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Proton therapy (PT) is delivered for certain types of cancer where conventional photon radiotherapy is challenging to apply. In Switzerland, a fixed list of indications has been defined by the Federal Office of Public Health, and compulsory health insurance covers the costs of PT for these indications. However, patients still have additional out-of-pocket expenses, such as travel to the proton center or accommodation during PT. This study investigates the financial toxicity of patients undergoing PT in a high-income country.

Between September 2019 and November 2021, 146 cancer patients living in Switzerland participated in the study, of which 90 (62%) were adult patients and 56 (38%) were caregivers of child cancer patients. For all patients, the costs of proton therapy were fully covered by health insurance. Financial toxicity was assessed using the FACIT Comprehensive Score for Financial Toxicity (COST). The score ranges from 0 to 44, with a lower score indicating low financial well-being. Financial coping strategies were explored using polar questions (yes-no questions). Out-of-pocket costs during PT were recorded in a diary that patients completed weekly

The median COST Score was 29.85 (IQR, 21.00-36.00) for all patients, 30 (IQR 21.25, 37.85) for adult patients, and 28 (IQR, 20.50, 34.00) for children’s caregivers, respectively. On multivariable analysis of the adult/children cohort, older age (Estimate 0.08, 95% CI [0.01;0.15], p=0.022), higher income (Estimate 8.82, 95% CI [4.59;14.06], p=<0.001), and distance of < 100 km from home to the center (Estimate -3.76, 95% CI [-5.63;-1.9], p=<0.001) were significantly associated with higher COST Scores indicating better financial well-being. The analysis of the adult group alone revealed that single adult patients had significantly better COST scores than those in partnerships (Estimate: -9.16, 95% CI [-14.45;-3.87] p=<0.001). Patients with high COST scores used significantly fewer coping strategies such as, saving on leisure activities (Estimate -9.94, 95% CI [-12.07;-6.22], p=<0.001), spending savings (Estimate -4, 95% CI [-6.47; -1.53], p=0.002), borrowing money (Estimate -5.79, 95% CI [ -0.96;  -1.62], p=0.007), and increased workload (Estimate -5.28, 95% CI [-10.37; -0.21], p=0.041).

Although the costs of proton therapy are covered by mandatory health insurance in Switzerland, some cancer patients face financial burdens that can be significant. Younger age of patients, long travel distances to the PT center, and low income have a negative impact on financial well-being during cancer treatment with PT.