The financial and psychological burden of cancer caregiving: quantifying out-of-pocket costs and their role as mediators of psychological distress at selected tertiary cancer treatment centres
1
Central Department of Public Health, Central Department of Public Health, Institute of Medicine, Kathmandu Nepal, Nepal
2
Brain and Neuroscience Center (BANC), Kathmandu Nepal, Nepal
3
Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen, Bergen, Norway
Popul. Med. 2026;8(Supplement Supplement 1):A2620
ABSTRACT
ABSTRACT:
Cancer caregiving imposes substantial financial and psychological burdens on family members (1,2), yet comprehensive costs, including indirect expenses like lost productivity and unpaid care, remain largely unaccounted in health policy frameworks (3,4,5). This study represents the first comprehensive examination of out-of-pocket (OOP) costs incurred by cancer patient caregivers and their association with psychological distress in Nepal (6,7). An analytical cross-sectional study enrolled 408 primary caregivers (≥18 years) of cancer patients at two tertiary cancer treatment centres. Data collection captured direct costs (medical and non-medical expenses) and indirect costs (productivity loss, informal care, travel time). Psychological distress was measured using the Hopkins Symptom Checklist-25 (HSCL-25). Multivariable linear regression with bootstrapping identified predictors of distress, adjusting for confounders. Psychological distress prevalence was 58.8% (anxiety: 61.8%; depression: 52.7%). Annual OOP costs averaged 714,932 NPR (USD 4,933), comprising direct costs of 325,041 NPR (USD 2,243) and indirect costs of 389,891 NPR (USD 2,690). Critically, indirect costs represented 55% of the total burden, indicating substantial productivity losses and caregiving demands. A causal mediation analysis revealed that OOP costs significantly mediated the relationship between informal caregiving hours and psychological distress. When controlling for key patient and caregiver factors, the indirect effect (ACME) of hours on distress via OOP costs was positive and significant (ACME=0.005, p=0.044), accounting for approximately 35% of the total effect. Strongest predictors of psychological distress included the highest OOP cost quintile (β=23.25), female caregivers (β=8.21), parent caregivers (β=8.87), nuclear family structure (β=3.19), caregiver comorbidities (β=3.23), non-ambulatory patient status (β=4.64), and temporary treatment stays (β=3.17). Notably, cervical cancer diagnosis was protective (β=-4.64) The findings reveal a dual burden where both time and financial strain are critical pathways to psychological distress. This highlights a key policy gap. Equitable cancer care in Nepal requires integrated support targeting both the economic and time burdens of caregivers.
Cancer caregiving imposes substantial financial and psychological burdens on family members (1,2), yet comprehensive costs, including indirect expenses like lost productivity and unpaid care, remain largely unaccounted in health policy frameworks (3,4,5). This study represents the first comprehensive examination of out-of-pocket (OOP) costs incurred by cancer patient caregivers and their association with psychological distress in Nepal (6,7). An analytical cross-sectional study enrolled 408 primary caregivers (≥18 years) of cancer patients at two tertiary cancer treatment centres. Data collection captured direct costs (medical and non-medical expenses) and indirect costs (productivity loss, informal care, travel time). Psychological distress was measured using the Hopkins Symptom Checklist-25 (HSCL-25). Multivariable linear regression with bootstrapping identified predictors of distress, adjusting for confounders. Psychological distress prevalence was 58.8% (anxiety: 61.8%; depression: 52.7%). Annual OOP costs averaged 714,932 NPR (USD 4,933), comprising direct costs of 325,041 NPR (USD 2,243) and indirect costs of 389,891 NPR (USD 2,690). Critically, indirect costs represented 55% of the total burden, indicating substantial productivity losses and caregiving demands. A causal mediation analysis revealed that OOP costs significantly mediated the relationship between informal caregiving hours and psychological distress. When controlling for key patient and caregiver factors, the indirect effect (ACME) of hours on distress via OOP costs was positive and significant (ACME=0.005, p=0.044), accounting for approximately 35% of the total effect. Strongest predictors of psychological distress included the highest OOP cost quintile (β=23.25), female caregivers (β=8.21), parent caregivers (β=8.87), nuclear family structure (β=3.19), caregiver comorbidities (β=3.23), non-ambulatory patient status (β=4.64), and temporary treatment stays (β=3.17). Notably, cervical cancer diagnosis was protective (β=-4.64) The findings reveal a dual burden where both time and financial strain are critical pathways to psychological distress. This highlights a key policy gap. Equitable cancer care in Nepal requires integrated support targeting both the economic and time burdens of caregivers.
| eISSN: | 2654-1459 |
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