Financial toxicity of cancer care and its associates among cancer patients with urban customized supplementary medical insurance in a Chinese city: a telephone survey

  Objective  To examine the financial toxicity (FT) of cancer care among cancer patients covered by urban customized supplementary medical insurance (customized insurance) and its influencing factors for providing evidence to the optimization of customized insurance and the development of FT-related intervention measures.

  Methods  Using random sampling and a self-designed questionnaire, we conducted telephone interviews among 600 registered cancer patients with customized insurance and ever attending local public hospitals for medication after December 2020 during July – August 2021 in a city. The Comprehensive Scores for Financial Toxicity (COST) scale was adopted to assess FT of cancer treatment. The influencing factors of FT were analyzed with stepwise multivariate linear regression model.

  Results  For the 560 participants finally included in the analysis, the COST score was 17.90 ± 8.01 and the number (proportion) of the participants with the scores indicating mild, moderate, and severe FT were 89 (15.89%), 307 (54.82%), and 164 (29.29%), respectively. The results of regression analysis showed that the participants with following characteristics were more likely to have a lower COST score indicating severe FT: with agricultural residence registration, aged 45 – 59 years, having an out-of-pocket medication expenditure of 10 000 Chinese Yuan (CNY) and more in the past year, ever borrowing money for cancer treatment in the past year, and abandoning treatment due to financial difficulties in the past year; while, the participants with other commercial health insurance in addition to customized insurance, having a total household income of 100 000 CNY and more in the past year, having a total household consumption expenditure of 100 000 CNY and more in the past year, and having been hospitalized 1 – 4 times for cancer treatment in the past year were more likely to have a higher COST score indicating mild FT.

  Conclusion  FT of cancer is common among cancer patients covered by customized insurance in a Chinese city and the prevalence of FT is impacted by sociodemographic factors and family financial factors, suggesting that effective intervention on FT needs to be carried out in various ways.