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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.
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).
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.
Shares Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Ovarian cancer, Non-small-cell lung cancer.
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