Financial Toxicity of Cancer Treatment: Evaluating the Direct and Indirect Economic Burden Among Patients Receiving Chemotherapy and Radiotherapy at National Hospital Abuja, Nigeria.
DOI:
https://doi.org/10.66811/eijrihs.vol1.no3.26Keywords:
Financial toxicity, Cancer treatment, Chemotherapy, Radiotherapy, Out-of-pocket expenditure, Economic burden, NigeriaAbstract
Background: According to the International Agency for Research on Cancer and World Health Organization, an estimated 127,763 new cancer cases occur annually in Nigeria. However, the National Health Insurance Scheme (NHIS) provides negligible coverage for oncological treatment. This forces patients into financially toxic out-of-pocket expenditure. The financial toxicity of cancer treatment has emerged both as a critical patient safety and equity concerns globally, yet empirical evidence from Nigerian tertiary health institutions remains sparse.
Objective: This study evaluates financial toxicity by estimating direct medical and non-medical costs, identifying patient coping strategies and determining socio-demographic and clinical determinants of economic burden among patients receiving chemotherapy and/or radiotherapy at the National Hospital Abuja.
Methods: A descriptive cross-sectional survey was conducted with 94 cancer patients using a structured, self-administered questionnaire. The data obtained were analyzed using descriptive statistics and presented in frequency tables and bar charts.
Results: It is found that direct medical costs constituted 84% of total treatment expenditure, with a mean out-of-pocket cost of ₦550,000 ($367.90) per patient, and no meaningful insurance mitigation. The dominant coping strategies reported by patients were depleting personal savings (90.4%), borrowing from family (84.0%), and accessing formal loans (76.6%), while socioeconomic status and absence of insurance were found to be the primary determinants of financial burden, high cost of imported drugs and equipment was perceived as the single largest structural cost driver (35.1%).
Conclusion: Financial toxicity is pervasive and structurally driven in Nigeria. Urgent reform of the NHIS to include comprehensive oncology coverage, establishment of government-funded cancer assistance programmes and integration of financial navigation into nursing care pathways are critically needed to achieve equitable cancer care access.
Downloads
References
Becker, G. S., & Schultz, T. W. (1964). Human capital: A theoretical and empirical analysis, with special reference to education. Columbia University Press.
Berman, P., Ahuja, R., & Bhandari, L. (2020). The impoverishing effect of healthcare payments in India: New methodology and findings. Economic & Political Weekly, 45(16), 65–71.
Bona, L. G., Geleta, D., Dulla, D., Deribe, B., Ayalew, M., & Ababi, G. (2021). Economic burden of cancer on cancer patients treated at Hawassa University Comprehensive Specialized Hospital. Cancer Control, 28, 1–8. https://doi.org/10.1177/10732748211038494
De-Moor, J. S., Williams, C. P., & Blinder, V. S. (2022). Cancer-related care costs and employment disruption: Recommendations to reduce patient economic burden as part of cancer care delivery. Journal of the National Cancer Institute Monographs, 2022(59), 79–84. https://doi.org/10.1093/jncimonographs/lgac011
Doherty, M., Gardner, D., & Finik, J. (2021). The financial coping strategies of US cancer patients and survivors. Supportive Care in Cancer, 29(10), 5753–5763. https://doi.org/10.1007/s00520-021-06134-0
Drummond, M. F., Sculpher, M. J., Torrance, G. W., & O'Brien, B. J. (2015). Methods for the economic evaluation of health care programmes (4th ed.). Oxford University Press.
