Nickel and dimed: Parking fees at NCI-designated cancer centers.

Abstract

2029 Background: Nonmedical costs from cancer treatment can be a significant out-of-pocket expense. As treatment may span over months, parking costs can become a significant burden on patients and caregivers. This cross-sectional study aims to report parking fees at National Cancer Institute (NCI)-designated cancer centers and to project parking costs for the treatment duration of certain cancers. Methods: Parking fees from NCI treatment centers were obtained via online search or phone call in Fall of 2019. City cost of living, median city household income, and discount availability were documented. Pearson correlation was used between parking costs and city variables. Parking costs were estimated for treatment of node positive breast cancer (12 daily rates plus 20 1-hr rates), definitive head and neck cancer (35 1-hr rates) and acute myeloid leukemia (AML) (42 daily rates). RStudio Version 1.2.5033 was used for analyses. Results: Parking costs were obtained for 100% of the 63 NCI centers included. Median city cost of living relative to New York City was 75.0 (out of 100); median city household income was $55,295 (range $28,974-$120,573). Twenty-five (40%) of NCI centers did not have detailed parking cost information online. Average parking costs were $3.55/hr (median $2, range 0-$15) and $7.79/day (median $5, range 0-$40). Twenty centers (32%) offered completely free parking for patients. Free parking was available at 43 (68%) centers for radiation appointments and 34 (54%) centers for chemotherapy appointments. Averaged estimated parking costs including discounts for a course of treatment for breast cancer was $122.03 (range 0-$800); head and neck cancer, $85.56 (range 0-$665); and AML hospitalization, $327.33 (range 0-$1470). City cost of living was positively correlated with daily parking costs (R = 0.7, p < 0.01) and negatively correlated with both free daily parking (R = -0.33, p = 0.02) and free parking during radiation (R = -0.34, p = 0.02) or chemotherapy (R = -0.37, p < 0.01). The median city household income was correlated with the daily parking costs (R = 0.30 p = 0.02) but not with free daily parking (R = -0.19, p = 0.16), free parking for patients on radiation (R = -0.23, p = 0.09) or on chemotherapy (R = -0.21, p = 0.14). Conclusions: Patients may face significant nonmedical costs through parking fees, even at centers that reflect the highest standard of care. There was high variability in costs with the potential for patients to pay hundreds of dollars in parking in order to receive their care. Efforts to minimize financial toxicity should focus on this potentially under-reported patient concern.