Cancer patients' willingness to trade time for health: factors that affect their decision

Cancer is a debilitating condition. Cancer patients may exhibit a willingness to trade time for better health, with the trade-off involving the exchange of certain years in their current health states for a shorter lifespan of full health status. However, the willingness to trade time for health greatly depends on individual factors. While some cancer patients may prioritise longer survival time to celebrate significant life events, some others may opt for improved quality of life over a shorter lifespan to reduce suffering. In many countries, the factors influencing the willingness to trade off time among cancer patients remain underexplored. Therefore, in this study, we aimed to determine the factors associated with the willingness of cancer patients to trade survival time for a better state of health in Malaysia.

This cross-sectional study utilised an online platform to survey 235 respondents suffering from the three major cancer groups, i.e. breast, colon, and lung cancers. Data collection was conducted between March and December 2022 using the Research Electronic Data Capture (REDCap) application. The time trade-off (TTO) method was used to measure the willingness to trade the time, which reflected the length of life expectancy. Data on the socio-demographic, medical profile, and health status (EQ-5D-5 L) of the patients were gathered.

Out of the 235 cancer patients who participated in this study, 135 (57.6%) expressed a willingness to trade time for better health while 100 (42.6%) were not open to such trade-offs. Univariate analysis revealed statistically significant racial differences in willingness to trade length of life. In contrast, age, gender, level of education, household income, insurance coverage, employment status and medical profile characteristics were all not significantly associated with willingness to trade time. The dimensions of self-care and anxiety/depression under EQ-5D-5 L were significantly associated with willingness to trade time (p < 0.05).

In this study, race, self-care, and anxiety/depression were the main factors affecting the willingness to trade time in the Malaysian cancer patient population. These factors significantly influenced their choices on survival time trade-offs. The identification of these factors will help healthcare providers to better align cancer treatment with patients' wellbeing and long-term goals.