atuwo-Ampoh, V. Della, Yakanu, F., Torgbenu, E., Ameyaw, E. K., Kitson-Mills, D., Vanderpuye, V., Kyei, K. A., Anim-Sampong, S., Khader, O. & Khader, J. (2022). Financial toxicity of cancer care in low- and middle-income countries: A systematic review and meta-analysis. Support Care Cancer, 30(9), 7159-7190. https://doi.org/10.1007/s00520-022-07044-z
  10. Ehsan, A. N., Wu, C. A., Minasian, A., Singh, T., Bass, M., Pace, L., Ibbotson, G. C., Bempong-Ahun, N., Pusic, A., Scott, J. W., Mekary, R. A. & Ranganathan, K. (2023). Financial toxicity among patients with breast cancer worldwide: A systematic review and meta-analysis. JAMA Network Open, 6(2), 1–14. https://doi.org/10.1001/jamanetworkopen.2022.55388
  11. Ezeife, D. A., Morganstein, B. J., Lau, S., Law, J. H., Le, L. W., Bredle, J., Cella, D., Doherty, M. K., Bradbury, P., Liu, G., Sacher, A., Shepherd, F. A. & Leighl, N. B. (2019). Financial burden among patients with lung cancer in a publically funded health care system. Clinical Lung Cancer, 20(4), 231–236. https://doi.org/10.1016/j.cllc.2018.12.010
  12. Fabian, A., Rühle, A., Domschikowski, J., Trommer, M., Wegen, S., Becker, J.-N., Wurschi, G., Boeke, S., Sonnhoff, M., Fink, C. A., Käsmann, L., Schneider, M., Bockelmann, E., Treppner, M., Krug, D. & Nicolay, N. H. (2023). Financial toxicity in cancer patients undergoing radiotherapy in a universal health care system – A prospective multicenter study of 1075 patients. Radiotherapy and Oncology, 183, 109604. https://doi.org/10.1016/j.radonc.2023.109604
  13. Faul, F., Erdfelder, E., Buchner, A. & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
  14. Huntington, S. F., Weiss, B. M., Vogl, D. T., Cohen, A. D., Garfall, A. L., Mangan, P. A., Doshi, J. A. & Stadtmauer, E. A. (2015). Financial toxicity in insured patients with multiple myeloma: A cross-sectional pilot study. The Lancet Haematology, 2(10), e408–e416. https://doi.org/10.1016/S2352-3026(15)00151-9
  15. Kesmodel, U. S. (2018). Cross-sectional studies – What are they good for?. Acta Obstetricia et Gynecologica Scandinavica, 97(4), 388–393. https://doi.org/10.1111/aogs.13331
  16. Kimman, M., Jan, S., Yip, C., Thabrany, H., Peters, S., Bhoo-Pathy, N., Woodward, M., Arounlangsy, P., Soe Aung, S., Balete, L., Bounxouei, B., Bui, D., Datukan, J., Gorospe, A. E., Khopaibul, P., Thanu & Klinwimol, T. (2015). Catastrophic health expenditure and 12-month mortality associated with cancer in Southeast Asia: Results from a longitudinal study in eight countries. BMC Medicine, 13(190), 1–11
  17. Knight, T. G., Deal, A. M., Dusetzina, S. B., Muss, H. B., Choi, S. K., Bensen, J. T. & Williams, G. R. (2018). Financial toxicity in adults with cancer: Adverse outcomes and noncompliance. Journal of Oncology Practice, 14(11), 683. https://doi.org/10.1200/JOP.18.00120
  18. Longo, C. J., Fitch, M. I., Banfield, L., Hanly, P., Yabroff, K. R. & Sharp, L. (2020). Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: A systematic review. Supportive Care in Cancer, 28(10), 4645–4665. https://doi.org/10.1007/s00520-020-05620-9
  19. Mady, L. J., Lyu, L., Owoc, M. S., Peddada, S. D., Thomas, T. H., Sabik, L. M., Johnson, J. T. & Nilsen, M. L. (2019). Understanding financial toxicity in head and neck cancer survivors. Oral Oncology, 95, 187–193. https://doi.org/10.1016/j.oraloncology.2019.06.023
  20. Mariotto, A. B., Robin Yabroff, K., Shao, Y., Feuer, E. J. & Brown, M. L. (2011). Projections of the cost of cancer care in the United States: 2010-2020. Journal of the National Cancer Institute, 103(2), 117–128. https://doi.org/10.1093/jnci/djq495
