Financial Burden Faced by Families due to Out‑of‑pocket Expenses during the Treatment of their Cancer Children: An Indian Perspective

 

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Abstract

Context: Life-saving cancer therapy is costly and may result in financial burden for these families. Financial costs for treating childhood cancer care are traditionally assessed based on the amount spent for diagnostic tests, hospitalization, and chemotherapy. The financial costs for travel, accommodation, out-of-pocket expenses for food, phone bills, and loss of income due to reduction or termination of parental employment are hidden nonmedical expenses that are rarely accounted for. Studies on the financial implications of pediatric cancer treatment are based on the Western model of healthcare with good government/state insurance coverage and hence literature on lifestyle implications for families in developing nations with limited resources is still scarce. Aims: The aim of this study is to find out the details of out-of-pocket expenses incurred by the families during their treatment of cancer children and its implications on their quality of life. Settings and Design: This study was conducted in a tertiary care center for pediatric malignancies for over 1-year period. Subjects and Methods: About seventy families whose children were diagnosed with acute leukemia and undergoing treatment at our center were asked to fill a questionnaire detailing their out-of-pocket expenses. Results: Nonmedical expenses accounts for about 46% of their monthly household income of parents from rural areas and 22% of their household income from urban areas. On an average, a family from rural area spends four times the normal amount spent on home for their daily food expenditure. Thirty-eight percent of families have borrowed money from money lenders with an average interest rate of about 12.5% which pushes them to a state of debt for the next few years. Conclusions: Out-of-pocket expenses contribute a significant proportion to the financial burden of the families with childhood malignancies and these invisible expenses should be recognized and provide adequate support to lessen the burden of this economic impact.

Publication History

Article published online:
06 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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• References

• 1 Magrath I, Steliarova-Foucher E, Epelman S, Ribeiro RC, Harif M, Li CK, et al. Paediatric cancer in low-income and middle-income countries. Lancet Oncol 2013;14:e104-16.
• 2 Rodriguez-Galindo C, Friedrich P, Alcasabas P, Antillon F, Banavali S, Castillo L, et al. Toward the cure of all children with cancer through collaborative efforts: Pediatric oncology as a global challenge. J Clin Oncol 2015;33:3065-73.
• 3 Dockerty JD, Skegg DC, Williams SM. Economic effects of childhood cancer on families. J Paediatr Child Health 2003;39:254-8.
• 4 Lansky SB. The high cost of cancer. Am J Pediatr Hematol Oncol 1987;9:89-91.
• 5 Heath JA, Lintuuran RM, Rigguto G, Tokatlian N, McCarthy M. Childhood cancer: Its impact and financial costs for Australian families. Pediatr Hematol Oncol 2006;23:439-48.
• 6 Tsimicalis A, Stevens B, Ungar WJ, McKeever P, Greenberg M, Agha M, et al. Amixed method approach to describe the out-of-pocket expenses incurred by families of children with cancer. Pediatr Blood Cancer 2013;60:438-45.
• 7 Metzger ML, Howard SC, Fu LC, Peña A, Stefan R, Hancock ML, et al. Outcome of childhood acute lymphoblastic leukaemia in resource-poor countries. Lancet 2003;362:706-8.
• 8 Sitaresmi MN, Mostert S, Schook RM, Sutaryo, Veerman AJ. Treatment refusal and abandonment in childhood acute lymphoblastic leukemia in Indonesia: An analysis of causes and consequences. Psychooncology 2010;19:361-7.
• 9 Yadav S, Anjan M, Sachdeva A. Outcome of children with haematological malignancies who are lost to follow up. Pediatr Blood Cancer 2007;49:527.
• 10 Howard SC, Pedrosa M, Lins M, Pedrosa A, Pui CH, Ribeiro RC, et al. Establishment of a pediatric oncology program and outcomes of childhood acute lymphoblastic leukemia in a resource-poor area. JAMA 2004;291:2471-5.
• 11 Mathews M, West R, Buehler S. How important are out-of-pocket costs to rural patients' cancer care decisions? Can J Rural Med 2009;14:54-60.
• 12 Lightfoot N, Steggles S, Gauthier-Frohlick D, Arbour-Gagnon R, Conlon M, Innes C, et al. Psychological, physical, social and economic impact of travelling great distances for cancer treatment. Curr Oncol 2005;12:1-7.
• 13 Bonilla M, Rossell N, Salaverria C, Gupta S, Barr R, Sala A, et al. Prevalence and predictors of abandonment of therapy among children with cancer in El Salvador. Int J Cancer 2009;125:2144-6.