Jieling Elaine Chen1, Vivian Weiqun Lou1,2, Hong Jian3, Zhen Zhou3, Meiqiong Yan3, Jingfen Zhu4, Guohong Li4, Yaping He5. 1. Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong. 2. Sau Po Centre on Ageing, The University of Hong Kong, Pok Fu Lam, Hong Kong. 3. Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 4. School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai, 200025, People's Republic of China. 5. School of Public Health, Shanghai Jiao Tong University, 227 South Chongqing Road, Shanghai, 200025, People's Republic of China. hypcyr@sina.com.
Abstract
PURPOSE: The purpose of this study is to examine the effect of financial burden, using objective and subjective indicators, on the health-related quality of life (HRQOL) in lung cancer patients. METHOD: A total of 227 patients diagnosed with lung cancer (from the inpatient unit of the department of internal medicine-chest oncology, in Shanghai Chest Hospital, China) participated in the study. Financial information was measured by direct medical costs, direct nonmedical costs, healthcare-cost-to-income ratio, and perceived financial difficulty. HRQOL was measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. FINDINGS: Catastrophic health spending, defined as a healthcare-cost-to-income ratio of more than 40%, was reported in 72.7% of the participants, whereas 37.0% reported that healthcare costs exceeded annual household income. Financial difficulty was perceived in 83.7% of the participants. Patients whose healthcare costs exceeded their annual household income and who perceived financial difficulty reported a clinically meaningful difference in overall HRQOL (> 6 points on the FACT-L) compared with participants without catastrophic health spending or perceived financial difficulty. Healthcare costs did not show a significant effect on HRQOL. CONCLUSION: Healthcare costs exceeding total annual household income and perceived financial difficulty are associated with poorer HRQOL in lung cancer patients. Subjective indicator of financial burden has a stronger effect on quality of life than objective indicators. IMPLICATION: Health-cost-to-income ratio and perceived financial difficulty can be implied as objective and subjective indicators of financial burden to identify the patients who may need additional assistance. Communication on deciding on cost-effective treatments can be facilitated.
PURPOSE: The purpose of this study is to examine the effect of financial burden, using objective and subjective indicators, on the health-related quality of life (HRQOL) in lung cancerpatients. METHOD: A total of 227 patients diagnosed with lung cancer (from the inpatient unit of the department of internal medicine-chest oncology, in Shanghai Chest Hospital, China) participated in the study. Financial information was measured by direct medical costs, direct nonmedical costs, healthcare-cost-to-income ratio, and perceived financial difficulty. HRQOL was measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. FINDINGS: Catastrophic health spending, defined as a healthcare-cost-to-income ratio of more than 40%, was reported in 72.7% of the participants, whereas 37.0% reported that healthcare costs exceeded annual household income. Financial difficulty was perceived in 83.7% of the participants. Patients whose healthcare costs exceeded their annual household income and who perceived financial difficulty reported a clinically meaningful difference in overall HRQOL (> 6 points on the FACT-L) compared with participants without catastrophic health spending or perceived financial difficulty. Healthcare costs did not show a significant effect on HRQOL. CONCLUSION: Healthcare costs exceeding total annual household income and perceived financial difficulty are associated with poorer HRQOL in lung cancerpatients. Subjective indicator of financial burden has a stronger effect on quality of life than objective indicators. IMPLICATION: Health-cost-to-income ratio and perceived financial difficulty can be implied as objective and subjective indicators of financial burden to identify the patients who may need additional assistance. Communication on deciding on cost-effective treatments can be facilitated.
Entities:
Keywords:
Catastrophic health spending; Financial burden; Lung cancer; Perceived financial difficulty; Quality of life
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