Patient Financial Well-Being and Access to Cancer Treatment During Wartime

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PURPOSE The high cost of cancer care is a barrier to treatment.,We explored the impact of patient-reported financial well-being on access to cancer care during Russia’s full-scale invasion of Ukraine. Ukraine has universal health insurance (UHC) that covers most cancer care costs. METHODS Cancer patients receiving treatment at public cancer centers in Cherkasy, Dnipro, Kyiv, and Kharkiv (the city closest to the front lines) filled out surveys in October 2023. Results were analyzed using descriptive statistics, Chi-Squared test, and Fisher’s exact test. RESULTS 522 patients filled out surveys, including 329 (63%) women. 214 (41%) were from Kyiv, 141 (27%) from regional centers, 167 (32%) from small towns/villages. 177 (34%) reported having money only for food, 183 (35%) for basic necessities, 131 (25%) for everything needed but not savings, and 26 (5%) were able to make savings. Among 522, 240 (46%) received all diagnostic procedures through UHC, 224 (43%) paid for some and 57 (11%) paid for all aspects of diagnosis. Official payments were most common for CT (73%), MRI (72%), PET-CT (44%), and biopsy (31%). Around half of patients had all treatment covered through UHC in case of chemotherapy (318 (61%)), radiotherapy (256 (49%)) and surgery (245 (47%)). Official payments were made most often for surgery (188 (36%)), radiotherapy (130 (25%)), and chemotherapy (120 (23%)). The most frequent official or unofficial payments for surgery were made in Kharkiv (55% vs. 41-50%, p < 0.05). Among 201 (39%) who paid for treatment, 64 (32%) bought surgical instruments, 58 (29%) bought cancer medicines, and 20 (10%) paid to avoid waiting for treatment. There were no significant differences in wait times for diagnosis and treatment were observed based on financial status (p > 0.05). CONCLUSION Reported financial well-being did not impact wait times for cancer care in Ukraine in the setting of UHC, even in times of war. In Kharkiv, the proximity of wartime hostilities resulted in increased out-of-pocket payments for treatment. Future research should describe strategies for overcoming barriers to access in the setting of limited resources and also evaluate the quality of cancer care against existing guidelines.

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