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| BRIEF RESEARCH ARTICLE |
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| Year : 2022 | Volume
: 66
| Issue : 2 | Page : 190-192 |
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Envisioning the financial and psychological hardships of cancer
Rupak Kumar Borah1, Bhavana Barman1, Hari Kanta Choudhury2
1 Research Scholar, Indian Institute of Information Technology Guwahati, Guwahati, Assam, India
2 Assistant Professor, Department of Humanities and Social Sciences, Indian Institute of Information Technology Guwahati, Guwahati, Assam, India
| Date of Submission | 26-Sep-2021 |
| Date of Decision | 27-Nov-2021 |
| Date of Acceptance | 02-Dec-2021 |
| Date of Web Publication | 12-Jul-2022 |
Correspondence Address:
Hari Kanta Choudhury
Department of Humanities and Social Sciences, Indian Institute of Information Technology Guwahati, Guwahati - 781 015, Assam
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijph.ijph_1844_21
 Abstract | | |
Cancer is one of the leading causes of premature death and disability worldwide. With the progress of the health-care system, the cost of cancer treatment is also rising. Poor households suffer disproportionately from the financial burden of cancer treatment, which has pushed many households into poverty. Thus, cancer poses an economic burden for individuals, families, societies, and governments because of the prolonged medical costs, out-of-pocket expenditures, loss of productivity, and premature deaths. Moreover, the psychological breakdown phenomenon and social implications of cancer play a vital role in dealing with cancer patients. The psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. With these backgrounds, an attempt is made in this review paper to highlight the implications of cancer on financial and psychological aspects.
Keywords: Cancer, economic burden, loss of productivity, out-of-pocket expenditure, premature death, psychological impact
How to cite this article:
Borah RK, Barman B, Choudhury HK. Envisioning the financial and psychological hardships of cancer. Indian J Public Health 2022;66:190-2 |
How to cite this URL:
Borah RK, Barman B, Choudhury HK. Envisioning the financial and psychological hardships of cancer. Indian J Public Health [serial online] 2022 [cited 2022 Aug 13];66:190-2. Available from: https://www.ijph.in/text.asp?2022/66/2/190/350665 |
| Introduction | |  |
Cancer is the second leading cause of death and disability worldwide. According to estimates of the World Health Organization (WHO) in 2019, cancer is found as one of the leading causes of death before the age of 70 years in 112 out of 183 countries.[1] Evidence is found in the literature that with the progress of the health-care system, the cost of cancer treatment at the household level is also growing. As a result, poor households suffer disproportionately from the financial effects of the costs of treatment for cancer. Thus, for a household, cancer poses an economic burden, which refers to both direct and indirect costs involved during the entire treatment period, due to the prolonged medical treatment, out-of-pocket (OOP) expenditures, which is again a part of the direct cost of treatment, loss of productivity, and premature deaths. Apart from the financial implications of cancer, the psychological breakdown phenomenon of cancer plays a vital role in how a patient deals with cancer. A collective welfare loss is seen in both the family members and patients, which the WHO describes as the loss of valued nonmarket assets, which contribute to the intrinsic value of human life and happiness. Therefore, it is necessary to understand the mental health positions of patients, the changing family dynamics of the cancer patient, and its impact on the healing process of cancer itself.
| Financial Implication of Cancer | | |
The process of cancer care involves both direct costs and indirect costs. The direct cost of cancer is defined as those costs associated with treatment services that patients receive and are typically measured by insurance payments and patient OOP expenditures. Indirect costs of cancer are financial losses related to time spent receiving medical care, time lost from jobs or other daily activities, and lost productivity due to premature death.
Literature on breast cancer treatment shows that there is a significant difference in the cost of treatment of breast cancer between private and government hospitals. The direct cost of treatment is found more in a private hospital, whereas indirect cost is reported more in government hospitals than private hospitals.[2] The study of All India Institute of Medical Sciences conducted in 2006–07 reported that the economic burden of cancer patients for a 5 to 7-week cancer therapy including radiotherapy represents approximately 330%–450% of the monthly per capita income of the family.[3] Thus, for most patients, treatment of cancer was unaffordable. Literature also suggests that the price of cancer medicines plays a major role in the cost of cancer treatment. Most anti-cancer drugs are unaffordable for the common masses because of their high and varied prices.
| Out-of-Pocket Expenditures | | |
The term OOP expenditure is referred to household spending for which they received health services including either inpatient services or outpatient services, and nonmedical expenditures such as transportation or accommodation. The relative impact of costs is rarely taken into account while calculating the economic burden of cancer.
