Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study

Abstract

Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001–1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13–24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913–0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00–0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03–0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.

Describing financial toxicity among cancer patients in different income countries: a systematic review and meta-analysis

“…A total of 47,964,650 cancer patients participated in a total of 64 studies carried out worldwide, with study samples ranging from 26 to 19.6 million. Out of the 64 studies, 15 studies included participants with any type of cancer ( 32 , 35 , 36 , 39 , 41 , 44 , 51 , 52 , 58 , 65 , 68 , 72 , 84–86 ), a mix of 2 or more types of cancers (10 studies) ( 27 , 33 , 38 , 53 , 56 , 62 , 69 , 71 , 79 , 81 ), breast cancer (11 studies) ( 30 , 40 , 45–47 , 50 , 55 , 66 , 76 , 82 , 83 ), colorectal cancer (6 studies) ( 48 , 57 , 59 , 67 , 70 , 75 ), colon cancer ( n = 1) ( 49 ), skin cancer (3 studies) ( 20 , 77 , 78 ), lung cancer (2 studies) ( 54 , 80 ), lung cancer with brain metastasis (1 study) ( 34 ), prostate cancer (3 studies) ( 63 , 64 , 74 ), pancreatic cancer (1 study) ( 28 ), bladder cancer (2 studies) ( 29 , 31 ), head and neck cancers ( n = 3 studies) ( 43 , 60 , 61 ), blood cancer (3 studies) ( 24 , 26 , 73 ), liver cancer (1 study) ( 42 ), gynecologic cancer (1 study) ( ...…”

“…In total, 30 studies provided data on subjective FT ( 24–27 , 29 , 31 , 32 , 37 , 39 , 41 , 44–46 , 49–52 , 58 , 59 , 61 , 62 , 64 , 67–69 , 71 , 73 , 75 , 80 , 85 ). The measures of FT varied widely among the studies.…”

“…The lowest score was reported among patients with acute myeloid leukemia and the highest among patients with gynecological cancers. Moreover, 10 studies used a 4- to 7-point Likert scale to assess the prevalence of subjective FT ( 24 , 29 , 45 , 58 , 59 , 61 , 62 , 64 , 67 , 80 ), where the reported prevalence ranged between 20.9 and 83.7%. In addition, two studies used the median of COST as a cutoff point to assess those with and without FT ( 25 , 26 ).…”

“…The direct non-medical cost was included in only seven studies ( 47 , 57 , 64 , 67 , 69 , 73 , 86 ). Two studies were conducted on colorectal cancer patients ( 44 , 67 ): one in prostate cancer patients ( 64 ), one among patients of three types of cancer, namely bladder, prostate cancer, and renal cancer ( 69 ), one among blood cancer patients ( 73 ), and one among patients of any cancer type ( 86 ). The cost in the last 3 months for prostate cancer was USD$ 379.38 in Canada ( 64 ).…”

A Comparison Between the Rates of Radiation Oncologist and Urologist Consultations in Men Diagnosed With Prostate Cancer in Northern Ontario, Canada

“…In addition, 50% of patients said they had incurred treatment-related absences from work. 19 In a similar study conducted in Ontario, 35.6% of patients reported that others within their support network were required to take time off from their employment to provide them with assistance, and 20% also reported that their expenses were ‘significant and unmanageable’. 20 All these factors would undoubtedly result in greater financial hardship in individuals who are in the lower income quintile in this study.…”