Introduction
Cancer is the second leading cause of death globally. According to a World Health Organization report, cancer resulted in 9.6 million deaths in 2018[1]. In high-income countries, cancer is the number one cause of disease-related death [2,3]. Several years of research have improved treatments options for cancer patients, thus improving their survival rate [4,5]. However, the cost of these treatments and the financial burden on patients and their families are high [6-9].
High healthcare expenses are also associated with treatments for childhood cancers. Childhood cancers are a leading cause of death and their prevalence has been increasing since 1980 [3,10,11]. The reported number of childhood cancer cases in Korea was 13,775 in 2014, which was 3.1% higher than that in 2010 [12]. In the United States, the 5-year survival rate for childhood cancer in 2020 is 84%, whereas it was 58% in the mid-1970s and 79% in the mid-1990s [13]. In the United Kingdom, the 5-year survival rate in 2020 is between 76% and 82%, whereas it was 36% in 1970 [14]. Along with the increased number of childhood cancer cases and survivors, the medical expense associated with childhood cancer treatment and care has also increased to 87.7 billion Korean Wons (KRW) in 2014 from KRW 83.1 billion in 2010 [15]. The cost of childhood cancer treatment is also high in the United States and begins at 833,000 United States Dollars (USD) [8].
Although deaths from childhood cancers are still high, it is curable with advanced medical therapy and technology. Therefore, it is important to provide these medical options to patients, while lowering the associated financial burden on the patients and their families [6,16-18]. For childhood cancer patients, the financial burden on their family is higher than that associated with treatment for adult cancer patients [9,16,17]. A study by Merrill et al. reported that the average cost per day for childhood cancer treatments was 700 USD higher than that of adult cancer treatments [19]. Additionally, the hospitalization cost for leukemia patients was higher in children at 55,700 USD compared with adults at 40,200 USD [20].
Due to the high medical costs associated with cancer treatments, the government has established a financial support program for patients. However, the financial burden on families continues to remain high [6-9,16-18,21,22]. Importantly, families of childhood cancer patients often experience disruptions in the regular employment of the caregiver, which significantly diminishes the household income [23-25]. Some studies show that families with childhood cancer patients are driven below the poverty line due to high medical costs [18,23,25,26]. Furthermore, some patients and their families make treatment decisions based on the associated cost, which can lead to undesirable outcomes [27]. Therefore, it is important to prioritize and allocate the limited healthcare resources in an efficient manner and provide financial support to patients and their families.
Although understanding the economic impact of childhood cancer is essential, there are very few studies describing the financial burden associated with medical treatments and its impact on patients’ families [22, 24]. The purpose of this study is to investigate the burden of childhood cancer costs on cancer survivors and their families based on socioeconomic status. To this end, we examined the medical costs associated with cancer survival for 5 years after the initial cancer diagnosis, based on childhood cancer type and socioeconomic status.