{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:11:08Z","timestamp":1790705468225,"version":"4.1.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T00:00:00Z","timestamp":1706227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The financial toxicity of cancer causes higher morbidity and mortality. As the financial burden due to head and neck cancer (HNC) in European healthcare systems with legally established compulsory health insurance is still poorly understood, we set up an investigation to assess the financial impact of HNC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between August 2022 and March 2023, HNC consecutive patients (<jats:italic>n<\/jats:italic> = 209) attending the cancer aftercare program of a university hospital in an outpatient setting were surveyed utilizing self-administered questionnaires about their socioeconomic situation, income loss, and out-of-pocket payments (OOPPs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The majority of HNC patients (<jats:italic>n<\/jats:italic> = 119, 59.5%) reported significant financial burden as a consequence of OOPP (<jats:italic>n<\/jats:italic> = 100, 50.0%) and\/or income loss (<jats:italic>n<\/jats:italic> = 51, 25.5%). HNC patients reporting financial burden due to OOPP had on average 1,716 \u20ac per year costs related to their disease, whereas patients reporting an income loss had a mean monthly income loss of 620.53 \u20ac. Advanced UICC (7th edition, 2017) stage, T3 or T4 category, and larynx\/hypopharynx cancer are significant predictors of financial burden.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>HNC survivors suffer from significant financial burden after HNC treatment, even in Germany with a healthcare system with statutory health insurance. The findings from this study offer valuable insights for healthcare professionals and policymakers, helping them acknowledge the economic impact of HNC.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2024.1329242","type":"journal-article","created":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T08:29:08Z","timestamp":1706257748000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Cancer-associated financial burden in German head and neck cancer patients"],"prefix":"10.3389","volume":"14","author":[{"given":"Jonas","family":"Rast","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veit","family":"Zebralla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Dietz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Wichmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Wiegand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1001\/jamaoncol.2014.161","article-title":"Disparities by race, age, and sex in the improvement of survival for major cancers: Results from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program in United States, 1990 to 2010","volume":"1","author":"Zeng","year":"2015","journal-title":"JAMA Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/1475-9276-13-3","article-title":"Inequalities in out-of-pocket payments for health care services among elderly Germans \u2013 results of a population-based cross-sectional study","volume":"13","author":"Bock","year":"2014","journal-title":"Int J Equity Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/OP.21.00683","article-title":"Financial hardship in patients with head and neck cancer","volume":"18","author":"Mott","year":"2022","journal-title":"JCO Oncol Pract"},{"key":"B4","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/jso.25374","article-title":"Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies","volume":"120","author":"Lentz","year":"2019","journal-title":"J Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2922-3","article-title":"The financial hazard of personalized medicine and supportive care","volume":"23","author":"Carrera","year":"2015","journal-title":"Support Care Cancer"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21443","article-title":"The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment: A Primer on Financial Toxicity","volume":"68","author":"Carrera","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-3019-8","article-title":"Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study","volume":"24","author":"Baili","year":"2016","journal-title":"Support Care Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdw540","article-title":"Cancer-related financial toxicity: beyond the realm of drug pricing and out-of-pocket costs","volume":"27","author":"Huntington","year":"2016","journal-title":"Ann Oncol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.3982","article-title":"Comparison of the financial burden of survivors of head and neck cancer with other cancer survivors","volume":"145","author":"Massa","year":"2019","journal-title":"JAMA Otolaryngol\u2013 Head Neck Surg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1055\/a-0731-0344","article-title":"R\u00fcckkehr in das Erwerbsleben nach kurativer Therapie von Kopf-Hals-Karzinomen","volume":"97","author":"Zebralla","year":"2018","journal-title":"Laryngo-Rhino-Otol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-021-07222-5","article-title":"Nutritional status at diagnosis is prognostic for pharyngeal cancer patients: a retrospective study","volume":"279","author":"Wu","year":"2022","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/hed.10174","article-title":"Psychosocial adjustment in head and neck cancer: The impact of disfigurement, gender and social support","volume":"25","author":"Katz","year":"2003","journal-title":"Head Neck"},{"key":"B13","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1186\/s12885-020-07773-6","article-title":"Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population","volume":"21","author":"Hammerm\u00fcller","year":"2021","journal-title":"BMC