Economic Impact:
Colleagues from the Global Taskforce are working on a wide range of economic impact studies.
Previous study of ASEAN countries led by Taskforce colleagues in Malaysia has shown that 1 in 2 cancer patients incurred catastrophic out of pocket expenditures just within a year of diagnosis. It is further conceivable that the COVID-19 pandemic would have exacerbated many of the inequalities already present. Professor Nirmala Bhoo Pathy is undertaking a validation study to determine if the COmprehensive Score for financial Toxicity (COST) questionnaire, developed in the United States will be a valid measure of financial toxicity in Malaysian cancer patients during the pandemic. This step will allow local adoption of the tool to measure financial toxicity, an important patient reported outcome. Subsequently, a cohort study will be undertaken to examine the economic, employment, insurance, and clinical factors associated with financial toxicity in women with breast cancer from urban and rural Malaysian settings. The association between financial toxicity and cancer treatment adherence will also be assessed. Apart from facilitating identification of economically and clinically disadvantaged patient subgroups who may need early intervention to prevent catastrophic financial outcomes, findings are expected to aid planning and tailoring of financial navigation services and resources that will serve a broader audience.
In Germany, Taskforce colleagues led by Prof Michael Schlander at DKFZ, Susanne Weg-Remers, Volker Arndt, Eva Winkler, Michael Baumann, and others are undertaking a cross-sectional study of 300 patients diagnosed with cancer, who contacted the Cancer Information Service (Krebsinformationsdienst, KID). The main objective is to gather data on the prevalence of “corona crisis” related negative effects on cancer patients, specifically; awareness of the pandemic and fear of potential infection, prioritization of health care provision in favor of patients with an acute infection with SARS-CoV-2 (COVID-19), protection of cancer patients against risk of infection with SARS-CoV-2, etc.; second, to assess the general level of psychological distress and anxiety, as well as the socioeconomic implications for cancer patients who have contacted KID, including distress and anxiety attributable to phenomena related to the “corona crisis”; third, if feasible, to explore the impact (if any) of rescheduling appointments, diagnostic or therapeutic measures on the
level of anxiety and distress and health-related quality of life (“intangible costs”), as well as vice versa (for example, re-scheduling of appointments by patients for fear of acquiring COVID-19), if and when applicable; including to also explore potential “tangible costs” to patients (financial consequences).
The same team is also conducting the The CroKuS study: “Folgen der Corona-Beschränkungen für Krebstherapie und Survivorship (CroKuS)” [The Impact of the Corona Pandemic on Cancer Patients and Their Families: Medical, Psychosocial and Economic Consequences.] The studies will be pseudonymized, non-interventional trend surveys and will be conducted in a cross-sectional design (CroKuS I) and subsequently in in four consecutive waves over 12 months. The studies will use a population-based cohort of adult cancer patients (and long-term disease-free cancer survivors) up to 5 years after a diagnosis of breast, colorectal, prostate, blood/hematologic or lung cancer from the Baden-Württemberg Cancer Registry (BWCR) and, in CroKus II, will also include data from their informal caregivers and also from a matched control group comprising non-cancer individuals. The primary objective will be to measure the impact of the Corona pandemic on cancer patients by comparing psychosocial and economic consequences for cancer patients who
experienced a change of medical or psychosocial cancer care in the context of the pandemic with those of cancer patients who did not experience a change of cancer care.
Anglo-Canadian Taskforce members led by Dr Ajay Aggarwal (Institute of Cancer Policy, King’s College London & London School Hygiene and Tropical Medicine) and Prof Chris Booth (Kingston University) have developed models for the impact of delays in diagnosis (https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(20)30388-0/fulltext) and impact of delays in treatment (https://www.bmj.com/content/371/bmj.m4087) which are being utilized to value the indirect health effects of COVID-19 due to excess cancer deaths. They estimate economic burden using several approaches that value productivity losses due to mortality and compare estimates from excess cancer deaths with the same number
of Covid-19 deaths. Such methods have been used before to quantify the wider economic implications of disease and health interventions in the UK, both in the context of cancer and other public health interventions such as vaccination.