research

Photo by HSIMS
L-R: Drs. Roy West, Maria Mathews and Sharon Buehler.

By Sharon Gray
Although the provincial government pays the full cost of cancer treatment in hospitals, many expenses related to that care are not covered. This cost is documented in a new study by Drs. Maria Mathews, Sharon Buehler and Roy West of Memorial’s Division of Community Health. The study is titled Closer to Home: The Burden of Out-of-Pocket Expenses on Cancer Patients in Newfoundland and Labrador.

“Expenses such as travel to and from a cancer clinic, lodging, meals, drugs and child or elder care are not covered,” explained Dr. Mathews. “For patients living in or near communities with cancer treatment facilities these costs are minimal, but cancer patients living in rural areas must travel for treatment and follow-up.”

By surveying about 500 cancer patients, interviewing about 20 care providers and analysing three years of cancer clinic data on adults, the researchers determined that one in three rural patients pay more than $200 for travel and lodging for a single visit to an oncologist and one in 11 pay more than $1,000, with some paying over $5,000. “Those getting radiation therapy have longer stays – 23 days on average – and thus spend more for lodging than those getting chemotherapy, follow-up care or other kinds of treatment such as hormone therapy.”

Dr. Mathews said that while cancer patients do not choose to go without treatment because of out-of-pocket expenses, some make choices that can reduce the effectiveness of their care. “Patients may take fewer pills than recommended to control pain or nausea, wait longer between treatments, or choose to die in hospital instead of at home.”

Most patients pay for cancer care-related costs from their monthly income, personal saving, or with the help of family and friends. The study found that only six per cent of patients make use of the province’s Medical Transportation Assistance Program.

Dr. Mathews said there are a number of recommendations in the study. “We feel that cancer services, particularly chemotherapy and follow-up, should be widely available in the province, for example through regional clinics.”

Furthermore, the study recommends that cancer patients should receive more information at the time they are diagnosed about the full extent of out-of-pocket costs associated with their care and about the various sources of financial support available to them. “The financial needs of patients should be assessed systematically – most people are not comfortable asking or answering questions about their personal finances and may wait too long before asking about financial assistance.”

Dr. Mathews said eligibility criteria for the Medical Transportation Assistance Program is currently limited to air travel and should be changed to include driving expenses.

Finally, the report recommends that the provincial drug program should be expanded to cover all drugs used to treat cancer, for all patients, in all settings.

“We need to continue to study the impact of out-of-pocket costs on cancer patients,” said Dr. Mathews. “Out study looked only at travel and lodging costs for a single visit to a cancer clinic and drug costs during one month of treatment. We need to determine total out-of-pocket costs for the patient’s entire course of treatment and its impact on their care and health outcomes.”