We are used to talking about tumors and the treatments that can be given to patients, case by case, especially in terms of the scientific opportunities that science increasingly makes available. But there are other aspects that should not be underestimated. Why a cancer diagnosis it also has an economic impact on the patient and the family, creating potential difficulties also in terms of financial availability. It's what it calls itself “financial toxicity”.
According to a recent study conducted by AIOM (Italian Association of Medical Oncology) experts, at the time of diagnosis more or lessor one in four people may present problems of this type. And the percentage can almost double during the treatment period. Here, we know, the healthcare system is universalistic and therefore treatments are provided to all people. But just dealing with the disease can put individuals and families in difficulty. To add knowledge on the topic, reiterating the importance of social as well as health support for those who face cancer and for those who overcome the pathology, a study now comes from the USA carried out by scientists from the American Cancer Society, which indicates that there is a prolonged financial impact after a cancer diagnosis for many adults of working age and their families.
What emerges from the American research
The study, published on CA: A Cancer Journal for Clinicians, what happens on the financial side essentially “weighs”. And the data that emerge makes us think. A cancer diagnosis and the time it takes to treat the disease can lead to disruptions at work, resulting in loss of family income And loss of health insurance coverage which is based precisely on professional activity.
Combining these possible financial difficulties with the high out-of-pocket costs for treatment leads to the point that well over half (it reaches almost 60%) among those who overcome cancer during their working years report at least one type of financial difficulty, such asinability to afford medical expenses or delaying or forgoing necessary medical treatment. In addition obviously to worry and anxiety, intangible but present. The research was coordinated by Robin Yabroff. It is noted, in the comments of the experts, that today almost half of cancer survivors of working age and not yet eligible for insurance coverage could have Effects of cancer diagnosis and treatment on employmentincome and access to health insurance coverage that is based on the employer.
A problem to address
The analysis of scholars from overseas, in addition to presenting a sort of typical “case”, examines the data of existing research with particular reference to the financial difficulties in 2019-2021, the most recent available years of the National Health Interview Survey (NHIS). The NHIS annually collects information on health conditions, including but not limited to cancer diagnoses, health status, employment, health insurance, socioeconomic status, and experience with health care from nearly 90,000 individuals in 35,000 households. It should be remembered, as Lisa Lacasse, president of the American Cancer Society, recalls in a press note, that “according to an ACS CAN study, the majority of cancer patients and survivors (74%) report being forced to miss work due to illness, most of whom report having missed more than four weeks of work.”
How is the situation in Italy
Recently, the issue of financial toxicity linked to a cancer diagnosis was also addressed by us, in a conference held at the Istituto Superiore di Sanità in Rome. And although the healthcare offering model is different than in the USA, in Italy there are also differences that need to be underlined.
First it should be remembered that the level of education represents an important variable when faced with cancer. In Italy, around a quarter of cancer deaths are attributable to low levels of education. Almost 30 thousand (29,727) cancer deaths in 2019 in our country, in the population between 30 and 84 years old, are in fact related to poor education (22,271 deaths in men and 7456 in women), as highlighted in a study published in the Journal of Public Health. It is therefore among the socioeconomic determinants capable of influencing cancer mortality the level of the study cycle, which often also affects subsequent earning capacity.
A cancer diagnosis can also cause further economic difficulties in patients. It's the so-called financial toxicity, which affects 26% of people with cancer and is linked to various factors, including the costs that patients have to bear to travel to places of treatment. Suffice it to say that, in 2022, in Italy almost 28 thousand cancer patients have changed region for treatment, in particular for surgery. But tools are needed to identify all the causes of financial toxicity and propose solutions to the institutions to remedy them. The first questionnaire in the world capable not only of measuring this condition but also of defining the reasons for it in the context of a public health service is Italian.
A questionnaire tailored for patients
“Financial toxicity also affects patients in universal healthcare systems like ours – explains Francesco Perrone, President of the Italian Association of Medical Oncology – AIOM. We have already demonstrated, in a study on 3,760 citizens with cancer in Italy, that at the time of diagnosis, 26% face economic problems and 22.5% worsen this uncomfortable condition during treatment. Furthermore, the latter have a 20% higher risk of death in the following months and years. In light of these data, we asked ourselves what the causes were. Hence the PROFFIT (Patient Reported Outcome for Fighting Financial Toxicity) questionnaire, made up of 16 statements to which patients are asked to express their assent or not. In the United States, COST was developed, a questionnaire made up of 11 statements that explore and measure the mainly psychological consequences of financial toxicity, without however investigating the causes, which are taken for granted. In PROFFIT, however, 9 statements concern the causes of economic difficulties and 7 measure their consequences”.
The 16 statements of PROFFIT touch on various themes, starting from quality of interaction between the patient and the healthcare workers and the ability of the latter to talk to each other and build a relationship reception networkin which the patient feels taken care of, until expenses that the system does not cover.
“Some releases – continues Perrone – concern the more or less frequent use of private healthcare. Others touch on additional medications or supplements, or useful additional treatments, such as physiotherapy which is difficult to practice in the public system. Then there's the logistics: the distance between the home and the place where the treatment is received and the transport costs to be paid. And this not only in extreme cases of healthcare migration from South to North. Problems can arise though reach the specialist centers from the province in the big cities. In short, a series of determinants, on which we want to raise awareness among political decision-makers and administrators, who can implement policies of change. PROFFIT is available to the scientific community and has been validated in English for its application also in the United Kingdom, because it is useful in all contexts where there is a public health system. It is important that no citizen, from prevention to access to treatment, is left behind. This is why we ask more investments and more staff, also to free clinicians from too many bureaucratic obligations. Oncology is a cornerstone of the National Health Service, but it must be supported with structural measures.”
