Impact of the cost of cancer treatment: an internet-based survey

Despite considerable discussion in the medical literature and lay press regarding the increasing cost of cancer care, there is limited information available on the perceived impact of treatment costs on individual patients and their families.

To directly address this issue, patients with cancer who had participated in an Internet-based oncology decision-support program and agreed to receive information concerning potential future surveys were asked via e-mail to complete a questionnaire dealing with treatment-related medical expenses.

Of 39,882 invitations sent to patients with cancers of the breast, colon, lung, and prostate, 1,767 (4.4%) were returned, which included a wide spectrum of disease, demographics, and annual incomes. Since diagnosis, 20% and 4% of patients reported having spent out of pocket more than $10,000 and more than $50,000, respectively, on treatment and medical care. Overall, 19% of patients and 39% of individuals with a yearly income of less than $40,000 reported the financial costs of treating their cancer had caused a "large amount of distress." Furthermore, although overall, 9% of patients stated they had decided "to not have a recommended cancer treatment because it was too expensive," this percentage increased to 25% for individuals with an income of less than $40,000.

This survey suggests that a substantial proportion of patients and their families experience considerable distress associated with the cost of cancer care delivery. Furthermore, these costs affect the decision of patients with cancer to receive recommended treatment. This is a particularly serious issue for individuals with a modest annual income.