  21. Ministry of Health Republic of Indonesia. (2018). Laporan hasil riset kesehatan dasar/Riskesdas 2018 [Report of the 2018 basic health research]. https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018
  22. Ministry of Health Republic of Indonesia. (2022). Kemenkes pastikan layanan 4 penyakit katastropik dapat dilakukan di RSUD Kabupaten/Kota [The Ministry of Health ensures that services for four catastrophic diseases can be conducted at regional general hospitals in Districts/Cities]. https://www.kemkes.go.id/article/view/22122400004/kemenkes-pastikan-layanan-4-penyakit-katastropik-dapat-dilakukan-di-rsud-kabupaten-kota.html
  23. Pangestu, S. & Karnadi, E. B. (2018). Financial toxicity in Indonesian cancer patients & survivors: How it affects risk attitude. Cogent Medicine, 5(1), 1525887. https://doi.org/10.1080/2331205X.2018.1525887
  24. Pearce, A., Tomalin, B., Kaambwa, B., Horevoorts, N., Duijts, 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. Journal of Cancer Survivorship, 13(1), 10–20. https://doi.org/10.1007/s11764-018-0723-7
  25. Perrone, F., Jommi, C., Di Maio, M., Gimigliano, A., Gridelli, C., Pignata, S., Ciardiello, F., Nuzzo, F., de Matteis, A., Del Mastro, L., Bryce, J., Daniele, G., Morabito, A., Piccirillo, M. C., Rocco, G., Guizzaro, L. & Gallo, C. (2016). The association of financial difficulties with clinical outcomes in cancer patients: Secondary analysis of 16 academic prospective clinical trials conducted in Italy. Annals of Oncology, 27(12), 2224–2229. https://doi.org/10.1093/annonc/mdw433
  26. Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A. & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
  27. Susilowati, M. & Afiyanti, Y. (2020). Dampak financial toxicity pada penyintas kanker [The impact of financial toxicity on cancer survivors]. Jurnal Ilmiah Ilmu Keperawatan Indonesia, 10(03), 72–77. https://doi.org/10.33221/jiiki.v10i03.658
  28. Susilowati, M. & Afiyanti, Y. (2021). The sociodemographic factors correlated with financial toxicity among patients with breast cancer in Indonesia. Journal of Public Health Research, 10(s1), 105–110. https://doi.org/10.4081/jphr.2021.2403
  29. Udayakumar, S., Solomon, E., Isaranuwatchai, W., Rodin, D. L., Ko, Y. J., Chan, K. K. W. & Parmar, A. (2022). Cancer treatment-related financial toxicity experienced by patients in low- and middle-income countries: A scoping review. Supportive Care in Cancer, 30(8), 6463–6471. https://doi.org/10.1007/s00520-022-06952-4
  30. Xu, B., Hu, L., Cheng, Q. & K.W. So, W. (2022). A systematic review of financial toxicity among cancer patients in China. Asia-Pacific Journal of Oncology Nursing, 9(2022), 100071. https://doi.org/10.1016/j.apjon.2022.04.010
  31. Yabroff, K. R., Dowling, E. C., Guy, G. P., Banegas, M. P., Davidoff, A., Han, X., Virgo, K. S., McNeel, T. S., Chawla, N., Blanch-Hartigan, D., Kent, E. E., Li, C., Rodriguez, J. L., De Moor, J. S., Zheng, Z., Jemal, A. & Ekwueme, D. U. (2016). Financial hardship associated with cancer in the United States: Findings from a population-based sample of adult cancer survivors. Journal of Clinical Oncology, 34(3), 259–267. https://doi.org/10.1200/JCO.2015.62.0468
  32. Yousuf Zafar, S., McNeil, R. B., Thomas, C. M., Lathan, C. S., Ayanian, J. Z. & Provenzale, D. (2015). Population-based assessment of cancer survivors’ financial burden and quality of life: A prospective cohort study. Journal of Oncology Practice, 11(2), 145–150. https://doi.org/10.1200/JOP.2014.001542

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