Patient and family financial burden associated with cancer treatment in Canada: a national study

Abstract

Goal To determine patient-reported financial and family burden associated with treatment of cancer in the previous 28 days across Canada. Methods A self-administered questionnaire (P-SAFE v7.2.4) was completed by 901 patients with cancer from twenty cancer centres nationally (344 breast, 183 colorectal, 158 lung, 216 prostate) measuring direct and indirect costs related to cancer treatment and foregone care. Monthly self-reported out-of-pocket-costs (OOPCs) included drugs, homecare, homemaking, complementary/ alternative medicines, vitamins/supplements, family care, accommodations, devices, and “other” costs. Travel and parking costs were captured separately. Patients indicated if OOPC, travel, parking, and lost income were a financial burden. Results Mean 28-day OOPCs were CA$518 (US Purchase Price Parity [PPP] $416), plus CA$179 (US PPP $144) for travel and CA$84 (US PPP $67) for parking. Patients self-reporting high financial burden had total OOPCs (33%), of CA$961 (US PPP $772), while low-burden participants (66%) had OOPCs of CA$300 (US PPP $241). “Worst burden” respondents spent a mean of 50.7% of their monthly income on OOPCs (median 20.8%). Among the 29.4% who took time off work, patients averaged 18.0 days off. Among the 26.0% of patients whose caregivers took time off work, caregivers averaged 11.5 days off. Lastly, 41% of all patients had to reduce spending. Fifty-two per cent of those who reduced spending were families earning < CA$50,000/year. Conclusions In our Canadian sample, high levels of financial burden exist for 33% of patients, and the severity of burden is higher for those with lower household incomes.

Acceptability and Feasibility of a Return-to-Work Intervention for Posttreatment Breast Cancer Survivors: Protocol for a Co-design and Development Study

“…In Canada, health care is free and primary care services are readily accessible to the general population. It should be noted that the majority of Canadians affected by cancer have paid sick leave included in their private insurance contracts [ 16 ]. Many people, including those without private insurance, only have access to 15 weeks of compensation from the Canadian government.…”

“…Fatigue, as well as memory loss and difficulty concentrating, can also impact RTW [ 11 ]. Furthermore, breast cancer survivors often live more precariously than the general population due to taking repeated sick leaves from work or having only part-time employment after cancer treatments [ 12 - 16 ]. Despite these challenges, both working and having good working conditions are related to better health [ 17 ], as is allowing for the maintenance of social interactions, self-esteem, psychological well-being, and financial security [ 2 , 18 , 19 ].…”

A Survey of Potentially Modifiable Patient-Level Factors Associated with Self-Report and Objectively Measured Adherence to Adjuvant Endocrine Therapies After Breast Cancer

“…Additionally, travel, gas, or parking for oncology appointments might represent related out-of-pocket costs. Even in universal public healthcare systems such as in Canada, significant out-of-pocket costs can occur 45 which may affect adherence.…”

“…Additionally, travel, gas, or parking for oncology appointments might represent related out-ofpocket costs. Even in universal public healthcare systems such as in Canada, significant out-of-pocket costs can occur 45 which may affect adherence. Side effect severity was most strongly associated with self-report adherence at baseline, accounting for 9% of the variance.…”

Relationships between Canadian adult cancer survivors’ annual household income and emotional/practical concerns, help‐seeking and unmet needs

“…Additionally, out-of-pocket costs created financial burden and were identified as a pressing issue for cancer survivors (Longo et al, 2021).…”