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Patient-Reported Financial Sacrifice and Cancer Care

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Key Points

  • Patients had a high rate of willingness to make personal/financial sacrifice to receive care.
  • The proportion of patients making sacrifices increased over 3 months.

In a study reported in the Journal of Oncology Practice, Chino et al found that high proportions of insured patients with cancer—most with stage IV disease—reported being willing to make considerable personal and financial sacrifices to receive cancer care.

The study included a longitudinal survey on patient-reported sacrifice and costs of cancer care among insured adults with solid tumors who had received chemotherapy or hormonal therapy for ≥ 30 days prior to enrollment at Duke University Medical Center and affiliated rural clinics. The survey was repeated at 3 months after baseline. Overall, 76% of patients had stage IV disease.

Patient Reports on Sacrifice

Of 349 patients invited to participate, 300 completed the baseline survey (86% response) and 245 completed the follow-up survey at 3 months (82% retention). Median patient-reported out-of-pocket costs for patients completing both surveys were $393 per month (range = $0–$26,586 per month) at baseline and $328 per month (range = $0–$8,210 per month) at 3 months.  

At baseline, 49% of patients reported willingness to declare personal bankruptcy, 38% to sell their home, and ≥ 65% to make other sacrifices, including borrowing money. At 3-month follow-up, there was some decrease in willingness to make sacrifices, with ≥ 70% of patients reporting the same opinion as at baseline on personal sacrifice; there was a 7% decline in willingness to declare bankruptcy.

At baseline, 59% of patients had made at least 1 financial sacrifice, including reduced spending on leisure activities, reduced spending on basics, using savings, or borrowing money. At follow-up, 67% had made at least 1 sacrifice (P = .003). The greatest increase was observed in patients who used their savings, from 41% at baseline to 54% at follow-up.

The investigators concluded, “A large proportion of insured patients with cancer were willing to make considerable personal and financial sacrifices to receive care; these attitudes did not change greatly over time. Shared decision-making is important to ensure patients fully understand the goals, risks, and benefits of therapy before they make such personal sacrifices.”

The study was supported by the Duke Cancer Institute Cancer Control Pilot Studies Program, Duke Clinical Research Institute Comparative Effectiveness KM1 Award, and American Cancer Society.

Fumiko Chino, MD, of Duke University Medical Center, is the corresponding author for the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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