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Original Article Beyond Medical Bills: High Prevalence of Financial Toxicity and Diverse Management Strategies Among Vietnamese Patients with Cancer
Binh Thang Tran1corresp_iconorcid , Dinh Duong Le1orcid , Thanh Gia Nguyen1orcid , Minh Tu Nguyen2orcid , Thanh Nhan Nguyen Pham3orcid , Minh Hanh Nguyen4orcid , The Due Ong5orcid

DOI: https://doi.org/10.3961/jpmph.24.090 [Accepted]
Published online: June 24, 2024
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1Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
2Undergraduate Training Office, University of Medicine and Pharmacy, Hue University, Hue city, Thua-Thien Hue, Vietnam, Hue, Viet Nam
3Da Nang Onocology Hospital, Da Nang city, Viet Nam
4Oncology Centre, Hue Central Hospital, Hue, Viet Nam
5Health Strategy & Policy Institute - Ministry of Health, Hanoi, Viet Nam
Corresponding author:  Binh Thang Tran,
Email: tranbinhthang@hueuni.edu.vn
Received: 21 February 2024   • Revised: 28 May 2024   • Accepted: 12 June 2024

Objectives
This study was conducted to measure financial toxicity (FT) among patients with cancer in Vietnam using the COmprehensive Score for financial Toxicity (COST) and to describe the cost management strategies employed by these patients.
Methods
This comprehensive cross-sectional study enrolled 634 patients from 2 specialized oncology hospitals in Vietnam. Using COST cutoff scores, FT was classified as none/mild (≥26), moderate (14–25), or severe (≤13). Cost management strategies, or coping mechanisms, were classified into 4 groups: lifestyle changes, financial resource strategies, treatment modifications, and support seeking.
Results
The prevalence of FT was 91.8%, with 51.7% of participants demonstrating severe and 40.1% exhibiting moderate FT. Severe FT was significantly associated with female sex, low education level, unstable employment, low household economic status, and advanced cancer stage. The most common coping strategies were as follows: among lifestyle changes, reducing spending on basic items and leisure activities (78.7%) and cutting back on essential household expenses (66.4%); among financial resource strategies, borrowing money from relatives or friends (49.1%) and withdrawing funds from retirement or savings accounts (32.1%); within treatment modifications, switching treatment facilities or doctors due to cost concerns (9.3%); and within support seeking, obtaining help from welfare or community organizations (18.8%). All strategies were significantly more likely to be used by patients with severe FT.
Conclusions
FT was highly prevalent among patients with cancer. Most patients relied on lifestyle adjustments and coping strategies, underscoring the need for improved financial support systems to alleviate the economic burden associated with cancer care.

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