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Financial toxicity and its associations with health-related quality of life among urologic cancer patients in an upper middle-income country

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Abstract

Purpose

This study examined the prevalence of financial toxicity (FT) and associated factors among urologic cancer patients. The association between FT and health-related quality of life (HRQoL) was also investigated.

Methods

A total of 429 respondents diagnosed with urologic cancers (prostate cancer, bladder and renal cancer) from Sarawak General Hospital and Subang Jaya Medical Centre in Malaysia were interviewed using a structured questionnaire. Objective and subjective FT were measured by catastrophic health expenditure (healthcare-cost-to-income ratio greater than 40%) and the Personal Financial Well-being Scale, respectively. HRQoL was measured with the Functional Assessment of Cancer Therapy – General 7 Items scale.

Results

Objective and subjective FT were experienced by 16.1 and 47.3% of the respondents, respectively. Respondents who sought treatment at a private hospital and had out-of-pocket health expenditures were more likely to experience objective FT, after adjustment for covariates. Respondents who were female and had a monthly household income less than MYR 5000 were more likely to experience average to high subjective FT. Greater objective FT (OR = 2.75, 95% CI 1.09–6.95) and subjective FT (OR = 4.68, 95% CI 2.63–8.30) were associated with poor HRQoL.

Conclusions

The significant association between both objective and subjective FT and HRQoL highlights the importance of reducing FT among urologic cancer patients. Subjective FT was found to have a greater negative impact on HRQoL.

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Acknowledgements

The authors would like to express their gratitude to the Director General of Health Malaysia for his permission to publish this manuscript. The authors are obliged to thank the Director of Sarawak General Hospital for his approval of the data collection for this study and his unconditional support of this study. The authors also thank Ms. Lim Chien Joo of Tan Tock Seng Hospital for her guidance with statistical analysis. Permission to use and translate the Personal Financial Well-being Scale© was granted by Dr. E. Thomas Garman, Virginia Tech University, and Dr. John Hoffmire, Chairman of Personal Finance Employee Education Fund Inc. ©Copyright by InCharge Education Foundation and E. Thomas Garman, 2004, 2005, 2006. All rights reserved.

License to use the English and Malay version of FACT-G7 was granted by Licensor (FACIT.org). The Functional Assessment of Chronic Illness Therapy system of Quality of Life questionnaires and all related subscales, translations and adaptations (“FACIT System”) are owned and copyrighted by David Cella, Ph.D. The ownership and copyright of the FACIT System resides strictly with Dr. Cella; Dr. Cella has granted FACIT.org (Licensor) the right to license usage of the FACIT System to other parties.

Funding

This study received funding from the Malaysian Society of Andrology and the Study of the Aging Male to cover the costs of the enumerators’ employment and overhead costs.

Author information

Authors and Affiliations

  1. Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Chuo Yew Ting, Haridah Alias & Li Ping Wong

  2. Training Management Division, Ministry of Health, Wilayah Persekutuan Putrajaya, Malaysia

    Chuo Yew Ting

  3. Department of Urology, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia

    Guan Chou Teh

  4. Department of Radiotherapy, Oncology and Palliative Care, Sarawak General Hospital, Ministry of Health, Kuching, Sarawak, Malaysia

    Kong Leong Yu

  5. Urology Clinic, Ramsay Sime Darby Medical Centre, Subang Jaya, Selangor, Malaysia

    Hui Meng Tan

  6. Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Hui Meng Tan

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  1. Chuo Yew Ting
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Corresponding authors

Correspondence to Hui Meng Tan or Li Ping Wong.

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Ethical approval

The study was reviewed and approved by the Ministry of Health Malaysia Medical Research Ethics Committee (MREC) on 8 March 2018 with registration number NMRR-18-86-39533. Informed consent was obtained from all the individual participants included in the study. All the data are restricted to the principal investigators and were solely used for research purposes. All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflicts of interest. The principal investigators have full control of all primary data and agree to allow the journal to review the data upon request.

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Ting, C.Y., Teh, G.C., Yu, K.L. et al. Financial toxicity and its associations with health-related quality of life among urologic cancer patients in an upper middle-income country. Support Care Cancer 28, 1703–1715 (2020). https://doi.org/10.1007/s00520-019-04975-y

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