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Research
Balamurugan A Vellayappan
National University Cancer Institute Singapore
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1077-1840
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Cancer survivors may experience financial toxicity (FT) arising from diagnosis, treatµent, and potential employment loss. The prevalence of FT in the context of Singapore healthcare model is unknown. We investigate if higher out of pocket (OOP) expenditure correlates positively with FT, and if higher FT correlates with a worse quality of life (QoL).
Methods
In this pilot study, a cross-sectional survey was administered to survivors of nasopharyngeal or breast cancer, at National University Hospital Singapore. Patients’ FT and QOL were measured using the COmprehensive Score on financial Toxicity (COST) and Functional Assessment of Cancer Therapy: General (FACT-G). Two multivariate regression models estimated (i) the association between FT and a range of variables and (ii) FT and QOL.
Results
63% of our cohort of 76 patients experienced mild-moderate FT. Overall, the mean COST and FACT-G scores are 18.0 (out of 44) and 68.3 (out of 108), respectively. There was a positive correlation between COST and FACT-G scores (r = 0.45). We did not find any significant association between OOP and FT. Predictors for FT included government-subsidized housing, lower education levels, hiring a formal caregiver, and the need for household members to take on extra employment.
Conclusion
Greater FT correlates with a decline in QoL. Lower socio-economic patients are at higher risk of FT. OOP was not directed related to FT, likely in view of the effective means-tested subsidies. Additional resources should be considered for this at-risk population. Based on our pilot study, our methodology to quantify FT and OOP can be scaled up to other cancer primaries.
Keywords
Financial Toxicity, Quality of life, Cancer survivors, Breast Cancer, Nasopharyngeal Cancer
This is a list of supplementary files associated with this preprint. Click to download.
- SupplementaryA.docx
Supplementary A Detailed description of process of data collection, participant enrollment and questionnaire administration
- SupplementaryFigure1.docx
Supplementary Figure 1 Boxplot diagram of OOP expenses by cancer site
- SupplementaryTableA.docx
Supplementary Table A Parameters obtained from 3 sources
- SupplementaryTableB.docx
Supplementary Table B Regression Results for Financial Toxicity based on survey results
- SupplementaryTableC.docx
Supplementary Table C Regression Results for Financial Toxicity based on survey results and medical bill data
- SupplementaryTableD.docx
Supplementary Table D Regression Results for Quality of Life
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This is a preprint. It has not completed peer review.
Research
Balamurugan A Vellayappan
National University Cancer Institute Singapore
Corresponding Author
ORCiD: https://orcid.org/0000-0002-1077-1840
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 17 Jun, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Cancer survivors may experience financial toxicity (FT) arising from diagnosis, treatµent, and potential employment loss. The prevalence of FT in the context of Singapore healthcare model is unknown. We investigate if higher out of pocket (OOP) expenditure correlates positively with FT, and if higher FT correlates with a worse quality of life (QoL).
Methods
In this pilot study, a cross-sectional survey was administered to survivors of nasopharyngeal or breast cancer, at National University Hospital Singapore. Patients’ FT and QOL were measured using the COmprehensive Score on financial Toxicity (COST) and Functional Assessment of Cancer Therapy: General (FACT-G). Two multivariate regression models estimated (i) the association between FT and a range of variables and (ii) FT and QOL.
Results
63% of our cohort of 76 patients experienced mild-moderate FT. Overall, the mean COST and FACT-G scores are 18.0 (out of 44) and 68.3 (out of 108), respectively. There was a positive correlation between COST and FACT-G scores (r = 0.45). We did not find any significant association between OOP and FT. Predictors for FT included government-subsidized housing, lower education levels, hiring a formal caregiver, and the need for household members to take on extra employment.
Conclusion
Greater FT correlates with a decline in QoL. Lower socio-economic patients are at higher risk of FT. OOP was not directed related to FT, likely in view of the effective means-tested subsidies. Additional resources should be considered for this at-risk population. Based on our pilot study, our methodology to quantify FT and OOP can be scaled up to other cancer primaries.
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