Impact of out-of-pocket expenses on cancer care.

6006 Background: How do out-of-pocket expenses for cancer care (OOPE) impact patient-reported lifestyle, quality, and satisfaction with cancer care?We recruited patients at Duke University Medical Center and from a national pool of applicants to the Healthwell Foundation (HF), a non-profit organization which assists the underinsured with healthcare costs. Eligible patients were receiving breast, lung, or colorectal cancer treatment. Eligibility was independent of receiving HF assistance. We did not share identified data with HF. Patients completed surveys on strategies to cope with OOPE, satisfaction with care, and 4 weekly expense diaries. Associations between demographics, coping strategies, and OOPE were examined.127 patients were enrolled (85% via HF), with a mean age of 65 years (range 41-88). Most were Caucasian (84%), female (94%), had breast cancer (84%), and had non-metastatic cancer (60%). All were insured; 64% had Medicare or Medicare plus supplemental insurance. 22% were employed, 51% were retired, and 73% had annual household income <$40,000. 45% perceived a significant or catastrophic financial burden with OOPE. OOPE averaged $1266/month. The largest proportion of OOPE was attributed to prescription medication ($523/month, 41%). Other monthly costs included: medical equipment ($197; 14%), travel ($122; 10%), special diet ($72; 6%), and non-prescription drugs ($68; 5%). As financial burden increased, patients used more strategies to cope with OOPE (p<0.001). To cope with OOPE, 52% spent less on food and clothing, 76% spent less on leisure activities like eating out or movies, 47% used all or part of their savings, 30% did not fill prescriptions, 20% took less medication than prescribed, and 49% borrowed money to pay for prescriptions. Older patients reported less financial burden compared to younger patients (p<0.001). Patients with greater financial burden reported lower levels of satisfaction with their cancer care (p=0.001).OOPE incurred by underinsured cancer patients triggered considerable lifestyle changes. OOPE might impact cancer care quality as patients took fewer prescribed medications. Patients saddled with OOPE were less satisfied with cancer care. OOPE thus diminished care at multiple levels.

Duke Scholars

Author Donald H. Taylor Jr. Sanford School of Public Policy