Discussion
Our study focused on the medical treatment-associated financial burden
borne by childhood cancer patients and their families based on their
socioeconomic status. Childhood cancer impacts not only the patient, but
also the family. In our study, we found that medical expenditure varied
based on socioeconomic status and treatment phase. Previous studies on
the financial burden of childhood cancers were limited to specific
hospitals or areas with small sample sizes. Because our study utilized
NHIS data, our sample size is greater and more representative of the
Korean population compared to previous studies.
We found that the medical expenditure at early phases of treatment is
the highest. Clinical research has reported that during the early phases
of cancer treatment, intensive care, lengthy hospitalization, and
frequent outpatient services are needed. Therefore, after cancer
diagnosis, patients and their families experience financial stress in
addition to the psychological stress associated with the diagnosis
itself [6,9,24,26]. Similar to our results, Warner et al. reported
that in the first year of diagnosis, childhood cancer patients and
families are financially vulnerable [27]. Considering that the main
caregiver for the patient is a parent, the inevitable disruption of
parents’ employment in many cases increases the financial burden on the
family [7,22,26]. Although this financial burden affects families
independently of socioeconomic status, patients and their families in
the low status category suffer more [18,26,28-31].
Cancer treatment requires long-term care that can place an immense
financial burden on patients’ families. Some patients could make
treatment decisions based on costs [16,29-31]. To reduce this
financial burden, the Korean government has a special system in place
wherein a cancer patient pays 5% of the total out-of-pocket medical
costs covered by insurance after the diagnosis [32]. While this
system provides some relief to patients and families, the treatments are
expensive, and some facets of treatment are not covered by the national
health insurance. As our results demonstrate, the medical cost for
childhood cancer survivors varies based on socioeconomic status.
Importantly, the results only include treatments covered by insurance.
If we factored in non-covered treatments in our calculations, it would
further exacerbate the gap in financial burden based on socioeconomic
status. In addition to the special system described above, the
government also provides financial support to low-income patients who
pay health insurance premiums below KRW 100,000 [32]. However, our
study found that medical costs of the low status group and the mid-low
status group showed no significant difference. In fact, the mid-low
status group had decreased cumulative medical costs at 1 year
post-diagnosis. Therefore, an effort to expand financial support for
families is required.
In conclusion, as improved medical treatments increase the numbers of
childhood cancer survivors, the economic burden associated with medical
treatment also increases. A better understanding of how the financial
burden is unevenly distributed across socioeconomic classes is required
to reduce the disparities in medical treatment received by patients. In
addition, considering the duration of healthcare needed for patients,
establishing a continuous economic support policy would be beneficial
for lowering the financial burden on childhood cancer patients and their
families.