More than a third of insured patients with cancer who received treatment faced out-of-pocket costs that were greater than they expected, and patients with the most financial distress were underinsured, paying almost one-third of their income in healthcare-related costs, according to a new report published in JAMA Oncology.
Fumiko Chino, MD, a radiologist at Duke University Medical Center in Durham, N.C., and colleagues 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 were covered under Medicaid.
Of the study patients, 16% reported high or overwhelming financial distress. The median relative cost of care (defined as monthly out-of-pocket costs divided by income) was 11% for all patients, 31% for those with high or overwhelming financial distress, and 10% for those with no, low, or average financial distress.
Nearly 40% of participants cited higher than expected financial burden from cancer care. In an additional analysis, this higher-than-expected burden was associated with high or overwhelming financial distress and a decreased willingness to pay for cancer care.
The investigators concluded that, “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 healthcare cost literacy might impact decision making.” They recommend that future studies should test interventions for cost mitigation through shared decision making.