Cancer"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3109\/10826084.2015.1122065","article-title":"Factors associated with concurrent tobacco smoking and heavy alcohol consumption within a socioeconomically disadvantaged Australian sample","volume":"51","author":"Twyman","year":"2016","journal-title":"Subst Use Misuse"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1465-3362.2012.00432.x","article-title":"Tobacco expenditure, smoking-induced deprivation, and financial stress: Results from the International Tobacco Control (ITC) four country survey","volume":"31","author":"Siahpush","year":"2012","journal-title":"Drug Alcohol Rev"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-07209-2","article-title":"Integrating financial coaching and referrals into a smoking cessation program for low-income smokers: a randomized waitlist control trial","volume":"37","author":"Rogers","year":"2022","journal-title":"J Gen Intern Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-022-01319-4","article-title":"Association of financial worry with substance use, mental health, and quality of life in cancer patients","volume":"17","author":"Jones","year":"2023","journal-title":"J Cancer Surviv"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104521","article-title":"Patient-reported financial toxicity and adverse medical consequences in head and neck cancer","volume":"101","author":"Beeler","year":"2020","journal-title":"Oral Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2013-0374","article-title":"Self-reported financial burden and satisfaction with care among patients with cancer","volume":"19","author":"Chino","year":"2014","journal-title":"Oncologist"},{"key":"B20","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1186\/s12885-020-07028-4","article-title":"The patient-level effect of the cost of Cancer care \u2013 financial burden in German Cancer patients","volume":"20","author":"Mehlis","year":"2020","journal-title":"BMC Cancer"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw205","article-title":"Financial hardships experienced by cancer survivors: A systematic review","volume":"109","author":"Altice","year":"2016","journal-title":"JNCI J Natl Cancer Inst"},{"key":"B22","unstructured":"Stat BundesamtGesundheitsausgaben im Jahr 2019 auf \u00fcber 400 Milliarden Euro gestiegen"},{"key":"B23","unstructured":"Statistisches BundesamtGesundheitsausgaben im EU-Vergleich 2020"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-04915-w","article-title":"Coping mechanisms for financial toxicity: a qualitative study of cancer patients\u2019 experiences in Germany","volume":"28","author":"Schr\u00f6der","year":"2020","journal-title":"Support Care Cancer"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1024","DOI":"10.1001\/jama.2018.1150","article-title":"Health care spending in the United States and other high-income countries","volume":"319","author":"Papanicolas","year":"2018","journal-title":"JAMA"},{"key":"B26","unstructured":"Bundesregier Inf StartseiteSozialversicherung: Neue Beitragsbemessungsgrenzen 2023 | Bundesregierung2023"},{"key":"B27","volume-title":"Health at a Glance: Europe 2020: State of Health in the EU Cycle","year":"2020"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-018-4498-1","article-title":"Out-of-pocket-payments and the financial burden of 502 cancer patients of working age in Germany: results from a longitudinal study","volume":"27","author":"B\u00fcttner","year":"2019","journal-title":"Support Care Cancer"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-022-01293-x","article-title":"Out-of-pocket payments and loss of income among long-term breast cancer survivors in Germany: a multi-regional population-based study","volume":"17","author":"Schneider","year":"2023","journal-title":"J Cancer Surviv"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz140","article-title":"Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications","volume":"30","author":"Witte","year":"2019","journal-title":"Ann Oncol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.06.023","article-title":"Understanding financial toxicity in head and neck cancer survivors","volume":"95","author":"Mady","year":"2019","journal-title":"Oral Oncol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.132.1.32","article-title":"Socioeconomic effects of and risk factors for disability in long-term survivors of head and neck cancer","volume":"132","author":"Vartanian","year":"2006","journal-title":"Arch Otolaryngol Neck Surg"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.133.5.464","article-title":"Patient-reported factors associated with discontinuing employment following head and neck cancer treatment","volume":"133","author":"Buckwalter","year":"2007","journal-title":"Arch Otolaryngol Neck Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.oraloncology.2009.11.001","article-title":"Employment and return to work in head and neck cancer survivors","volume":"46","author":"Verdonck-de Leeuw","year":"2010","journal-title":"Oral Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2769-7","article-title":"Meaning of work and the process of returning after head and neck cancer","volume":"24","author":"Isaksson","year":"2016","journal-title":"Support Care Cancer"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.4115","article-title":"Survivorship and quality of life in head and neck cancer","volume":"33","author":"Ringash","year":"2015","journal-title":"J Clin Oncol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25609","article-title":"International validation of the revised European Organisation for Research and Treatment of Cancer Head and Neck Cancer Module, the EORTC QLQ-HN43: Phase IV","volume":"41","author":"Singer","year":"2019","journal-title":"Head Neck"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000260591.82762.b5","article-title":"Postoperative medical complications???