Several studies have pointed out that cancer patients pay substantial OOP costs per month, most of which are spent on cancer medications, caregiver expenses, transport, and travel expenses. Rural households have to bear additional OOP expenses in the form of traveling and boarding/lodging at distant medical institutions.[4] It is worth mentioning that a study by Mahal et al. found that cancer-affected households had a significantly higher rate of borrowing money and selling assets as compared to control households.[5]
| Out-of-Pocket Expenditures in Indian Scenario | | |
India's cancer burden is by any means no less and poses a threat to the overall welfare and development of the citizens. Using the unit-level data from the 71st round of the National Sample Survey Organization (2014), Kastor and Mohanty estimated the catastrophic health expenditure (CHE) incurred by households for cancer and compared it to CHE from other diseases. CHE is defined by the authors as household spending on health care which exceeds 10% of the total household consumption expenditure. About 28% of households faced CHE for various diseases. CHE of cancer was found to be the highest (79%) among all other diseases such as heart diseases, neurological disorders, genitourinary problems, musculoskeletal diseases, gastrointestinal problems, and injuries. They also reported that households experienced distressed financing as a result of CHE. Distress financing is defined as borrowing money and the sale of assets to meet health-care expenses. The study found that the possibility of incurring distress financing was 3.2 times higher for those hospitalized for cancer and 2.6 times for tuberculosis patients.[6]
In India, the government, private, and community-based health insurance schemes also do not adequately cover the catastrophic OOP expenditures incurred by households of all income groups. A study done by Dalui et al. on 253 rural households showed that around 64.3% of households of the total sample were covered by health insurance. However, almost one-sixth of the sample households experienced CHE on various diseases.[7] It is worth mentioning here about the Pradhan Mantri Jan Arogya Yojana, which is an insurance/assurance scheme funded by the Government of India that gives a cover of Rs. 5 lakhs/year per family for private and public hospitalizations in India for the bottom 40% of the Indian population. Although this scheme acts as a major relief for affected poor families, it does not fully solve the problem of the economic burden of cancer patients in India.[8]
| Psychological Implications of Cancer | | |
Many cancer patients and survivors suffer from psychological problems such as depression and anxiety. Various issues such as grief over bodily changes (hair loss and deformity) and depression about impending death affect a cancer patient. Not only the individual but also the social relationships of the patients have with others also become strained. In addition to coping with the stress brought about by cancer, patients and their families must cope with the stresses induced by physically demanding and also often life-threatening treatments for the illness. The permanent health impairment, disability, fatigue, and pain that stays even after the cancer is gone take their toll on the patient.[9] However, the psychological impact of cancer on diagnosed patients with or without a prior psychiatric history is often undermined during and after cancer treatment. Focus is primarily given to monitoring physical health symptoms and side effects.
| Impact of Cancer on Family Caregivers | | |
The phenomenon of cancer itself is a family experience that impacts the lives of all its members, bringing an immense amount of stress and many challenges. A significant percentage of caregivers react negatively to cancer and develop an affective disorder. The modern health-care system presents the cancer patient and his or her family with a complex and strange ecology, changing their daily routine life. This alienates the patient from their informal caregivers, and they suffer from caregiving fatigue after a point. Studies have pointed out that due to the lack of communication, family functioning as a unit was disrupted after the diagnosis of cancer.[10] Cancer affects a couple's relationship, their sex life, and it can also be a cause of major trauma among their children and adolescents. Sources of distress during treatment are related to their worry about the patient's ability to tolerate the treatment, if the treatment will be effective, and if side effects and symptoms associated with the treatment will be manageable. Family members of cancer patients may experience negative mental symptoms (such as anxiety, depression, a sense of burden, helplessness, and fear) as an aftermath of their caregiving.
| Conclusion | | |
The impact of cancer is so far-fetched that it cannot be calculated based on the patient's health alone. The social relationship of the patient, the financial impact on the family, the fatigue and stress experienced by the family need to be studied thoroughly to visualize the tangible and intangible impact of cancer. Poor households suffer excessively from the financial burden of cancer treatment, which pushes many households into poverty. Cancer poses a severe economic burden for individuals, families, societies, and governments because of the prolonged medical costs, OOP expenditures, loss of productivity, and premature deaths. Moreover, the psychological effect of battling with cancer falls not only on the patient but also on the caregivers and family members. Therefore, there is a need to spread awareness among the common masses about the consequences of cancer and the possible way to prevent it. It should also be mentioned here that it is possible to prevent some kinds of cancers such as cervical and breast cancer, provided adequate measures are taken at the right time. In the context of India's recent policy, adopted to control drug prices to provide relief to cancer patients, it is to be mentioned here that the National Pharmaceutical Pricing Authority has brought several anti-cancer drugs under its price control framework. As a result, the prices of those anti-cancer drugs have been reduced significantly. Thus, government policies have a crucial role in bringing down the prices of not only cancer medicines but also other life-saving drugs.
Acknowledgment
This paper is the outcome of a sponsored project entitled “Determinants of Women's Acceptance of Cervical Cancer Screening Program: A case study of Kamrup district of Assam,” financially supported by the Indian Council of Social Science Research, New Delhi under the IMPRESS scheme of the Ministry of Education. We gratefully acknowledge the ICSSR and the Ministry of Education, Government of India, for sponsoring the project.
Financial support and sponsorship
The study was supported by Indian Council of Social Science Research (ICSSR), New Delhi, File No: IMPRESS/P2627/463/2018-19/ICSSR.
Conflicts of interest
There are no conflicts of interest.
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