Out-of-Pocket Costs and Financial Toxicity Associated With the Surgical Management of Oesophageal Cancer

Patients undergoing cancer treatment incur significant out-of-pocket costs attributed to both medical and non-medical expenditure. We quantified out-of-pocket costs for patients receiving surgical treatment for oesophageal cancer and their financial toxicity.

Patients who had undergone oesophagectomy for cancer completed an out-of-pocket questionnaire which determined medical costs (e.g., gap payments and medications), non-medical costs (e.g., travel, accommodation, wage loss) and carer costs (travel and wage loss). Financial toxicity was assessed using the validated Comprehensive Score for Financial Toxicity (COST) questionnaire. Out-of-pocket costs and financial toxicity were summarised using medians with bootstrapped 95% confidence intervals (CIs) (1000 resamples). Between-group comparisons were assessed with Wilcoxon rank-sum and Kruskal-Wallis tests and associations with income percentiles using Spearman's correlation.

Seventy individuals completed the survey (43.3% response rate). The majority were male (85.7%), aged 60-79 (76.5%) and 0-5 years post-cancer diagnosis (55.7%). Median out-of-pocket expenditure was $1352 and was mainly attributed to wage loss (64.7%), followed by carer cost (23.7%). Out-of-pocket costs were higher for younger age groups (40-59 years) compared to those aged 60-79 years (p = 0.003). There was no statistically significant difference in out-of-pocket costs between public versus privately insured patients. Median out-of-pocket costs trended higher for rural ($1696) versus urban located patients ($1235), but this was not statistically significantly different (p = 0.140). The median financial toxicity score was 23.5 (95% CI: 21.0-27.5), indicating moderate financial toxicity. Financial toxicity did not differ significantly by age, gender, country of birth, education or location. A lower income percentile was associated with greater financial toxicity (ρ = -0.30, p = 0.012).

Patients facing oesophagectomy for cancer incur many out-of-pocket costs, mostly due to wage loss from time spent away from work for both patients and carers. Younger patients and those with lower income face proportionately greater financial burdens, highlighting a need for targeted support to reduce financial stress.