Cost Concerns of Patients With Cancer

Copyright © 2013 by American Society of Clinical Oncology

Cost Concerns of Patients With Cancer

1. Tammy K. Stump, MS,
2. Naa Eghan,
3. Brian L. Egleston, PhD,
4. Olivia Hamilton,
5. Melanie Pirollo, MS, RN,
6. J. Sanford Schwartz,
7. Katrina Armstrong,
8. J. Robert Beck, MD,
9. Neal J. Meropol, MD and
10. Yu-Ning Wong, MD, MSCE⇑

+ Author Affiliations

1. University of Utah, Salt Lake City, UT; Premier Research Group Limited; Fox Chase Cancer Center; University of Pennsylvania, Philadelphia, PA; South Jersey Healthcare, Vineland, NJ; and University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH

1. Corresponding author: Yu-Ning Wong, MD, MSCE, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111; e-mail: Yu-ning.wong@fccc.edu.

Abstract

Purpose: Health care providers are accustomed to identifying populations for whom cost-related concerns may be a significant barrier, such as the poor, but few empiric data have been collected to substantiate such assumptions, particularly among insured patients.

Methods: Patients with cancer from academic and community hospitals completed a questionnaire that included closed-ended items concerning demographic variables, optimism, numeracy, and concerns about present and future medical costs. In addition, they answered open-ended questions regarding cost concerns and medical expenses.

Results: Nearly all (99%) participants were insured. In response to the closed-ended questions, 30.3% of patients reported concern about paying for their cancer treatment, 22.3% reported that their family had made sacrifices to pay for their care, and 8.3% stated that their insurance adequately covered their current health care costs, and 17.3% reported concerns about coverage for their costs in the future. On open-ended questions, 35.3% reported additional expenses, and 47.5% reported concerns about health care costs. None of the assessed patient characteristics proved to be a robust predictor across all cost-related concerns. There was a strong association between the identification of concerns or expenses on the open-ended questions and concerns on closed-ended questions.

Conclusion: Cost concerns are common among patients with cancer who have health insurance. Health care providers may alleviate concerns by discussing cost-related concerns with all patients, not only those of lower socioeconomic status or those without insurance. A closed-ended screening question may help to initiate these conversations. This may identify potential resources, lower distress, and enable patients to make optimal treatment decisions.