Gakunga, R., Korir, A., & Bouttell, J. (2025). Evaluating the impact of the National Health Insurance Fund oncology benefits package and a healthcare workers' strike on time to cancer treatment initiation in Nairobi County, Kenya: An interrupted time series analysis. PLoS ONE, 20(5), e0324593. https://doi.org/10.1371/journal.pone.0324593
Gilligan, A. M., Alberts, D. S., Roe, D. J., & Skrepnek, G. H. (2018). Death or debt? National estimates of financial toxicity in persons with newly diagnosed cancer. American Journal of Medicine, 131(10), 1178–1199. https://doi.org/10.1016/j.amjmed.2018.05.020
International Atomic Energy Agency. (2021). Radiotherapy infrastructure and access in Africa: Technical report. IAEA. https://www.iaea.org/publications
Jabbari, A., Hadian, M., Mazaheri, E., & Jelodar, Z. K. (2023). The economic cost of cancer treatment in Iran. Journal of Education and Health Promotion, 12(32), 1–6. https://doi.org/10.4103/jehp.jehp_1070_22
Jalali, F. S., Seif, M., Jafari, A., Zangouri, V., Kerhayarz, K., & Ravangard, R. (2023). Factors affecting the economic burden of breast cancer in Southern Iran. BMC Cancer, 23, 1332. https://doi.org/10.1186/s12885-023-11416-x
Kim, J., Park, H., Lee, S., & Choi, Y. (2025). Assessing the economic impact of cancer care: A study on out-of-pocket expenditures and utilisation in South Korea. Cancer Medicine, 14(3), e70593. https://doi.org/10.1002/cam4.70593
Lentz, R., Benson III, A. B., & Kircher, S. (2019). Financial toxicity in oncology: A practical review and guidelines for patient financial counseling. American Society of Clinical Oncology Educational Book, 39, 55–64. https://doi.org/10.1200/EDBK_100058
Mariotto, A. B., Enewold, L., Zhao, J., Zeruto, C. A., & Yabroff, K. R. (2020). Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiology, Biomarkers & Prevention, 29(7), 1304–1312. https://doi.org/10.1158/1055-9965.EPI-19-1534
Maurya, P. K., Murali, S., Jayaseelan, V., Thulasingam, M., & Pandjatcharam, J. (2021). Economic burden of cancer treatment in a region in South India: A cross-sectional analytical study. Asian Pacific Journal of Cancer Prevention, 22(12), 3755–3762. https://doi.org/10.31557/APJCP.2021.22.12.3755
Mustapha, M. I., Ali-Gombe, M., Abdullahi, A., Adenipekun, A., & Campbell, O. B. (2020). Financial burden of cancer on patients treated at a tertiary health facility in South West Nigeria. Journal of the West African College of Surgeons, 10(4), 23–29.
Nigeria Global Cancer Observatory. (2022). Statistics at a glance: Nigeria. International Agency for Research on Cancer. https://gco.iarc.fr
Onoka, C. A., Onwujekwe, O. E., Uzochukwu, B. S., & Ezumah, N. N. (2019). Promoting universal coverage: Can social health insurance work in Nigeria? Health Policy and Planning, 28(1), 1–11. https://doi.org/10.1093/heapol/czs006
Organisation for Economic Co-operation and Development. (2024). Tackling the impact of cancer on health, the economy and society. OECD Health Policy Studies. OECD Publishing. https://doi.org/10.1787/85e7c3ba-en
Project Pink Blue. (2024). Nigeria cancer statistics report 2024. Project Pink Blue.
Rice, D. P. (1967). Estimating the cost of illness. American Journal of Public Health, 57(3), 424–440. https://doi.org/10.2105/AJPH.57.3.424
Siegel, R. L., Miller, K. D., & Jemal, A. (2020). Cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(1), 1–15. https://doi.org/10.3322/caac.21590
Teli, B. D., Behzadifar, M., Beiranvand, M., Rezapour, A., & Taheri Mirghaed, M. (2025). The economic burden of breast cancer in western Iran: A cross-sectional cost-of-illness study. Journal of Health, Population and Nutrition, 44(16), 1–11. https://doi.org/10.1186/s41043-025-00718-8
World Bank. (2023). Out-of-pocket expenditure (% of current health expenditure): Nigeria. World Development Indicators. https://data.worldbank.org
World Health Organization. (2022). Global cancer burden growing, amidst mounting need for services. WHO Press.
Yabroff, K. R., Lund, J., Kepka, D., & Mariotto, A. (2021). Annual report to the nation on the status of cancer, Part 2: Patient economic burden associated with cancer care. Journal of the National Cancer Institute, 113(12), 1670–1682. https://doi.org/10.1093/jnci/djab192
Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., Zhong, X., & Abernethy, A. P. (2025). Financial toxicity of cancer treatment: A multinational study. Journal of Clinical Oncology, 33(14), 1647–1654. https://doi.org/10.1200/JCO.2014.59.10
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Anthony Idoko Onoja, Khadijat Bolanle Abubakar, Christiana O. Abah, Mary Ene Adaje, Sola J. Abubakar (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
