Abstract
Purpose
Out of Pocket costs (OOP) sustained by cancer patients also in public NHS contribute to disease-related financial toxicity. Aim of the study was to investigate the amount and the types of OOP sustained by Italian cancer patients for care services.Methods
A sample survey was conducted by FAVO in December 2017-June 2018, in 39 adhering hospitals and 1289 patients diagnosed from 1985 to 2018, by standardized questionnaire inquiring on: yearly expenditure by cancer service, age, year of diagnosis, disease phase, cancer site, sex, marital status, education, residence. Univariate and multivariable regression analyses were performed between OOP and each variable. Multilevel mixed-effects negative binomial regression was used to assess the combined effects of patients characteristics on the differences in acquiring health services.Results
The yearly average OOP was 1841.81€, with the highest values for transports (359.34€) and for diagnostic examinations (259.82€). Significantly higher OOP were found in North and Centre than South and Islands (167.51 vs. 138.39). In the fully adjusted multivariable analysis, the variables significantly associated with higher than reference expenditure were: medium/high education (OR 1.22 [1.05-1.42], upper gastrointestinal tract cancer (OR 1.37 [1.06-1.77]), disease phase of treatments for cancer progression or pain therapy (OR 1.59 [1.30-1.93]).Conclusion
Italian cancer patients in 2018 sustained OOP quite similar to those measured in 2012 to supplement NHS services. The main component of the OOP costs were diagnostic examination and transportation. The NHS should pay attention to potentiate its ability to answer unmet needs of patients with advanced cancer who are the most fragile ones.Implications for cancer survivors
Reinforcing the services where the main OOP expenses are located can help in promoting public health actions and reduce socio-economic needs that could compromise the receipt of optimal care along the whole disease course, from diagnosis to rehabilitation.References
Articles referenced by this article (19)
The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.
Oncologist, (4):381-390 2013
MED: 23442307
Financial Burden Among Patients With Lung Cancer in a Publically Funded Health Care System.
Clin Lung Cancer, (4):231-236 2018
MED: 30797721
Prospective Survey of Financial Toxicity Measured by the Comprehensive Score for Financial Toxicity in Japanese Patients With Cancer.
J Glob Oncol, 1-8 2019
MED: 31070981
Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review.
Support Care Cancer, (10):4645-4665 2020
MED: 32653957
The association of financial difficulties with clinical outcomes in cancer patients: secondary analysis of 16 academic prospective clinical trials conducted in Italy.
Ann Oncol, (12):2224-2229 2016
MED: 27789469
A survey in Nepalese patients with acute leukaemia: a starting point for defining financial toxicity of cancer care in low-income and middle-income countries.
Lancet Haematol, (9):e638-e639 2020
MED: 32853583
Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study.
Support Care Cancer, (5):2225-2233 2015
MED: 26573280
The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
J Natl Cancer Inst, (5):365-376 1993
MED: 8433390
Development and validation of a patient-reported outcome tool to assess cancer-related financial toxicity in Italy: a protocol.
BMJ Open, (9):e031485 2019
MED: 31501130
Show 9 more references (10 of 19)
Citations & impact
Impact metrics
Alternative metrics
Discover the attention surrounding your research
https://www.altmetric.com/details/142122671
Smart citations by scite.ai
Explore citation contexts and check if this article has been
supported or disputed.
https://scite.ai/reports/10.1007/s10198-022-01544-9
Article citations
Confirmatory validation analysis of the PROFFIT questionnaire to assess financial toxicity in cancer patients.
ESMO Open, 8(6):102192, 05 Dec 2023
Cited by: 0 articles | PMID: 38052104 | PMCID: PMC10774953
Similar Articles
To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Out-of-Pocket Spending and Financial Burden Among Medicare Beneficiaries With Cancer.
JAMA Oncol, 3(6):757-765, 01 Jun 2017
Cited by: 92 articles | PMID: 27893028 | PMCID: PMC5441971
Out-of-Pocket Expenditures for Imaging Examinations: Perspectives From National Patient Surveys Over Two Decades.
J Am Coll Radiol, 20(1):18-28, 06 Oct 2022
Cited by: 1 article | PMID: 36210041
Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study.
Support Care Cancer, 24(5):2225-2233, 16 Nov 2015
Cited by: 11 articles | PMID: 26573280
Health services utilization, out-of-pocket expenditure, and underinsurance among insured non-elderly cancer survivors in the United States, 2011-2015.
Cancer Med, 10(16):5513-5523, 30 Jul 2021
Cited by: 3 articles | PMID: 34327859 | PMCID: PMC8366084
The out of pocket cost of breast cancer survivors: a review.
J Cancer Surviv, 4(3):202-209, 17 Apr 2010
Cited by: 60 articles | PMID: 20401542 | PMCID: PMC2922410
Review Free full text in Europe PMC