Cancer Surgery at a Cost: Understanding Financial Toxicity Among Patients in Pakistan.

Area of Science:

• Oncology
• Health Economics
• Public Health

Background:

• Cancer treatment incurs substantial out-of-pocket expenses, leading to financial toxicity (FT).
• Data on FT in low- and middle-income countries, such as Pakistan, are limited.
• This study investigates the prevalence and determinants of FT in patients undergoing gastrointestinal cancer surgery in Pakistan.

Purpose of the Study:

• To evaluate the prevalence of financial toxicity (FT) among patients undergoing gastrointestinal cancer surgery.
• To identify key determinants associated with FT in this patient population.
• To inform the development of financial protection strategies in Pakistan.

Main Methods:

• A cross-sectional study was conducted with 221 gastrointestinal cancer surgery patients across three tertiary hospitals in Karachi.
• Data collected included demographics, surgery type, income, healthcare costs, and treatment modalities.
• Financial toxicity was assessed using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy, with multivariable negative binomial regression used for analysis.

Main Results:

• A high prevalence of FT was observed, with 88.7% of patients affected.
• Factors associated with increased FT included spending ≥40% of annual income on healthcare and specific surgical procedures (e.g., rectal resections).
• Female patients and those in middle-income tertiles reported significantly lower FT.

Conclusions:

• Financial toxicity is highly prevalent among gastrointestinal cancer surgery patients in Pakistan, primarily driven by economic status and healthcare expenditure.
• Cancer type, stage, and insurance status were less influential than economic factors.
• Urgent implementation of financial protection strategies, including counseling, subsidized insurance, and income support, is crucial to mitigate financial hardship and ensure equitable cancer care access.