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.