Influence of financial burden on withdrawal or change of cancer treatment in Japan: results of a bereavement survey

Purpose: This study aimed to examine the effect of financial burden of cancer treatment from diagnosis to end-of-life on treatment withdrawal or change in Japan. Methods: This study was part of a nationwide survey of bereaved family members of cancer patients in Japan (J-HOPE2016 study). We asked questions regarding withdrawal or change of cancer treatment (stratified according to whether the treatment was recommended by physicians or based on the patients’ request), experiences of financial difficulties in coping with cancer treatment expenses, and the participants’ socioeconomic background. We conducted descriptive analyses and used logistic regression to examine the factors related to withdrawal or change of cancer treatment. Results: Approximately 7.5% of participants reported withdrawal or change of cancer treatment for financial reasons. The experiences of financial difficulties in coping with cancer treatment expenses such as using up all or a portion of one’s savings (OR=2.14, 95% CI=1.14-4.04, p=0.018 / OR=3.45, 95% CI=1.52-7.81, p=0.003) and subjective financial burden (OR=2.54, 95% CI=1.25-5.14, p=0.010 / OR=3.89, 95% CI=1.68-9.00, p=0.002) were significantly related to withdrawal or change of cancer treatment (recommended by physicians / based on patient request). Conclusion: Fewer participants reported withdrawal or change of cancer treatment than in previous studies, which might reflect the characteristics of the Japanese health-care system. However, there are patients in Japan who withdraw or change cancer treatment for financial reasons. Medical staff should consider financial toxicity as a serious side effect and assist patients in their decision-making regarding treatment while considering their socioeconomic background.