Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa

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dc.contributor.advisorCunnama, Lucy
dc.contributor.advisorOkova, Denis
dc.contributor.authorGokool, Kairav
dc.date.accessioned2026-06-22T10:49:12Z
dc.date.available2026-06-22T10:49:12Z
dc.date.issued2026
dc.date.updated2026-06-22T10:42:00Z
dc.description.abstractBackground: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, limited research exists on the financial and socio-economic impacts of CRC and CRC-related stoma care in LMIC contexts. This exploratory study investigated the extent of catastrophic health expenditure (CHE) among CRC patients with stomas and the financial coping strategies they employ. Methods: A cross-sectional observational study was conducted at Groote Schuur Hospital in Cape Town, South Africa, from October to November 2024. A questionnaire was administered to 21 patients with CRC and stomas to gather data on demographics, direct and indirect costs, and coping mechanisms. Statistical analysis included descriptive statistics, computing CHE and penalised logistic regression models to identify determinants of CHE. Cost-coping strategies were also examined. Results: Transportation costs accounted for the largest share of OOP expenditure (48.9%) and followed by medicines (27.8%). CHE, defined as annual OOP costs exceeding 10% of household expenditure, affected 38% of participants, with a disproportionate burden on poorer households and patients with late-stage CRC. Among the poorest households, 60% experienced CHE compared with 50% of poor households, similarly 50% of stage 3 and 33.33% of stage 4 CRC households reported CHE. Financial coping strategies were reported by 81% of households, most commonly reducing household expenditures (47.7%) and taking on additional work (19%). A notable proportion (19%) reported employing no coping mechanisms. Conclusion: This study highlights the significant financial burden faced by CRC patients with stomas. To mitigate this burden, policymakers should prioritize expanding financial protection measures, such as subsidies for essential medications and transport assistance programs. Integrating CRC care into existing universal health coverage (UHC) frameworks can also enhance affordability and accessibility. Adopting early screening initiatives may also play a crucial role in alleviating late-stage disease burdens and the accompanying likelihood of financial catastrophe.
dc.identifier.apacitationGokool, K. (2026). <i>Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa</i>. (). University of Cape Town ,Faculty of Health Sciences ,Unknown. Retrieved from http://hdl.handle.net/11427/43345en_ZA
dc.identifier.chicagocitationGokool, Kairav. <i>"Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa."</i> ., University of Cape Town ,Faculty of Health Sciences ,Unknown, 2026. http://hdl.handle.net/11427/43345en_ZA
dc.identifier.citationGokool, K. 2026. Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa. . University of Cape Town ,Faculty of Health Sciences ,Unknown. http://hdl.handle.net/11427/43345en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Gokool, Kairav AB - Background: Colorectal cancer (CRC) is the second leading cause of cancer mortality globally, with an increasing burden in low- and middle-income countries (LMICs) like South Africa. CRC, often accompanied by stoma formation, imposes significant out-of-pocket (OOP) expenses for patients. However, limited research exists on the financial and socio-economic impacts of CRC and CRC-related stoma care in LMIC contexts. This exploratory study investigated the extent of catastrophic health expenditure (CHE) among CRC patients with stomas and the financial coping strategies they employ. Methods: A cross-sectional observational study was conducted at Groote Schuur Hospital in Cape Town, South Africa, from October to November 2024. A questionnaire was administered to 21 patients with CRC and stomas to gather data on demographics, direct and indirect costs, and coping mechanisms. Statistical analysis included descriptive statistics, computing CHE and penalised logistic regression models to identify determinants of CHE. Cost-coping strategies were also examined. Results: Transportation costs accounted for the largest share of OOP expenditure (48.9%) and followed by medicines (27.8%). CHE, defined as annual OOP costs exceeding 10% of household expenditure, affected 38% of participants, with a disproportionate burden on poorer households and patients with late-stage CRC. Among the poorest households, 60% experienced CHE compared with 50% of poor households, similarly 50% of stage 3 and 33.33% of stage 4 CRC households reported CHE. Financial coping strategies were reported by 81% of households, most commonly reducing household expenditures (47.7%) and taking on additional work (19%). A notable proportion (19%) reported employing no coping mechanisms. Conclusion: This study highlights the significant financial burden faced by CRC patients with stomas. To mitigate this burden, policymakers should prioritize expanding financial protection measures, such as subsidies for essential medications and transport assistance programs. Integrating CRC care into existing universal health coverage (UHC) frameworks can also enhance affordability and accessibility. Adopting early screening initiatives may also play a crucial role in alleviating late-stage disease burdens and the accompanying likelihood of financial catastrophe. DA - 2026 DB - OpenUCT DP - University of Cape Town KW - Colorectal cancer KW - CRC KW - Catastrophic Health Expenditure KW - CHE KW - South Africa KW - Stoma KW - Household costs KW - Financial protection LK - https://open.uct.ac.za PB - University of Cape Town PY - 2026 T1 - Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa TI - Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa UR - http://hdl.handle.net/11427/43345 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/43345
dc.identifier.vancouvercitationGokool K. Catastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa. []. University of Cape Town ,Faculty of Health Sciences ,Unknown, 2026 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/43345en_ZA
dc.language.isoen
dc.language.rfc3066eng
dc.publisher.departmentUnknown
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectColorectal cancer
dc.subjectCRC
dc.subjectCatastrophic Health Expenditure
dc.subjectCHE
dc.subjectSouth Africa
dc.subjectStoma
dc.subjectHousehold costs
dc.subjectFinancial protection
dc.titleCatastrophic health expenditure and financial coping strategies among patients with colorectal cancer (crc) and stomas: a cross-sectional study at Groote Schuur Hospital, Western Cape, South Africa
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPH
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