# Financial difficulties and outcomes of cancer patients in Italian academic trials

Source: https://onco.cc/key-papers/paper-perrone-financial-difficulties-italy-annonc-2016/  
OnCo record `paper-perrone-financial-difficulties-italy-annonc-2016` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Even in Italy, where the national health service pays for cancer drugs, a quarter of patients in sixteen trials reported money problems before treatment, and those whose finances worsened during treatment were more likely to die.

## Summary

Data were pooled from 16 prospective multicentre academic trials in lung, breast or ovarian cancer run within the Italian public health system, all of which used the EORTC QLQ-C30 questionnaire, whose question 28 asks whether the illness or its treatment caused financial difficulties. Financial burden was any difficulty at baseline; financial toxicity was a worsening score later. At baseline 26 per cent of 3,670 patients reported financial burden, which was associated with worse quality of life and a higher chance of quality of life getting worse (odds ratio 1.35, 95 per cent confidence interval 1.08 to 1.70) but not with death or severe toxicity. Of 2,735 patients who filled in later questionnaires, 616 (22.5 per cent) developed financial toxicity, which was associated with a higher risk of death (hazard ratio 1.20, 95 per cent confidence interval 1.05 to 1.37, p 0.007).

## Fields

- Kind: Key paper
- Last checked: 2026-11-03
- Journal: Annals of Oncology
- Year: 2016
- DOI: 10.1093/annonc/mdw433
- Authors: Perrone F, Jommi C, Di Maio M, et al.
- Findings: 26 per cent of 3,670 trial patients reported financial difficulties before starting treatment.; Financial difficulty at baseline predicted a worse quality-of-life response (odds ratio 1.35) but not death or severe toxicity.; 22.5 per cent developed financial toxicity during treatment, associated with a higher risk of death (hazard ratio 1.20, 95% CI 1.05 to 1.37).
- What it means: Free medicines do not make cancer free. Lost earnings, travel and the costs the health service does not cover reach patients in a universal system too, and in this analysis they tracked with survival. The same Naples group went on to build PROFFIT, an Italian questionnaire for measuring financial toxicity, with AIRC funding.
- Caveats: Secondary analysis of trials not designed to study finances, using a single questionnaire item.; An association, not proof that financial toxicity causes death; trial patients are a selected group.

## Sources

- Annals of Oncology 2016: https://doi.org/10.1093/annonc/mdw433
- PubMed: https://pubmed.ncbi.nlm.nih.gov/27789469/

## Connected records

- key papers: [People living after cancer in Italy and the share who are cured, 2018 to 2030](https://onco.cc/key-papers/paper-guzzinati-cure-prevalence-italy-esmo-open-2024/)
- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Ovarian cancer](https://onco.cc/cancers/ovarian/)
- institutions: [Istituto Nazionale Tumori IRCCS Fondazione G. Pascale](https://onco.cc/institutions/pascale-naples/)
- terms: [Financial toxicity](https://onco.cc/terms/financial-toxicity/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)

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