A 38-year-old businessman, operating near Tan Binh market in TP HCM, once felt confident about his financial standing with a monthly income of 50-70 million VND. However, after a year of expensive cancer treatments, his entire savings are nearly depleted.

In 2023, he was diagnosed with a ureteral tumor, undergoing surgery to remove a kidney, ureter, and part of his bladder. More than a year later, he experienced coughing up blood and discovered the cancer had recurred, metastasizing to his lungs and bones. He traveled to Singapore, hoping for better treatment. There, he underwent immunotherapy, targeted therapy combined with chemotherapy, and PET/CT scans after every three cycles. Despite these efforts, the disease continued to progress. After spending approximately 4 billion VND, he could no longer afford treatment in Singapore and returned to a hospital in Vietnam.

According to doctor Lam Trung Hieu, Head of the Palliative Care Department at the Cancer and Nuclear Medicine Institute, Military Hospital 175, many families facing cancer often choose the most expensive treatment methods, hoping for the best possible outcomes. However, cancer treatment typically extends over a long period, and not everyone can sustain costly methods until the end.

A 45-year-old female patient, who owns a small manufacturing workshop, found herself in a similar predicament. Diagnosed with kidney cancer, she was prescribed a regimen of immunotherapy combined with targeted therapy, projected to last 35 cycles, with each cycle costing around 100 million VND.

The treatment regimen helped the patient recover from severe debilitation, enabling her to walk robustly again. Yet, to maintain treatment, her family had to borrow from the bank and sell a piece of land, which still proved insufficient. Most recently, they arrived at the hospital 10 days late because they had not yet secured enough money to purchase medication.

"The pressure caused the husband, who was normally calm, to become increasingly irritable with medical staff, carrying a tense mindset every time he brought his wife through the patient reception gate," doctor Hieu recounted.

Choosing a sustainable treatment path

Doctor Hieu recalled meeting a patient who underwent 8 cycles of immunotherapy before having to stop midway due to running out of funds. Therefore, when developing a treatment plan, doctors need to consider not only the disease stage, tumor characteristics, and responsiveness but also the family's financial capability. This allows them to advise on options that are affordable and sustainable in the long term.

"We should not lay out a 'buffet' of all possible methods and let patients choose for themselves. If a family can only afford a certain amount, doctors need to advise within that limit, rather than letting them strive for the most expensive option only to run out of money halfway through," he stated.

This approach also helps families reduce feelings of regret when they cannot afford the most expensive method. Patients and their relatives need to be honest about their financial capacity so that doctors can collaboratively plan a suitable treatment course.

Cases of having to borrow money or change treatment due to financial constraints are not isolated incidents. A study published in 2024, involving 634 patients at two oncology hospitals in Vietnam, reported that 91,8% experienced financial burden due to cancer, with 51,7% suffering severely. Nearly half had to borrow money from relatives and friends, and 34,1% had to withdraw their savings.

Another study of 309 breast cancer patients at two central hospitals recorded that 41% faced financial burden. The average amount exceeding their ability to pay was approximately 153 million VND, with some cases reaching up to 1,36 billion VND.

Cancer patients receive treatment at Ho Chi Minh City Oncology Hospital. Photo: Quynh Tran

The burden beyond hospital fees

Doctor Diep Bao Tuan, Director of Ho Chi Minh City Oncology Hospital, explained that treatment costs depend on the type of cancer, its stage, the tumor's biological characteristics, and the treatment method and duration. Recurrence, metastasis, multiple lines of treatment, or a combination of methods often lead to significantly higher costs.

Targeted therapy, immunotherapy, and molecular biology tests enable personalized treatment, but often require long-term use. Some treatment regimens involve medication costs of hundreds of millions of VND annually, or even over a billion VND. For example, a one-year course of trastuzumab can cost approximately 800-900 million VND; pembrolizumab costs over 60 million VND per vial, and depending on the regimen, multiple vials may be needed per cycle.

Beyond hospital fees, patients also incur costs for travel, accommodation, caregivers, lost workdays, and reduced income. According to doctor Tuan, health insurance (BHYT) is an important pillar that helps reduce direct costs, but patients need clear advice on their benefits and out-of-pocket expenses before starting treatment. When professionally appropriate, doctors can consider generic drugs or biosimilars instead of original brand-name drugs. Some medications also have patient support programs that help reduce treatment costs.

Doctors advise patients not to arbitrarily reduce dosages, extend treatment intervals, or stop medication. When facing difficulties, it is crucial to discuss them with a doctor to find suitable options, preventing the need to stop treatment midway due to an inability to pay.

Le Phuong