Does Financial Toxicity Exist Amongst Adult Cancer Survivors Treated with Curative-Intent Radiotherapy? A Pilot Study from Singapore

Abstract Background Cancer survivors may experience financial toxicity (FT) arising from diagnosis, treatµent, and potential employment loss. The prevalence of FT in the context of Singapore healthcare model is unknown. We investigate if higher out of pocket (OOP) expenditure correlates positively with FT, and if higher FT correlates with a worse quality of life (QoL). Methods In this pilot study, a cross-sectional survey was administered to survivors of nasopharyngeal or breast cancer, at National University Hospital Singapore. Patients’ FT and QOL were measured using the COmprehensive Score on financial Toxicity (COST) and Functional Assessment of Cancer Therapy: General (FACT-G). Two multivariate regression models estimated (i) the association between FT and a range of variables and (ii) FT and QOL. Results 63% of our cohort of 76 patients experienced mild-moderate FT. Overall, the mean COST and FACT-G scores are 18.0 (out of 44) and 68.3 (out of 108), respectively. There was a positive correlation between COST and FACT-G scores (r = 0.45). We did not find any significant association between OOP and FT. Predictors for FT included government-subsidized housing, lower education levels, hiring a formal caregiver, and the need for household members to take on extra employment. Conclusion Greater FT correlates with a decline in QoL. Lower socio-economic patients are at higher risk of FT. OOP was not directed related to FT, likely in view of the effective means-tested subsidies. Additional resources should be considered for this at-risk population. Based on our pilot study, our methodology to quantify FT and OOP can be scaled up to other cancer primaries.