Implications of financial toxicity in the lives of cancer patients: a reflection

Financial toxicity in allogeneic haematopoietic stem cell transplant patients from a social determinants of health perspective

PURPOSE

Financial toxicity (FT) refers to the subjective perception of financial distress resulting from objective economic strain due to illness, exerting a detrimental influence on health outcomes. This study aimed to describe FT among allogeneic haematopoietic stem cell transplant (allo-HSCT) recipients within a public health framework, employing a social determinants of health approach.

METHODS

A multi-centre cross-sectional study involving adult allo-HSCT patients was conducted across three public hospitals in Madrid. FT was assessed using a validated COST scale (range 0-44; lower scores indicating higher FT). Patient-administered paper/online questionnaires were utilized to collect data on sociodemographic, socioeconomic, clinical, and healthcare access variables. Descriptive, non-parametric univariate statistical analysis and multiple linear regression models were performed.

RESULTS

Sixty-six patients, with a mean age: 52.5 years (SD: 11.5), 50% women, 28.7% displaced to Madrid for HSCT, and 71.4% lacking financial support were included. The median FT score was 20 points (IQR 12-27.25). Independent factors associated with higher FT included being females (Coef = -3.26; p = 0.079), perceived income loss after HSCT (Coef = -6.81; p < 0.001) and a monthly household income of ≤1000 € compared to 1001-2500€ (Coef = 8.29; p = 0.005) or >2500 € (Coef = 15.75; p < 0.001).

CONCLUSIONS

Despite the limited sample size, our findings underscore the presence of financial toxicity among allo-HSCT patients, shaped by social determinants of health. Recognizing and addressing FT within the HSCT process is essential to mitigate social inequalities in health.

Quality of life assessment of patients undergoing palliative chemotherapy

BACKGROUND

Palliative chemotherapy uses systemic antineoplastic agents to treat an incurable malignancy. The results of cancer treatment need to be measured in terms of what physical and psychological limitations it brings to the patient. Therefore, there is a need to evaluate and establish the impact of the disease and its treatment on the patient's quality of life.

OBJECTIVE

To evaluate the quality of life of cancer patients undergoing palliative antineoplastic chemotherapy.

METHOD

A cross-sectional study with quali-quantitative unfolding. Three research instruments were applied: sociodemographic and clinical data; European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30); interview script with predefined open questions.

RESULTS

The quality of life of the participants was considered good. Fatigue and financial difficulty were the main factors that interfered in daily activities. Three analytical categories emerged from the content analysis of the interviews: communication between the health team and the patient; patient's perception of their health/disease; concerns vs prospects.

CONCLUSION

The evaluation of quality of life for people who are at the end of life needs to balance technological and therapeutic advances, alongside aspects such as the perspective of these patients and the context of their lives.

Seeking cancer treatment for their children: experience of parents from areas distant from Lima-Peru

OBJECTIVE

To understand the experiences of parents of children with cancer who come from areas distant from Lima-Peru during the search for cancer treatment for their children.

METHOD

A descriptive-exploratory qualitative approach study. Focus groups and semi-structured interviews were carried out. The sample consisted of 18 parents who come from remote areas from Lima who attended specialized hospitals. The qualitative analysis was of thematic content, proposed by Minayo.

RESULTS

Three categories emerged: Accessing cancer care in Lima hospitals; Having diverse personal experiences during their child's treatment; and Reporting the socioeconomic and labor impact during their stay in Lima.

FINAL CONSIDERATIONS

Understanding these experiences could help health professionals to implement strategies of socioeconomic support to facilitate access to health services for children with cancer. Hospitals must guarantee the satisfaction of the basic needs of parents.