Financial Toxicity After Cancer in a Setting With Universal Health Coverage: A Call for Urgent Action.

Area of Science:

• Oncology
• Health Economics
• Public Health

Background:

• Financial toxicity poses a significant threat to the well-being of cancer survivors.
• Understanding its incidence, cost drivers, and associated factors is crucial, especially in universal health coverage settings.

Purpose of the Study:

• To examine the incidence, cost drivers, and predictors of financial toxicity among cancer patients in Malaysia, an upper-middle-income country with universal health coverage.

Main Methods:

• The study observed 1,294 newly diagnosed cancer patients across different hospital types in Malaysia.
• Data on financial toxicity, including financial catastrophe, medical impoverishment, and economic hardship, were collected using cost diaries and questionnaires.
• Multivariable analyses identified predictors of financial toxicity.

Main Results:

• Financial catastrophe (FC) affected 51% of patients within one year, with higher rates in private and public university hospitals.
• Thirty-three percent of households experienced medical impoverishment, and 47% reported economic hardship.
• Low-income status, hospital type, and lack of health insurance were significant predictors of FC, with nonmedical costs contributing to financial toxicity in public hospitals.

Conclusions:

• Cancer patients face substantial financial burdens, even within universal health coverage systems.
• Nonmedical expenditures represent a significant, often overlooked, driver of financial toxicity.
• Targeted interventions addressing socioeconomic factors and nonmedical costs are needed to mitigate financial hardship for cancer survivors.