Objectives/purpose: Several studies have highlighted the significant out-of-pocket expenditures incurred by patients and their families in seeking and receiving care, particularly for cancer. Our study aimed to quantify these costs for patients receiving care and treatment for oesophageal cancer.
Sample and setting: Survivors of oesophageal cancer (adenocarcinoma or squamous cell carcinoma) who had undergone oesophagectomy or definitive chemoradiotherapy at Flinders Medical Centre in South Australia were invited to participate in this prospective cohort study.
Procedures: Financial toxicity was assessed using the validated COmprehensive Score for financial Toxicity (COST) questionnaire. Self-reported out-of-pocket (OOP) expenses included direct medical (e.g., gap payments and medications), non-medical costs (e.g., travel, accommodation, wage loss) incurred during and after treatment and carer costs (carer travel and wage loss). Descriptive statistics were calculated, and non-parametric tests (Wilcoxon rank-sum, Kruskal–Wallis) were used to assess differences in financial toxicity and costs across sociodemographic groups.
Results: A total of 77 individuals completed the survey (43.3% response rate). The majority of respondents were male (85.7%), aged 60-89 (87.1%), and 0-5 years post diagnosis (55.7%). The mean financial toxicity score was 24.25, indicating moderate financial toxicity. The average OOP expenditure per patient was $13,493, mainly attributed to wage loss (64.7%), followed by carer cost (23.7%). Financial toxicity scores were not significantly associated with gender, education level, marital status, or place of birth. Higher OOP costs were significantly associated with younger age groups (40-59 years, p = 0.048), while rural participants incurred higher mean costs ($14,950) compared to urban participants ($22.19), which was statistically significant (p = 0.020).
Conclusions: Oesophageal cancer survivors face substantial financial burden during curative treatment, mainly attributed to wage loss due to time spent away from work for patients and carers. These findings underscore the importance of financial support mechanisms in planning to mitigate economic distress in cancer care.