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Although awareness is growing that a cancer diagnosis may have an adverse financial impact on some patients, few studies have been carried out to date. Although costs are likely to be multi-dimensional, most studies have investigated single dimensions, such as employment or travel costs. We aimed to: (1) quantify the proportion of patients incurring cancer-related additional expenditure or financial difficulties; (2) identify patient sub-groups at greatest risk of cancer-related additional expenditure/financial difficulties; and (3) assess monetary and psychosocial consequences of cancer-related additional expenditure.
The study setting was Ireland, which has a mixed public-private healthcare system. A postal questionnaire was developed from literature review and qualitative interviews with hospital-based oncology social workers and cancer survivors. Questionnaire topics included: expenses incurred (e.g. hospital parking, prescriptions, GP visits, household utilities, etc.) and impact of cancer on income/benefits, meeting mortgage/loan payments, and household ability to make ends meet. The questionnaire also assessed levels of concern about household financial situation since diagnosis with cancer, and depression, stress and anxiety (using the DASS). Individuals with a primary breast, prostate, or lung cancer diagnosed within the previous 18 months were identified from the National Cancer Registry, Ireland and invited to complete the questionnaire during June-September 2008.
740 completed questionnaires were received (response rate = 54%). Respondents had extra costs associated with travelling to hospital appointments (71%), parking (52%), GP visits (36%), consultant visits (45%), physiotherapy (9%) and counselling (6%). 59% reported increased household bills due to their cancer diagnosis. Meeting mortgage or loan payments was more difficult for 43% and 57% respectively. 30% of respondents reported decreased income. The consequences of additional expenses included: using savings (55% used some or all of their savings); borrowing money (11%); reduced spending on “extras” such as take-away meals (21%). One third was more concerned about their household’s financial situation; this did not vary by socio-demographic factors. For 44% of patients the cancer diagnosis had made it more difficult for their household to make ends meet. This percentage was higher amongst patients who were younger, of working age, or had dependents. Those who reported more difficulty in making ends meet were significantly more likely to be depressed, stressed or anxious (p<0.01).
Most patients/families incur cancer-related additional costs. For some, these costs are substantial. The consequences of this additional expenditure are wide-ranging. These findings have important implications for patient support organisations, health and social services and policy makers.