-not microsurgical complications???-negatively influence the morbidity, mortality, and true costs after microsurgical reconstruction for head and neck cancer","volume":"119","author":"Jones","year":"2007","journal-title":"Plast Reconstr Surg"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.18.00665","article-title":"Clinical factors associated with cost in head and neck cancer: implications for a bundled payment model","volume":"15","author":"Tom","year":"2019","journal-title":"J Oncol Pract"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1002\/lary.23459","article-title":"The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery","volume":"122","author":"Hennessey","year":"2012","journal-title":"Laryngoscope"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1097\/COC.0000000000000487","article-title":"Factors associated with head and neck cancer hospitalization cost and length of stay\u2014A national study","volume":"42","author":"Adjei Boakye","year":"2019","journal-title":"Am J Clin Oncol"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1186\/1758-3284-4-15","article-title":"The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid","volume":"4","author":"Jacobson","year":"2012","journal-title":"Head Neck Oncol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2009.46","article-title":"Incidence and costs of treatment-related complications among patients with advanced squamous cell carcinoma of the head and neck","volume":"135","author":"Lang","year":"2009","journal-title":"Arch Otolaryngol - Head Neck Surg"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1177\/0194599812437534","article-title":"Cost considerations in the treatment of Oropharyngeal squamous cell carcinoma","volume":"146","author":"Moore","year":"2012","journal-title":"Otolaryngol Neck Surg"},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.14694\/EdBook_AM.2013.33.e230","article-title":"Assessing and Improving Quality of Life in Patients with Head and Neck Cancer","volume-title":"Am Soc Clin Oncol Educ Book","author":"Singer","year":"2013"},{"key":"B46","doi-asserted-by":"publisher","first-page":"26686","DOI":"10.3402\/ijch.v74.26686","article-title":"Undesirable financial effects of head and neck cancer radiotherapy during the initial treatment period","volume":"74","author":"Egestad","year":"2015","journal-title":"Int J Circumpolar Health"},{"key":"B47","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1186\/s12885-021-08236-2","article-title":"Screening for distress, related problems and perceived need for psycho-oncological support in head and neck squamous cell carcinoma (HNSCC) patients: a retrospective cohort study","volume":"21","author":"Kunz","year":"2021","journal-title":"BMC Cancer"},{"key":"B48","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1001\/jamaoto.2013.4072","article-title":"Depression among long-term survivors of head and neck cancer treated with radiation therapy","volume":"139","author":"Chen","year":"2013","journal-title":"JAMA Otolaryngol Neck Surg"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1177\/11795549221147730","article-title":"Understanding financial toxicity in patients with head and neck cancer: A systematic review","volume":"17","author":"Rosi-Schumacher","year":"2023","journal-title":"Clin Med Insights Oncol"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3390\/biology10020144","article-title":"Course of self-reported dysphagia, voice impairment and pain in head and neck cancer survivors","volume":"10","author":"Zebralla","year":"2021","journal-title":"Biology"},{"key":"B51","article-title":"Eckpunktepapier Krankenhausreform [Term sheet hospital reform]","year":""},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2013-0343","article-title":"Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia","volume":"19","author":"Lee","year":"2014","journal-title":"Oncologist"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31643","article-title":"Costs of cancer along the care continuum: What we can expect based on recent literature","volume":"124","author":"Pisu","year":"2018","journal-title":"Cancer"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1177\/0361198121991497","article-title":"Investigating the role of transportation barriers in cancer patients\u2019 Decision making regarding the treatment process","volume":"2675","author":"Etminani-Ghasrodashti","year":"2021","journal-title":"Transp Res Rec J Transp Res Board"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2012-0279","article-title":"The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient\u2019s experience","volume":"18","author":"Zafar","year":"2013","journal-title":"Oncologist"},{"key":"B56","volume-title":"2018-NCOS-Results.pdf","year":""},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.28814","article-title":"The development of a financial toxicity patient-reported outcome in cancer: The COST measure: Financial PRO Measure in Cancer","volume":"120","author":"De Souza","year":"2014","journal-title":"Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1329242\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T08:29:11Z","timestamp":1706257751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1329242\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,26]]},"references-count":57,"alternative-id":["10.3389\/fonc.2024.1329242"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1329242","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,26]]},"article-number":"1329242"}}