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Financial distress in cancer care

More than one-third of insured cancer patients receiving treatment faced out-of-pocket costs that were greater than they expected and those patients with the most financial distress were underinsured, paying almost one-third of their income in health care-related costs, a research letter published by JAMA Oncology reports.

The financial burden of treating cancer is well known and even insured patients face financial burden and a worsened quality of life. Underinsured patients (those who spend more than 10 percent of their income on health care costs) are a growing group.

Fumiko Chino, M.D., of the Duke University Medical Center, Durham, N.C., and coauthors conducted a survey of financial distress and cost expectations among 300 insured patients with cancer presenting for treatment at a comprehensive cancer center and three affiliated rural oncology clinics.

Nearly all of the patients had private insurance or Medicare and the rest had Medicaid.

Of the patients, 49 (16 percent) reported high or overwhelming financial distress.

The median relative cost of care (defined as monthly out-of-pocket costs divided by income) was 11 percent for all patients, 31 percent for those with high or overwhelming financial distress and 10 percent for those with no, low or average financial distress.

"Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision making. Interventions to improve patient health care cost literacy might impact decision making.... Future studies should test interventions for cost mitigation through shared decision making," the research letter concludes.

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Cancer Intelligence