Most Patients in China With Lung Cancer Experience Financial Toxicity

Despite the rollout of universal health insurance more than a decade ago, financial toxicity remains a major issue for people in China who are diagnosed with lung cancer, according to a new study.

The report, published in Cancer Medicine, found those with advanced cancers or a poorer health status were more likely to experience financial toxicity.

Advances in cancer diagnosis and treatment have led to rising costs, and with those rising costs has come an increasing financial burden for patients, noted corresponding author Yuanli Liu, PhD, of the Chinese Academy of Medical Sciences and Peking Union Medical College. Previous research suggests that the financial burden associated with treatment can, in some cases, reach the level of toxicity, when it starts to affect patient health. For example, some patients may begin to ration medications or delay therapy due to financial concerns.

China has had a universal health care program since 2009, but Liu and colleagues said many people with lung cancer still struggle with the financial responsibilities that fall on patients. They noted that lung cancer is the most expensive cancer to treat, and its prevalence is also on the rise. In 2015, 733,300 people in China were diagnosed with lung cancer, and 610,200 people died of the disease, the authors noted.

In an effort to better understand the degree to which financial toxicity was affecting the lung cancer patient population in China, the investigators used data from a national survey to score lung cancer patients according to the comprehensive score of financial toxicity (COST) questionnaire.

In total, 843 people with lung cancer completed the questionnaire and were deemed evaluable for the study. COST scores can range from 0-44, with lower numbers indicating a higher degree of financial toxicity. Of the participants in the survey, the median toxicity score was 20. Three-quarters of patients (77%) had scores reflecting financial toxicity, with 54.5% of participants qualifying as having “mild” financial toxicity, and 22.5% having moderate or severe toxicity.

“Overall, a relatively high prevalence of [financial toxicity] in patients with lung cancer in China presents a serious challenge, with urgent attention and interventions needed,” Liu and colleagues wrote.

The investigators identified a number of factors that appeared to increase a person’s risk of experiencing financial toxicity. People in western China, which is less developed, had a higher risk of toxicity, as did men, people with a lower education level, and people of lower family income. Patients with advanced stages of lung cancer or whose self-reported health status was poor also were more likely to report financial toxicity.

The investigators said the data suggested that toxicity was, in fact, affecting patients’ medical care. Those with higher degrees of financial stress tended to be less compliant with their medical regimens, and also tended to have lower expenditures on living expenses.

“The medical compliance domain, which is related to direct negative consequences, accounted for a large proportion of patients with deteriorating [financial toxicity],” the authors wrote. “These alert for specific attention to patients with high financial risks.”

The authors said their study showed that despite “remarkable” progress at expanding the availability of health care in China, the country still must do more to lessen the burdens a lung cancer diagnosis can have on people of lower socioeconomic status.

Reference

Liu M, Huang D, Liu Y. Financial toxicity of patients with lung cancer in China: results from a National Survey Study. Cancer Med. Published online September 21, 2022. doi:10.1002/cam4.5244