August 10, 2017
2 min read

Out-of-pocket cancer expenses often exceed patients’ expectations

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S. Yousuf Zafar

One-third of insured patients with cancer had out-of-pocket costs that exceeded their expectations, according to study results.

Underinsured patients faced the greatest financial distress, often paying one-third of their income for health-related costs, results showed.

“This study adds to the growing evidence that we need to intervene,” S. Yousuf Zafar, MD, medical oncologist at Duke Cancer Institute, said in a press release. “We know there are a lot of barriers that prevent patients from talking about cost with their providers. We need to create tools for patients at risk [for] financial toxicity and connect them with resources in a timely fashion so they can afford their care.”

Underinsured patients — or those who pay more than 10% of their income on health care costs — represent a growing proportion of patients. However, even well-insured patients face financial burden, which can worsen quality of life and survival outcomes.

Despite the increasing attention on the financial burden of cancer care, little had been known about patients’ expectations regarding costs and decision-making.

Zafar and colleagues conducted a cross-sectional survey study about financial distress and cost expectations in 300 patients (median age, 59.6 years; 52% men; 75.3% white) who presented at a comprehensive cancer center and three affiliated rural oncology clinics for anticancer therapy.

Researchers surveyed patients about whether their costs met their expectations, and about how much they were willing to pay out of pocket for cancer treatment, outside of insurance premiums.

Fifty-six percent of the patients had private insurance, 35.7% had Medicare and 7.3% had Medicaid.

Using a validated tool to measure financial distress on a scale of 1 to 10 — where 1.9 or lower indicates no distress and higher than 9 indicates overwhelming distress — researchers found that 49 patients (16%) had high or overwhelming financial distress (score > 7).

Researchers then measured median relative cost of care, calculated by dividing monthly out-of-pocket costs by income. Results showed the median relative cost of care was 11%. Patients with high or overwhelming distress had a higher median relative cost of care than those with no, low or average financial distress (31% vs. 10%).

Thirty-nine percent of patients (n = 118) reported higher-than-expected financial burden from cancer care.

Unadjusted analyses showed unexpected financial burden appeared more common in patients who were younger, unmarried, nonwhite and unemployed/not retired. Researchers also linked unexpected financial burden with lower household income, higher costs, colorectal or breast cancer diagnosis, lower quality of life and higher financial distress.


Adjusted analyses showed unexpected financial burden increased likelihood of having high or overwhelming financial distress (OR = 4.78; 95% CI, 2.02-11.32), and decreased patients’ willingness to pay for cancer care (OR = 0.48; 95% CI, 0.25-0.95).

“Overall, the patients in the study were paying an average of 11% on out-of-pocket costs for their cancer treatment,” Fumiko Chino, MD, resident in radiation oncology at Duke Health, said in the release. “Those who spend more than 10% of their income on health care costs are considered underinsured. Learning about the cost-sharing burden on some insured patients is important right now, given the uncertainty in health insurance.”

The researchers called for studies to evaluate interventions that would improve patient health care cost literacy for shared decision-making. – by Alexandra Todak

Disclosure: The researchers report no relevant financial disclosures.