Out-of-pocket costs for breast cancer probably manageable for most Canadian women

Out-of-pocket costs resulting from breast cancer care in the year following diagnosis are likely manageable for most women, but some women are at a higher risk of experiencing the financial burden that comes from those costs in Canadian breast cancer patients, according to a study published January 24 in the Journal of the National Cancer Institute.

While extensive information about the level of out-of-pocket after early breast cancer diagnosis has been unavailable until now, the costs resulting from the disease and the effects the costs have on family financial situations may highlight a negative consequence of the disease further down the road. Despite the publically provided health care provided in Canada, patients still incur costs from transportation to treatments, follow-up visits, consultations, and domestic help, particularly during the first year following diagnosis.

In order to determine the extent of out-of-pocket costs and the effects they have on and families in the first year after diagnosis, Sophie Lauzier, Ph.D., Unité de recherche en santé des populations (URESP), Centre de recherche du CHU de Québec, Université Laval, Quebec, Canada, together with colleagues in the team led by Elizabeth Maunsell, Ph.D., estimated the costs incurred using information obtained from telephone interviews with patients and families. Generalized linear models identified women at risk for having higher costs and the effects that those costs may have on the financial situation of their families.

The researchers found that the overall, women's median out-of-pocket costs during the year following diagnosis were $1,002 (in 2003 Canadian dollars), once any insurance or had been taken into account. The percentages of women with higher out-of-pocket costs were significantly greater among the more highly educated, those working at the time of diagnosis and those living at least 50 km from the hospital where the surgery occurred. The proportion of family income represented by out-of-pocket costs was higher for women with lower incomes. However, in terms of the impact of these costs on changes for the worse in the family's during the year after diagnosis "we found that women's out-of-pocket costs played a secondary role to wage losses; it is wage losses that appeared to drive changes for the worse," the authors write.

In an accompanying editorial, Matthew P. Banegas, Ph.D., and K. Robin Yabroff, Ph.D., M.B.A., both of the Health Services and Economics Branch Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute write that the study adds to the important information to understanding the of cancer. "Overall, such evidence on the scope of financial consequences of cancer care for patients and their families, in addition to the clinical benefits and risks, will enhance discussions of the "value" of cancer treatment, which is something oncologists in both the United States and Canada acknowledge as a fundamental component of high-quality care."

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