Cancer treatment-related financial toxicity in Japan: a scoping review

Cost-effectiveness of datopotamab deruxtecan in previously treated advanced nonsquamous NSCLC

BACKGROUND

To evaluate the cost-effectiveness of datopotamab deruxtecan (Dato-DXd) in patients with previously treated advanced nonsquamous non-small-cell lung cancer from the perspective of a payer in the United States.

METHODS

A partitioned survival model with 3 states was employed to simulate patients receiving Dato-DXd or docetaxel (Dato-DXd or docetaxel group). The data on cost and health preferences were collected from the literature.

RESULTS

The Dato-DXd group generated an additional 0.11 quality-adjusted life years (QALYs) compared with the docetaxel group but at an additional cost of $119,575. This leads to incremental cost-effectiveness ratios of $1,054,809 per QALY. The results of the univariate sensitivity analysis indicated that the cost of Dato-DXd, the utility of progression-free survival, and progressive disease had the greatest impacts on the outcomes. The probability sensitivity analysis showed that Dato-DXd had a 0% chance of being considered cost-effective. When the cost of Dato-DXd decreased to 0.116 times the current price, the incremental cost-effectiveness ratio would decrease to a level below the willingness-to-pay threshold of $150,000/QALY.

CONCLUSION

In our model, from the perspective of a U.S. payer, Dato-DXd was not considered cost-effective for previously treated advanced nonsquamous non-small-cell lung cancer at a willingness-to-pay threshold of $150,000/QALY. This underscores the importance of assessing the cost-effectiveness of new treatments in the context of limited healthcare resources. Given the escalating costs of cancer care and the increasing demand for efficacious therapies, it is imperative that policymakers take into account not only the immediate costs of treatments but also their wider, long-term repercussions on patient outcomes and the sustainability of the healthcare system.

Caregiving Burden and Psychological Vulnerability of Young Adult Caregivers in Parental End-Of-Life Cancer Care: A Nationwide Bereavement Study

OBJECTIVE

With the aging population, family caregivers, including young adults, play an increasingly important role in supporting patients with cancer. This study compares the caregiving burden and psychological vulnerability faced by individuals caring for parents with terminal cancer during end-of-life (EOL) care and bereavement among three age groups: young adult caregivers (YACs), adult caregivers, and older caregivers.

METHODS

This cross-sectional study entailed a secondary analysis of Japanese national bereavement survey data. Data from bereaved family members who had cared for parents with cancer were used, and YACs (18-25 years) were compared with adult (26-39 years) and older (≥ 40 years) caregivers regarding caregiving burden, mental health, and depressive or grief symptoms. Statistical analyses included descriptive summaries and logistic regression to identify group differences.

RESULTS

From the original dataset, 18,145 parent-caring participants were analyzed, including 43 YACs. Compared to older caregivers, YACs reported higher psychological vulnerability, with significantly poorer mental health during the final week of caregiving (64.3% vs. 36.3%, OR: 3.15; 95% CI: 1.70-6.08) and higher depressive symptoms 1-2 years post-bereavement (29.3% vs. 11.9%, OR: 3.06; 95% CI: 1.50-5.86). Moreover, YACs showed a lower mean score for personal growth than older caregivers (4.5 vs. 5.0 difference: -0.5, 95% CI: -1.0 to -0.1) despite a similar caregiving burden across groups.

CONCLUSIONS

Notably, YACs face distinct challenges during EOL care, including increased psychological vulnerability and limited recognition of personal growth. Tailored interventions, including early mental health screening and resiliency-building strategies, are critical for effectively supporting this population.

Addressing Financial Toxicity From a Global Perspective: How to Advance Shared-Learning to Facilitate Change?

Financial Toxicity is a global issue requiring international efforts, but importantly, where to next?

Impact of financial literacy and education on breast and cervical cancer screening participation in Japan

Despite government efforts, the uptake of screening for breast and cervical cancers among Japanese women remains low. This study employs financial literacy and financial education as proxies for rational decision-making to explore their potential to enhance cancer screening practices in Japan. Using data from Osaka University's Preference Parameters Study, mean comparison tests and probit regression models are utilized to examine the association between breast and cervical cancer screening and financial literacy and financial education. The results of probit regression show that individuals with higher levels of financial education tend to participate in both breast and cervical cancer screening. In contrast, individuals with higher financial literacy are likely to participate in breast cancer screening, whereas no significant impact is observed for cervical cancer screening. Furthermore, our findings reveal that financial education positively influences both breast and cervical cancer screening. Factors such as employment, marriage, higher education, increased household income, and greater assets demonstrate robust positive relationships with breast and cervical cancer screening. Meanwhile, psychological factors including happiness, a myopic view of the future, anxiety about later life, and perceived health status have no significant associations, except for a positive association between anxiety about life and cervical cancer screening. Our study suggests the development of targeted educational programs that leverage financial literacy and financial education to raise awareness about the importance of breast and cervical cancer screening.

Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients With Cancer

OBJECTIVES

This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.

METHODS

This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cut-off scores, FT was classified as none/mild (≥26), moderate (14-25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.

RESULTS

The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (34.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.

CONCLUSIONS

FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

Analysis of Influencing Factors of Major Depression After Spinal Cord Injury

Objective

To analyze the risk factors of major depressive disorder (MDD) after spinal cord injury (SCI).

Methods

Patients with SCI in our hospital from February 2020 to February 2023 were selected as the study objects. According to the Hamilton Depression Scale (HAMD) score, patients with 36~75 points were included in the major depression group, and 0~35 points were included in the non-major depression group. The general sociological characteristics (age, gender, educational level, place of residence, family economic status, payment method of medical expenses, marital status) and disease-related characteristics (course of disease, cause of injury, neurological level of injury, type of injury, degree of pain) of all patients were collected, and the items with differences were selected for logistic regression analysis to analyze the risk factors for major depression in patients with spinal cord injury.

Results

Totally 216 patients were enrolled in our study, including 45 patients (18.98%) had moderate-to-severe depression and 175 patients (81.02%) had non-severe depression. Univariate analysis showed that gender (χ2 = 11.865, P < .001), course of disease (χ2 = 12.967, P < .001), family economic status (χ2 = 8.610, P = .003), educational level (χ2 =15.287, P < .001), neurological level of injury (χ2 = 9.013, P = .003) and pain level (χ2 = 16.673, P < .001) were statistically significant differences between the 2 groups. Multivariate logistic regression analysis showed that gender [odds ratio (OR) (95 % CI) = 3.986 (1.743~9.116), P = .001], course of disease [OR (95 % CI) = 4.033 (1.818~8.947), P = .001], family economic status [OR (95 % CI) = 3.136 (1.449~6.785), P = .004], educational level [OR (95 % CI) = 4.332 (1.998~9.388), P = .000], neurological level of injury [OR (95 % CI) = 2.848 (1.414~5.734), P = .003], and pain level [OR (95 % CI) = 5.767 (2.309~14.404), P < .001] were risk factors for major depressive disorder in SCI patients.

Conclusion

Gender, disease duration, family economic status, education level, level of nerve injury, and pain level may be the independent risk factors of MDD incidence in patients with spinal cord injury.

Financial Toxicity in Japanese Patients with Metastatic Renal Cell Carcinoma: A Cross-Sectional Study

Information on the financial toxicity experienced by Japanese patients with metastatic renal cell carcinoma (mRCC) is lacking, even though Japan has its own unique public health insurance system. Thus, a web-based survey was conducted to evaluate the financial toxicity experienced by Japanese mRCC patients using the COmprehensive Score for financial Toxicity (COST) tool. This study enrolled Japanese patients who underwent, or were undergoing, systemic therapy for mRCC. The outcomes evaluated were the distribution of COST scores, the correlation between COST and quality of life (QOL) assessed by the Functional Assessment of Cancer Therapy-General (FACT-G) scale, and demographic factors associated with financial toxicity. The median (range) COST score was 19.0 (3.0-36.0). The Pearson correlation coefficient for COST and FACT-G total scores was 0.40. Univariate analysis revealed that not having private health insurance and lower household income per year were significantly associated with lower COST scores. Multivariate analyses showed that age < 65 years and not having private health insurance were significantly associated with lower COST scores. This study revealed that Japanese mRCC patients experience adverse financial impacts even under the universal health insurance coverage system available in Japan, and financial toxicity negatively affects their QOL.

Relationship between nurses' perceptions and financial toxicity management in the public health insurance system

Aims: To describe nursing practices for financial toxicity management based on nurses' perceptions. Materials & methods: A survey was conducted with 615 oncology nurses in Japan, focusing on nurses' perspectives on the importance of financial toxicity, nursing practices to manage financial toxicity and factors inhibiting its management. Results: A total of 521 participated, of whom 266 respondents (51.1%) considered nurses' role important, and they engaged in a significantly higher proportion of nursing practices. Participants with greater perceptions of their role included certified or specialized nurses and nurses responsible for outpatient care. Conclusion: Interventions leveraging the expertise of certified or specialized nurses and nurses involved in outpatient care could help to spread proactive nurse practices addressing financial toxicity.