Financial Distress in Testicular Cancer Survivors and Its Impact on Cancer Survivors´ Quality of Life in the German Health Care System

The financial burdens associated with a cancer diagnosis are an increasingly recognized problem in healthcare. Particularly in testicular cancer patients, who are often diagnosed at a younger age, the financial consequences can be significant. Financial toxicity refers to the financial difficulties and stresses that patients experience as a result of their disease and treatment. These stresses can not only threaten the financial stability of those affected but may also significantly affect their future psychological and medical well-being.

The Problems of Long-Term Survivors of Testicular Cancer
Testicular cancer is a rare but aggressive form of cancer that is usually diagnosed in young men between the ages of 15 and 35. Despite its rarity, it is the most common cancer in men in this age group. Treatment often includes surgery and chemotherapy, and - today rarely - in some cases radiotherapy. The long-term survival rates are today excellent but come at a price. Testicular cancer treatments can have long-term effects on patients' fertility, physical health, and emotional well-being.

The Financial Aspects of Cancer Treatment
Treatment of testicular cancer can incur significant costs, even in health systems with inclusive insurance systems. Direct costs include:

Hospitalization
Medications and chemotherapy
Follow-up visits and examinations

In addition, there are indirect costs that are often overlooked, such as:

Loss of income due to inability to work
Travel and accommodation costs for treatments
Costs for childcare and other family obligations

These financial burdens can significantly impact patients' daily lives and lead to a form of financial toxicity that can affect not only financial stability but also the overall quality of life of those affected.

Definition and Dimensions of Financial Toxicity
Financial toxicity can be defined as a form of economic stress resulting from the high costs and financial demands of cancer treatment. According to studies, many patients report:

Difficulty paying medical bills
Increasing debt burden
Forgoing necessary treatments or medications due to financial stress

Studies have shown that such financial toxicity will affect patients' emotional well-being, leading to anxiety, depression, and reduced levels of life satisfaction.

Impact on Treatment Adherence and Outcomes
The financial burdens of testicular cancer may impact adherence to treatment and follow-up care. Patients experiencing financial difficulties may be inclined to refuse recommended treatments or not take medications correctly to save costs. This may compromise treatment effectiveness and lead to poorer health outcomes.

One example is chemotherapy, which is often necessary in testicular cancer patients. The high cost of chemotherapy and additional medications, the costs of travel to treatment centers, and the associated time commitment may reduce patients' willingness to complete all scheduled therapy sessions. In addition, time spent for treatment reduces time at work and income.

Psychosocial Impact of Financial Toxicity
In addition to the direct health impacts, financial toxicity can also have profound psychosocial consequences.

Stigma and shame: patients may feel ashamed to openly admit their financial difficulties, which may lead to feeling isolated.
Stress and anxiety: constant worry about paying medical bills can lead to increased stress and anxiety, which in turn can affect the mental health of patients.
Relationship problems: financial problems can also cause tension in relationships, both within the family and in social circles.

Strategies to Reduce Financial Toxicity
To reduce financial toxicity in testicular cancer patients, several strategies are necessary:

Early risk identification: healthcare providers should be able to identify patients who are at high risk of financial toxicity and intervene proactively.
Education about financial support: providing information about financial support through foundations, health care programs, or social services can help patients reduce the burden.
Transparent cost estimates: healthcare facilities should inform patients in advance about the expected costs to avoid unpleasant surprises.
Integrated care: an interdisciplinary team, including social workers and financial advisors, can help patients address their financial concerns and find solutions.

Conclusion
The impact of financial toxicity on testicular cancer patients is a serious problem that can significantly affect treatment outcomes and quality of life. It is imperative that healthcare systems and policies take action to reduce the financial burden on cancer patients. This can be done through education, support,t and adequate resources aimed at mitigating financial challenges and ensuring quality care. Only by taking a holistic approach - considering the medical, psychological, and financial aspects of cancer treatment - can we ensure that patients with testicular cancer receive the best possible care without the additional burden of financial worries.

Written by: Desiree Louise Draeger, Julia Nolting, Vanessa Rossberg, Oliver W. Hakenberg

Department of Urology, University of Rostock, Rostock, Germany

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