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Joshi S, Damani A, Garg A, Malik S, Dewan AK, Sharma R, Joshi U. Financial toxicity in cancer palliative care in India: Addressing existence and beyond - Seeking remedies for a balanced financial journey. Ecancermedicalscience 2024; 18:1820. [PMID: 40171460 PMCID: PMC11959117 DOI: 10.3332/ecancer.2024.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Indexed: 04/03/2025] Open
Abstract
Financial toxicity (FT) places a significant burden on individuals undergoing cancer care, leading to emotional distress, social isolation and financial burnout. In India, the growing number of cancer cases and the ever-expanding population, combined with insufficient government investment in public healthcare, inadequate insurance coverage, poor financial literacy among medical and non-medical communities and the lack of comprehensive financial planning exacerbate the financial difficulties faced by patients. This article aims to address FT as a source of suffering and explores potential frameworks and solutions for preventing and managing FT in patients undergoing cancer treatment and seeking palliative and hospice care in India. We conducted a literature search to review the burden of FT, across diverse healthcare settings for cancer patients. The prevalence of FT in cancer care ranges from 30% to 90.1% and is influenced by various socio-demographic, disease and healthcare-related factors. The sources of distress financing include consumption of savings, asset sales and borrowing, which add to the financial suffering. This interdisciplinary collaborative research paper highlights the dearth of financial literacy in our population and emphasises the pressing need to enhance financial awareness for healthcare professionals, cancer patients and their families. More than 30% of the Indian population lacks any form of insurance coverage, and many of those who do have it mostly lack 'adequate' coverage. We explore essential financial strategies, such as budgeting, expense analysis, asset consolidation, liquidity management, understanding estate planning tools and banking operations, streamlining paperwork, ensuring smooth transactions, adopting methods like low-interest loans and crowdfunding platforms, advance care planning, early palliative care ntegration and timely transition to hospice care. We also highlight the importance of available community resources, non-profit organisations, cancer foundations, health insurance and government support. Overall, integrating financial planning into cancer palliative care seems essential for reducing FT and enhancing the quality of cancer care in India. Further research on the topic is needed.
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Affiliation(s)
- Saurabh Joshi
- Hospice Education India LLP, New Delhi 110088, India
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Anant Garg
- Hospice Education India LLP, New Delhi 110088, India
- Arthroplasty and Arthroscopy SIOR, Pune, India
- Spinal Surgery, KUMC Seoul, Seoul, South Korea
- RG Kar Medical College and Hospital, Kolkata 700004, India
| | - Sunny Malik
- Hospice Education India LLP, New Delhi 110088, India
- Department of Pain Management, Hospice Care & Palliative Medicine, Rajiv Gandhi Cancer Institute and Research Centre (RGCI&RC), Niti Bagh, New Delhi 110049, India
| | - Ajay Kumar Dewan
- Rajiv Gandhi Cancer Institute, Sector-5, Rohini, Delhi 110085, India
| | - Rakesh Sharma
- Hospice Education India LLP, New Delhi 110088, India
- Rajiv Gandhi Cancer Institute, Mahender Kumar Jain Marg, Niti Bagh, New Delhi 110049, India
- National Board in Critical Care Medicine (DrNB-CCM), National Board of Examinations (NBE), New Delhi 110029, India
- West Bengal University of Health Sciences, Kolkata 700064, India
- Narayana Health-Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata 700099, India
| | - Upkar Joshi
- Hospice Education India LLP, New Delhi 110088, India
- Ascent Capital Financial Services Private Limited, New Delhi 110088, India
- Gargi College, University of Delhi, New Delhi 110049, India
- Business Economics, Bhim Rao Ambedkar College, University of Delhi, New Delhi 110032, India
- Academic Advisory Council, New Delhi Institute of Management, New Delhi 110062, India
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Linkeviciute A, Canario R, Peccatori FA, Dierickx K. Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care. Cancers (Basel) 2024; 16:455. [PMID: 38275896 PMCID: PMC10813952 DOI: 10.3390/cancers16020455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/13/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy-namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)-and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance.
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Affiliation(s)
- Alma Linkeviciute
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Rita Canario
- Cancer Metastasis i3S-Institute for Research & Innovation in Health, R. Alfredo Allen 208, 4200-135 Porto, Portugal;
- Research Centre, Portuguese Oncology Institute of Porto, 4200-072 Porto, Portugal
- ICBAS—School of Medicine and Biomedical Sciences, University of Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, KU Leuven, 3000 Leuven, Belgium;
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Kleisiaris C, Maniou M, Karavasileiadou S, Togas C, Konstantinidis T, Papathanasiou IV, Tsaras K, Almegewly WH, Androulakis E, Alshehri HH. Psychological Distress and Concerns of In-Home Older People Living with Cancer and Their Impact on Supportive Care Needs: An Observational Survey. Curr Oncol 2023; 30:9569-9583. [PMID: 37999112 PMCID: PMC10670276 DOI: 10.3390/curroncol30110692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
(1) Background: Cancer patients are experiencing psychological problems after diagnosis, such as emotional distress and social anxiety, which may increase their demands for emotional and supportive care. This study aimed to assess the influence of both emotional distress and concerns on the supportive care needs of cancer patients receiving home-based healthcare. (2) Methods: In this door-to-door screening program, 97 cancer patients were approached, with a mean age of 73 years old (mean = 73.43; SD = 6.60). (3) Results: As expected, 42.3% of patients highlighted their treatment as their main psychological priority, with 20.6% identifying concerns about the future of their family in this regard. No significant associations with respect to sex were identified in terms of focus, though females reported the need for more frequent psychological support (58.7% vs. 37.3%, respectively, p = 0.035) compared to males. Patients who had experienced an increased number of concerns during the last weeks (IRR = 1.02; 95% CI: 1.00-1.03, p = 0.007) had a significantly greater risk of presenting an increased rate of supportive care needs. Notably, male patients with bone cancer presented a significantly greater number of supportive care needs (mean rank 45.5 vs. 9.0, p = 0.031) respectively, in comparison to those with other types of cancer. (4) Conclusions: Supportive care needs arise from a greater concern and specific type of cancer, highlighting the need for supportive care, such as psychosocial and psychological support. This may have significant implications for treatment and patient outcomes in home care settings.
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Affiliation(s)
- Christos Kleisiaris
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece; (C.K.); (M.M.); (T.K.)
| | - Maria Maniou
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece; (C.K.); (M.M.); (T.K.)
| | - Savvato Karavasileiadou
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Constantinos Togas
- Department of Social Service, Ministry of Public Order, 22100 Tripolis, Greece;
| | - Theocharis Konstantinidis
- Department of Nursing, Faculty of Health Sciences, Hellenic Mediterranean University, 71410 Heraklion, Greece; (C.K.); (M.M.); (T.K.)
| | | | - Konstantinos Tsaras
- Department of Nursing, University of Thessaly, 41500 Larissa, Greece; (I.V.P.); (K.T.)
| | - Wafa Hamad Almegewly
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Emmanouil Androulakis
- Department of Statistics and Insurance Science, University of Piraeus, 18534 Piraeus, Greece;
| | - Hanan Hamdan Alshehri
- Department of Medical-Surgical Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh 116711, Saudi Arabia;
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