The Invisible Costs of Cancer Treatment: Quantifying Non-Medical Economic Consequences for Cancer Survivors Undergoing Systemic and Radiation Therapies

Background: The non-medical economic consequences of cancer on individuals and families in low- and middle-income countries, including Bangladesh, remain poorly quantified. This study measures the non-medical economic consequences of cancer survivors and their families, including sacrifices in essential family consumption, social participation and family members' schooling. Methods: We conducted a cross-sectional survey between January and May 2022, involving 607 adult patients receiving cancer treatment at two tertiary specialised cancer hospitals in Bangladesh. Participants reported any occurrence of non-medical economic consequences: reduction in essential goods (REG) consumption, avoidance of social events (ASE) and cessation of schooling (CS) of family members. We used a multivariable logistic regression model to assess the associations between each non-medical economic consequence and clinical and socioeconomic factors. Additionally, we fitted a Poisson regression to model the count of non-medical economic consequence events as a function of disease stage and relevant covariates. Results: Overall, 39% of patients reported REG, 36% ASE, and 38% CS. After adjusting for co-variates, advanced cancer (stage IV) was a significant predictor of non-medical economic consequence (REG: OR = 5.58, 95% CI 0.99–31.44, p = 0.051; ASE: 11.35, 1.81–71.07, p = 0.009; SS: 101.56, 2.47–4173.90, p = 0.015) compared with early cancer (stage I). Compared with the highest-income families, patients from low- and lower-middle-income families had significantly higher odds of experiencing all outcomes (REG: OR = 7.57, 3.01–19.06, p < 0.001 and 7.23, 1.81–28.89, p = 0.005; ASE: 10.21, 3.81–27.36, p < 0.001 and 17.99, 4.26–75.96, p < 0.001; CS: 11.37, 3.23–40.00, p < 0.001 and 12.58, 1.90–83.19, p = 0.009). Employed patients were also at markedly higher risk, with substantially increased odds of REG (18.27 times), ASE (41.01 times) and CS (72.34 times) compared with non-employed patients (all p < 0.01). Conclusion: ...