Nearly half of Singaporeans feel they are not financially prepared to handle a cancer diagnosis: Study
A woman receiving radiation therapy treatment for cancer.
SINGAPORE — Nearly half of Singaporeans (43 per cent) who have never had cancer believed that they are not financially well-prepared to manage the disease if they are diagnosed with it, a study here has found.
Almost one in three (32 per cent) also expressed concerns over the cost of cancer care, which may significantly affect their decisions about whether to delay or receive treatment, the study’s researchers said.
Such concerns are not limited to those in lower-income groups but also extend to middle-income respondents, they said in a press release on Monday (Jan 15).
These results were part of a "perception survey" done during the initial phase of an ongoing three-part study sponsored by DBS bank and designed by the National University Cancer Institute, Singapore (NCIS) and the Research For Impact, a local think tank.
Around 1,200 respondents were surveyed online by Blackbox Research from August to September last year, which the researchers said was representative of Singapore's population.
The study aimed to assess how aware people were of potential costs associated with a cancer diagnosis. Its researchers sought to shed light on how financial knowledge can influence one’s ability to cope with the challenges posed by cancer treatment and care, they said.
Early survey data suggested that a significant share of Singapore resident households may feel under-prepared financially to cope with shocks such as cancer, and more specifically, are unclear of what cancer entails — from disease incidence to treatment costs and healthcare financing.
WHY IT MATTERS
Cancer was the leading cause of death in Singapore in 2022, making up 23.9 per cent of all 26,891 recorded deaths that year.
Researchers from the study stated that the financial impact of cancer diagnosis can be significant, given the expenses in medical care settings on medications and procedures such as chemotherapy.
Indirect costs also contribute to "financial toxicity", they said.
Such "toxicity" includes income loss experienced by the patient from cancer-related disabilities and by family members providing care.
In oncology practice, financial toxicity is used to describe the detrimental effects of the excess financial strain caused by the diagnosis of cancer on the well-being of patients, their families and society — and it is increasingly recognised to adversely affect a person's quality of life.
Dr Jen Wei Ying, the clinical lead of the study and a consultant at NCIS’ department of haematology-oncology, said that the financial impact of cancer is “a real but poorly understood and infrequently acknowledged concern” in cancer care and survivorship.
“The data presented here show that cost concerns are prevalent, even in respondents who do not have a cancer diagnosis,” she said, adding that such concerns may significantly affect their decisions about whether to delay or receive treatment.
WHAT THE STUDY FOUND
- Around half (47 per cent) of the respondents with no history of cancer felt financially prepared for a cancer diagnosis, with many (30 per cent) saying that they were "moderately" well-prepared for the disease
- Conversely, around 42 per cent of the respondents believed that they would be ill-prepared, with 14 per cent of respondents perceiving that they are "not well at all" financially prepared for such a diagnosis
- When asked how confident they were that their existing health or critical illness insurance policies, or both, would fully cover the cost of cancer treatment in the future, 43 per cent of the respondents said that they were slightly confident, while 29 per cent said that they had no confidence their insurance would be able to cover the full cost of treatment
- Only 33 per cent of the 1,200 respondents were aware of the recent changes to the financing of outpatient cancer treatment based on the Ministry of Health's Cancer Drug List, which had been announced before the survey
In addition, the study's researchers also made the following preliminary observations, although they did not provide specific numbers:
- Respondents without critical illness insurance coverage said that unaffordable premiums was a key reason for not buying insurance policies
- Respondents with insurance coverage may not be knowledgeable about their own insurance plans, specifically policy benefits, exclusions, co-payments and claim amounts
- Respondents who perceived themselves as "highly financial literate" were less likely to anticipate delaying or foregoing cancer treatment due to cost concerns
A CANCER PATIENT'S EXPERIENCE WITH MEDICAL COSTS
When he was first diagnosed with acute myeloid leukaemia last year, Mr Abdul Rashid did not know if could afford his cancer treatment, so he initially considered not undergoing any treatment and letting fate decide.
It was only after the National University Cancer Institute, Singapore stepped in to help him secure financial assistance that he was able to afford the treatment.
Mr Abdul Rashid, a 31-year-old firefighter with the Singapore Civil Defence Force, told TODAY that his estimated medical bills at the time reached S$150,000, were it not for the financial aid from the Government as well as charity organisations such as the Leukemia Lymphoma Foundation and the Bone Marrow Donor Programme.
After going through chemotherapy and a stem cell transplant in July last year, he paid around S$5,000 out-of-pocket, with the rest of the treatment costs covered by MediSave and MediShield Life from his Central Provident Fund account.
Despite this, he is still anxious about his financial situation and he does not know if he can afford further treatment if he suffers from a relapse.
“If I have a relapse, the cost of treatments would be much more expensive than what I’m facing right now. So I’m a bit scared of that, and I’m still unaware of what costs I will face if, touch wood, that happens.”
WHAT'S NEXT
Dr Joanne Yoong said that financial literacy can have wider impacts for long-term health and welfare.
She is the chief executive officer, principal economist and a behavioural scientist at Research For Impact and an adjunct professor at the Centre for Behavioural and Implementation Science Interventions with the Yong Loo Lin School of Medicine, National University of Singapore.
That is why she said that it is important to empower consumers to develop their own financial capability and understanding of the policy and insurance environment, especially since Singapore’s complex healthcare financing schemes may hamper financial decision-making on cancer treatment.
To this, Dr Jen of NCIS said that there should be a holistic, total approach to preventative health and well-being to address the challenge of financial preparedness for critical illnesses.
“Policymakers, financial institutions, the healthcare industry and, critically, all Singapore residents, must share responsibility in mitigating the financial burdens of critical illness."
She added that this can be accomplished through education and outreach, ensuring that insurance coverage is accessible, and by making the wordings in insurance policies more comprehensible.
In the next phase of the study, researchers will use qualitative research methods such as in-depth interviews to gather comprehensive insights into the experiences and challenges faced by different stakeholders.
These will include oncologists, medical social workers, financial counselling teams, cancer patients and their caregivers.
The final results of the three-part study are expected to be published by mid-2025.
