Abstract
Objective
This research informs existing work by examining the full scope of out-of-pocket costs and lost income, patients’ private insurance behaviors, and their overall management of finances during their cancer treatment. The intent was to gain a deeper understanding of patient circumstances and the related costs.
Methods
Participant qualitative interviews were conducted in person during outpatient clinic visits or by telephone and were recorded between June 2011 and July 2012. Interviews were transcribed verbatim and subjected to a descriptive qualitative analysis. The research team collaborated early in the process (after three subjects were enrolled) to develop a preliminary coding framework. The coding framework was modified to incorporate additional emerging content until saturation of data was evident. Transcripts were coded using the qualitative software NVivo version 9.0.
Results
Fifteen patients agreed to participate in the study and 14 completed the interview (seven breast, three colorectal, two lung, and two prostate). Consistent with existing published work, participants expressed concerns regarding expenses related to medications, complementary/alternative medicines, devices, parking and travel. These concerns were exacerbated if patients did not have insurance or lost insurance coverage due to loss of work. Although many acknowledged in hindsight that additional insurance would have helped, they also recognized that at the time of their diagnoses, it was not a viable option. Previously unidentified categorical costs identified in this study included modifications to housing arrangements or renovations, special clothing, fitness costs and the impact of an altered diet.
Conclusion
We confirmed the results of earlier Canadian quantitative work. Additionally, cost categories not previously explored were identified, which will facilitate the development of an improved and more comprehensive quantitative questionnaire for future research. Many patients indicated that supplemental health insurance would have made their cancer journey less stressful, highlighting existing gaps in the government funded health care system.
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References
Mirolla M (2004) The cost of chronic disease in Canada. The Chronic Disease Prevention Alliance of Canada, Nova Scotia
Sanmartin C, Hennessy D, Lu Y, Law MR (2014) Trends in out-of-pocket health care expenditures in Canada, by household income, 1997 to 2009. Statistics Canada, catalogue no. 82-003-X. Health Rep 25(4):13–17
Longo CJ, Deber R, Fitch M, Williams AP (2006) Financial and family burden associated with cancer treatment in Ontario. Support Care Cancer 14:1077–1085
Longo CJ, Deber R, Fitch M, Williams AP, DeSouza D (2007) An examination of cancer patients’ monthly “out-of-pocket” costs in Ontario”. European Journal of Cancer Care 16:500–507
Longo CJ, Bereza BG (2011) A comparative analysis of monthly ‘out-of-pocket’ costs for breast cancer patients versus other common cancers in Ontario, Canada. Curr Oncol V18(1):e1–e8
Mathews M, Buehler S, West R (2009) Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care. Curr Oncol V4:3–8
Lauzier S, Mausell E, Drolet M, et al. (2008) Wage losses in the year after breast cancer: extent and determinants among Canadian women. J Natl Cancer Inst V100:321–332
Hopkins RB, Goeree R, Longo CJ (2010) Estimating the national wage loss from cancer in Canada. Curr Oncol 17(2):40–49
Lauzier S, Maunsell E, De Koninck M, Drolet M, Hebert-Croteau N, Robert J (2005) Conceptualization and sources of costs from breast cancer: findings from patient and caregiver focus groups. Psycho-Oncology 14(5):351–360
Azzani M, Roslani AC, Su TT (2015) The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer 23(3):889–898
Pizu M, Azuero A, McNees P, Burkhardt J, Benz R, Meneses K (2010) The out of pocket cost of breast cancer survivors: a review. J Cancer Surviv 4(3):202–209
Dumont S, Jacobs P, Turcotte V, Turcotte S, Johnston G (2015) Palliative care costs in Canada: a descriptive comparison of studies of urban and rural patients near end of life. Palliat Med. doi:10.1177/0269216315583620
Cook PJ, Graham DA (1977) The demand for insurance and protection: the case of irreplaceable commodities. Q J Econ 91(1):143–156
Viscusi WK, Evans WN (1990) Utility functions that depend on health status: estimates and economic implications. Am Econ Rev 80(3):353–374
Zeckhauser R (1973) Coverage for catastrophic illness. Public Policy 21(2):149–172
Eeckhoudt L, Mahul O, Moran J (2003) Fixed-reimbursement insurance: basic properties and comparative statics. JRisk & Insur 70(2):207–218
Thorne S (1997) Focus on qualitative methods interpretive description: a non-categorical qualitative alternative for developing nursing knowledge. Research in Nursing & Health 20:169–177
Morse JM, Barrett M, et al. (2002) Verification strategies for establishing reliability and validity in qualitative research. International J Qualitative Methods 1(2):1–19
Braunstein S, Welsh C (2002) Financial literacy: An overview of practice, research, and policy. Fed. Res. Bulletin: 445
Roberts RO, Bergstralh EJ, Schmidt L, Jacobsen SJ (1996) Comparison of self-reported and medical record health care utilization measures. J Clin Epidemiol 49(9):989–995
Weissmann JS, Levin K, Chasan-Taber S, Massagli MP, Seage GR, Scampini L (1996) The validity of self-reported health care utilization by AIDS patients. AIDS 10(7):775–783
Acknowledgments
We would like to acknowledge the financial support of the Canadian Centre for Applied Research in Cancer Control (ARCC) which in turn is funded through the Canadian Cancer Society Research Institute. We also received assistance from Jennifer Reddock (McMaster PhD student) in the interview process, and the initial phase of interview coding.
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Longo, C.J., Fitch, M., Grignon, M. et al. Understanding the full breadth of cancer-related patient costs in Ontario: a qualitative exploration. Support Care Cancer 24, 4541–4548 (2016). https://doi.org/10.1007/s00520-016-3293-0
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DOI: https://doi.org/10.1007/s00520-016-3293-0