An evaluation of the financial toxicity amongst older patients with cancer in India.

Abstract

12048 Background: Financial toxicity (FT) of cancer is prevalent among older patients in high-income countries, but there is no data about the financial burden faced by older patients in India. This study aimed to explore the FT of cancer among older Indian patients. Methods: This was a cross-sectional observational study conducted in the geriatric oncology clinic of Tata memorial hospital (Mumbai, India). Patients aged 60 years and above with cancer were included. Patients and their relatives were enquired regarding their occupations, monthly income, and source of funding for cancer treatment. The modified Kuppuswamy scale was used for stratification of socio-economic status (SES). The financial burden was evaluated using the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale. In addition, the Consumer Financial Protection Bureau Financial Well-Being Scale and the 28th question of QORTC QLQ-C30 were used to assess the financial quality of life. Results: Between June 2022 and January 2023, 498 patients were included. The median age was 67 (IQR, 63-72) years, and 360 (72.3%) were male. Common malignancies included gastrointestinal (199, 40.0%), lung (169, 34.0%) and urological (63, 12.7%); 320 (64.4%) had metastatic disease. According to the modified Kuppuswamy scale, most of the participants belonged to upper-lower SES (223, 44.8%), followed by lower-middle (115, 23.1%), upper-middle (97, 19.5%), lower (59,11.8%) and only 4 (0.8%) belonged to upper SES. The source of funding was mostly from family members (264, 53.9%), insurance (72, 14.7%), while 59 patients (12.0%) did not require external support. Sixty-one (12.4%) had to borrow money, twenty-one (4.3%) participants had taken a loan, and 13 (2.6%) had sold their assets for the purposes of treatment. Moderate-severe burden on COST-FACIT was present in 165 (33.1%), whereas 333 (66.9%) experienced no or mild burden. High FT was associated with lower socioeconomic status (OR: 4.69, 95%CI 2.47-8.91, p-value < 0.001), poor financial well-being (OR: 9.35, 95%CI 5.52-16.46, p-value < 0.001) and poor score on Financial quality of life (OR: 5.16, 95%CI 3.39-7.86, p-value < 0.001). Conclusions: In older Indian patients with cancer, there is a high prevalence of financial burden and is associated with poor socioeconomic status, poor financial well-being and poor financial quality of life. More than half the patients depended on their family members to meet the cost of cancer treatment.