Patient and Family Financial Burden in Cancer: A Focus on Differences across Four Provinces, and Reduced Spending Including Decisions to Forego Care in Canada

Christopher J Longo; Tuhin Maity; Margaret I Fitch; Jesse T Young

doi:10.3390/curroncol31050206

Patient and Family Financial Burden in Cancer: A Focus on Differences across Four Provinces, and Reduced Spending Including Decisions to Forego Care in Canada

Curr Oncol. 2024 May 11;31(5):2713-2726. doi: 10.3390/curroncol31050206.

Authors

Christopher J Longo^{1

2}, Tuhin Maity¹, Margaret I Fitch³, Jesse T Young^{2

4

5

6

7

8}

Affiliations

¹ DeGroote School of Business-Health Policy & Management, McMaster University, Hamilton, ON L8S 4L8, Canada.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5S 1A1, Canada.
³ Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5S 1A1, Canada.
⁴ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON M5T 1R8, Canada.
⁵ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3052, Australia.
⁶ Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia.
⁷ School of Population and Global Health, The University of Western Australia, Crawley, WA 6009, Australia.
⁸ Curtin School of Population Health, Curtin University, Bentley, WA 6102, Australia.

Abstract

Goal: This study aimed to examine provincial differences in patient spending for cancer care and reductions in household spending including decisions to forego care in Canada.

Methods: Nine-hundred and one patients with cancer, from twenty cancer centers across Canada, completed a self-administered questionnaire (P-SAFE version 7.2.4) (344 breast, 183 colorectal, 158 lung, and 216 prostate) measuring direct and indirect costs and spending changes.

Results: Provincial variations showed a high mean out-of-pocket cost (OOPC) of CAD 938 (Alberta) and a low of CAD 280 (Manitoba). Differences were influenced by age and income. Income loss was highest for Alberta (CAD 2399) and lowest for Manitoba (CAD 1126). Travel costs were highest for Alberta (CAD 294) and lowest for British Columbia (CAD 67). Parking costs were highest for Ontario (CAD 103) and lowest for Manitoba (CAD 53). A total of 41% of patients reported reducing spending, but this increased to 52% for families earning <CAD 50,000 per year. The highest national rates of decisions to forego care were in relation to vitamins/supplements, the selection made by 21.3% of those who indicated spending reductions. Reductions for complementary and alternative medicine (CAM) were made by 16.3%, and for drugs, by 12.8%. Most cost categories had higher proportions of individuals who decided to forego care when family income was <CAD 50,000 per year and for patients under 65 years of age.

Conclusions: Levels of financial burden for patients with cancer in Canada vary provincially, including for OOPC, travel and parking costs, and lost income. Decisions to forego cancer care are highest in relation to vitamins/supplements, CAM, and drugs. Provincial differences suggest that regional health policies and demographics may impact patients' overall financial burden.

Keywords: cancer; financial burden; financial toxicity; foregone care; out-of-pocket costs; regional differences; self-administered questionnaire.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Canada
Cost of Illness*
Female
Health Expenditures* / statistics & numerical data
Humans
Male
Manitoba
Middle Aged
Neoplasms* / economics
Neoplasms* / therapy
Surveys and Questionnaires

Grants and funding

Canadian Centre for Applied Research (funded through the Canadian Cancer Society Research Institute, Grant # 2015-703559, year 2015) $185,000; Ontario MoH/Cancer Care Ontario—Planning and Regional programs, Grant # NA, year 2018) $36,000; McMaster Arts Research Board—SSHRC, Grant # NA year 2019) $9000.