Financial toxicity amongst cancer patients and survivors: a comparative study of the United Kingdom and United States

Background
The study investigated the experiences of financial toxicity (FT) amongst cancer patients/survivors in the United Kingdom (UK) and the United States (USA/US).

Methods
Six hundred cancer patients/survivors residing in the UK (n = 319) or USA/US (n = 281) completed an online cross-sectional survey using the COmprehensive Score for financial Toxicity (COST)—a validated measure of FT. Severity of FT was defined as ‘no’ (COST scores ≥ 26), ‘mild’ (14–25), and ‘moderate/severe’ (0–13).

Results
Thirty-four percent of UK participants faced FT which was significantly lower compared to the USA/US at 55% (crude OR = 2.44, 95% CI 1.73–3.42). An ordered logistic regression model showed that in the USA/US, being 65 + years old (adjusted OR = 0.19, 95% CI 0.07–0.48), retired (aOR = 0.26, 95% CI 0.09–0.75), and having a higher household income (aOR ranged 0.03–0.19) decreased the risk of FT, whilst being female increased the risk (aOR = 1.83, 95% CI 1.01–3.32). In the UK, age and sex did not have an effect, but higher income and being retired showed an identical pattern compared to the US.

Conclusions
FT was less prevalent and less severe in the UK, compared to the USA/US. The high prevalence of FT underscores the need to provide an additional level of protection to the most vulnerable groups than is currently offered in either country.