Financial Toxicity and Health-related Quality of Life in Indonesian Patients with Cancer [védés előtt]

Kivonat, rövid leírás

Financial toxicity has been increasingly recognized as an adverse consequence of cancer care across various health systems worldwide. It is defined as the negative financial impact of cancer diagnosis and treatment, which can be categorized into objective (e.g., out-of-pocket costs) and subjective (e.g., perceived financial distress) forms. This thesis explores the association between financial toxicity and health-related quality of life (HRQoL) among patients with cancer in Indonesia, using a mixed-methods approach presented across five articles/chapters published in peer-reviewed scientific journals. The first chapter presents a systematic literature review and meta-analysis of 31 studies. All but one study reported a negative association between subjective financial toxicity (measured by the COST: A FACIT Measure of Financial Toxicity [FACIT-COST]) and HRQoL, with a moderate correlation (r=0.49) pooled from 10 studies in the meta-analysis. The second chapter employs qualitative interpretive phenomenological analysis to explore the lived finanical toxicity experiences of patients with cancer in Indonesia. Two central themes emerged: (1) experienced financial burden (attributed to underinsurance, non-medical costs, and employment disruptions) and (2) financial coping strategies (including budget reallocation, family support, treatment adjustment, and insurance top-up). The third chapter focuses on the psychometric validation of the Indonesian version of the FACIT-COST measure through a longitudinal study involving 300 female patients with breast cancer in Indonesia —a dataset also used for the two subsequent chapters. The analysis confirmed the FACIT-COST’s adequate psychometric properties, establishing it as a reliable tool for assessing subjective financial toxicity within the Indonesian context. The fourth chapter assesses the psychometric performance of the EQ Health and Wellbeing (EQ-HWB) and its short form (EQ-HWB-S) compared to widely used and validated instruments (Functional Assesssment Cancer Therapy – General [FACT-G], FACT Eight Dimension [FACT-8D), Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS], and Short WEMWBS [SWEMWBS]]. Both EQ-HWB and EQ-HWB-S performed strongly, with EQ-HWB-S showing potential health technology assessments in breast cancer care. The fifth and final chapter applies multivariate logistic and linear regression analyses to explore relationships between financial toxicity (both objective and subjective), HRQoL, and well-being. Subjective financial toxicity was associated with increased problems in multiple HRQoL and well-being domains, including anxiety, depression, exhaustion, and pain, alongside lower overall HRQoL and well-being scores. This thesis offers novel theoretical contributions in the literature of financial toxicity and the measurement of health in cancer. Practical policy implications, highlighting the importance of measuring and mitigating financial toxicity, are also discussed.