50% cancer patients face financial burden: Study

It said the situation is similar in Kerala, which is known for high out-of-the-pocket spending by public irrespective of their financial status.
(For representational purposes.)
(For representational purposes.)

THIRUVANANTHAPURAM: Around 50% of cancer patients and their families in the country struggle financially to manage care for the disease, which is one of the leading causes of morbidity and mortality in India, a study has found. It said the situation is similar in Kerala, which is known for high out-of-the-pocket spending by public irrespective of their financial status.

The study, a review analysis of the financial toxicity of cancer care in India done by a team of researchers comprising Kochi-based oncologist Dr Aju Mathew, Kozhikode-based medical student Jeffrey Mathew Boby and Hyderabad-based oncologist Senthil Rajappa, has been published in the latest issue of Lancet Oncology, a prestigious medical journal.

As per the study, the high cost of cancer care often leads to substantial financial burden on patients and their family. In India, one-third of households having a cancer patient are estimated to spend more than half of their annual per capita household expenditure on hospitalisations due to the disease, it has found. To pay the ‘catastrophic health expenditure’, patients and families often resort to distress (or hardship) financing – they borrow money, pawn jewellery, use up all of their savings or sell their assets. In India, distress financing is done to pay for over 60% of hospitalisations in rural areas and 40% in urban areas, said the study.

The study reviewed 22 studies done in the country on the burden of cancer care. The scale of cancer care’s impact on personal finances is huge and the study recommends the government to step up investment in public health, especially in cancer care, to address the social impact of the disease. In 2020, around 13 lakh new cancer cases and 8.5 lakh deaths were estimated to have occurred in India.

Besides policy intervention, the study sought to stress on the importance of proper communication between oncologists and patients. A realistic understanding of the situation would help patients choose the kind of treatment they want.

“How long will I live?” and “How much will I have to spend for it?” are the basic questions a cancer patient or family members have while visiting an oncologist. Those visiting a top doctor would know that even these questions are skipped due to the doctor’s busy schedule or due to the mental agony of the family after one among them is diagnosed with cancer.

“It is the right of the patients and family members to ask questions and it is the duty of the treating doctor to explain the disease and treatment. In some cases, a doctor may prescribe chemotherapy to extend a patient’s life by a couple of months. However, patients assume it would cure them and are willing to bear the expenses even if it is beyond their financial capacity,” said Dr Aju, oncologist at Malankara Orthodox Syrian Church Medical College, Kolenchery. In Kerala, there is social pressure on cancer patients to go to the best hospital for treatment, irrespective of financial condition, he said.

Everyone in family is affected

  • Cancer the leading cause of mortality and morbidity in India
  • 13 lakh new cancer cases and 8.5 lakh deaths in 2020
  • More than 50% of cancer patients struggle financially during treatment
  • 33% patients’ families spend more than half of annual per capita expenditure on treatment
  • Financial toxicity is due to low governmental expenditure on public health care, poor insurance coverage, and high out-of-pocket spending
  • Over 75% of total cancer treatment in India financed through out-of-pocket payments by patients
  • Financial toxicity eventually pushes families into poverty and hardship

Impact of financial toxicity on family and cancer care

  • Decreased expenditure on education and recreational activities
  • Accumulation of debt leading to long-term hardship
  • Premature entry of younger family members into labour sector
  • Need to work overtime or do part-time jobs

Consequences

  • Poor quality of life
  • Delay to get therapy
  • Lack of follow-up
  • Non-adherence to therapy

Catastrophic health expenditure is any out-of-pocket medical expenditure in excess of 40% of a household’s non-subsistence income, or any health expenditure greater than 10% of monthly household income

Findings
The study ‘Review on financial toxicity in cancer care in India’ reviewed 22 studies involving 10,000 patients

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