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.