Financial impacts of cancer found to intensify disease burden among German patients

By European Society for Medical Oncology
A study conducted in Germany draws attention to the fact that the socio-economic burden of cancer is real in Europe too, and not only in the context of the US healthcare system where it has been associated with higher morbidity and mortality. The results to be presented at the ESMO 2018 Congress in Munich show that income loss is the main source of perceived financial hardship, and that this is associated with adverse psychological effects in patients.
The work also highlights the absence of clear definitions and valid instruments with which to examine this issue. Prof. Eva Winkler, study author, medical oncologist at the National Centre for Tumour Diseases (NCT) in Heidelberg, explained the background: "We conducted a systematic literature review of the tools used to measure the subjective financial burden of cancer patients: of the 39 studies we found, most came from the USA, and the instruments they used were either not transferrable to the German context or not sufficiently focused on the subject," she said.

Study co-author Dr. Katja Mehlis from the NCT added: "We were, however, able to identify three broad dimensions through which subjective financial burden could be assessed: material aspects, psychological effects and behavioral changes such as support seeking and coping strategies. Based on this, we developed our own, yet non-validated set of questions covering income, cancer-related out-of-pocket costs, distress and lifestyle changes."
A total of 247 patients, 122 diagnosed with neuroendocrine
tumors and 125 treated for colorectal cancer, responded to the survey between November 2016 and March 2017. The results brought to light financial impacts in a significant proportion of patients: 80.6% of respondents stated that they faced higher out-of-pocket costs related to their illness.

Although most medical costs in Germany are covered by a person's health insurance, patients do have to contribute co-payments for prescription drugs. Cancer patients may additionally face travel expenses to get to the hospital or medical centre, as well as potentially having to pay for care, housekeeping or childcare. For over three quarters of the patients who responded to the survey, disease-related out-of-pocket costs amounted to less than 200 euros monthly.

Cancer-related income loss was reported by 37.2% of survey participants. "In our study, this effect was more serious than out-of-pocket costs, as the suffered losses exceeded 800 euros per month in almost half of cases. They were mainly due to patients being unable to work or forced to reduce their working hours," said Mehlis.