Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary; Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary; Faculty of Economics and Business, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia.
Faculty of Psychology, Gadjah Mada University, Yogyakarta, Indonesia.
Value Health Reg Issues. 2024 May;41:25-31. doi: 10.1016/j.vhri.2023.11.007. Epub 2023 Dec 27.
Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia.
Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis.
We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members.
This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.
经济毒性（FT）是癌症的一个重要不良影响。最近的系统评价表明，FT 可能导致治疗不依从和健康相关生活质量受损，这两者都可能对患者的生存率产生不利影响。然而，人们对患者如何承受 FT 知之甚少，特别是在中低收入国家。本研究旨在探讨印度尼西亚癌症患者经历和应对 FT 的情况。
采用半结构式深入访谈法，探讨了印尼癌症患者的经历。采用解释现象学分析方法对定性数据进行分析。我们有目的地招募了 8 名正在接受积极治疗（年龄 27-69 岁）的患者，他们在诊断前 5 年内被诊断患有癌症，并且在诊断时拥有健康保险。
我们确定了 2 个主要主题：（1）所经历的经济负担，包括保险不足、非医疗癌症相关自付费用、就业中断的负面收入效应等子主题；（2）财务应对策略，包括重新分配家庭预算、寻求家庭支持、合理化治疗决策以及为家庭成员增加保险等子主题。
这是文献中关于 FT 的第一项解释性现象学研究，也是印度尼西亚关于 FT 的第一项定性研究。我们的研究结果深入了解了印度尼西亚癌症患者发生 FT 的情况和使用的应对策略。患者的主观体验可以进一步改进肿瘤学护理，支持对 FT 的测量需求，并为患者提供缓解计划。
