Abstract
Cancer patients face substantial care-related out-of-pocket (oop) costs that may influence treatment decisions, attitudes, and use of drug- or appointment-related cost-saving strategies. We examined the relationship between oop costs and care-related responses by patients. We surveyed 170 prostate and 131 breast cancer patients presenting at clinics or support groups, or listed on the cancer registry in Newfoundland and Labrador. In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than $500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients. Few patients (8.8% prostate, 15.3% breast) ever adopted any drug- or appointment-related cost-saving strategy. Few patients (7.2% prostate, 9.6% breast) said oop costs influenced treatment decisions, told their physicians about their oop costs (27.0% prostate, 21.1% breast), or were aware of available financial assistance programs (27.3% prostate, 36.9% breast). Compared with patients having low or moderate oop costs (22.9% prostate, 16.7% breast, and 25.7% prostate, 58.3% breast respectively), a larger proportion of prostate (56.0%) and breast (58.3%) cancer patients with high oop costs said that those costs created stress. Among prostate cancer patients, a larger proportion of those having high oop costs (compared with low or moderate costs) used drug-related (22.2% vs. 3.3% and 9.6% respectively) and appointment-related (11.1% vs. 1.1% and 3.8% respectively) cost-saving strategies, said oop costs created an unusual amount of stress (48.0% vs. 18.4% and 10.4%), and had difficulty paying those costs (29.2% vs. 6.2% and 10.4%). For a small group of breast and prostate cancer patients, oop costs are high, but rarely lead to the use of care-related cost-saving strategies or influence care decisions.
Highlights
Several groups of researchers in Canada have examined the out-of-pocket costs associated with cancer care
In the 3-month period before the survey, 18.8% of prostate and 25.2% of breast cancer patients had oop costs greater than $500. Those oop costs consumed more than 7.5% of quarterly household income for 15.9% of prostate and 19.1% of breast cancer patients
Longo et al.[1] noted that, of cancer patients surveyed in Ontario, 20.4% reported that oop costs for cancer care created a significant or unmanageable financial burden
Summary
Several groups of researchers in Canada have examined the out-of-pocket (oop) costs associated with cancer care. Longo et al.[1] noted that, of cancer patients surveyed in Ontario, 20.4% reported that oop costs for cancer care created a significant or unmanageable financial burden Those authors examined costs related to travel, lodging, and meals (for the patient and companion); drugs and supplies (including prostheses and wigs); and lost wages, if applicable. Using qualitative interviews with cancer care providers, researchers in Newfoundland and Labrador (hereinafter Newfoundland) suggested that patients may adopt care-compromising strategies (such as skipping appointments or rationing drugs) and that providers may change treatments to ease the financial burden for patients[8] Despite such reports, we were unable to find Canadian studies that directly examined the association between oop costs and cost-related responses by patients
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