Abstract 1879P
Background
Cancer care-related out of pocket expenses and financial toxicity (FT) are a rising burden for patients. We aimed to evaluate patient-reported FT and to identify relevant correlates within a Tunisian medical oncology population.
Methods
We conducted a survey using the 11-item comprehensive score for Financial Toxicity (COST). Total possible scores could range from 0=high to 44=low FT. Scores were collected along with data regarding patient medical/social features and out-of-pocket expenses. Univariate and multivariate analyses were performed to identify factors associated with a higher financial burden.
Results
Among the 105 participants, median COST score was 20.9, with 81% of patients experiencing FT: Grade0=19%, Grade 1=72.4%, Grade 2=8.6%, Grade 3=0%. Financial support was needed in 60.4% of cases (44.8% received from family and 15.7 % from other sources). Patients wanted to discuss financial issues with their doctor in 33% of cases but only 18.1% actually did it. Most patients (99%) had government-sponsored health insurance, 62% of patients used to work before cancer, only 17.1% still working and 44.7% reported stopping work because of cancer. Time to go to the hospital was >1hour in 34.1% of cases and 82% spent money on transportation. All participants had to spend out of pocket expenses on cancer care-related procedures: 87.6% for blood tests and imaging, 11.4% for chemotherapy drugs, 65.7% for non-chemotherapy drugs, 24.8% to buy complementary medicine, 9.5% to rent a house close to the hospital, 7.6% for out-patient/emergency visits. Patients working status, time to hospital and suspending work because of the cancer were significantly associated with lower COST scores on univariate analysis (p=0.042, p=0.005, p=0.035 respectively). Only "time to hospital” was significant in multivariate analysis (p=0.002). Gender, cancer type/stage/therapy, type of health care insurance, type of out-of-pocket expenses, familial status did not have an impact on FT.
Conclusions
Despite wide health care insurance coverage in Tunisia, patients experience FT. It may be explained by the unequal distribution of health care access among Tunisian cities making transportation to the hospital the main source of financial distress.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.