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Time spent getting cancer care substantial


Jan 3, 2007 - 4:07:53 PM

In the U.S. last year, the amount of money patients pay for the first year after diagnosis because of the time they spent getting cancer care amounts up to $2.3 billion, according to a new stud published in the January 3 issue of the Journal of the National Caner Institute. But the personal time cost varies among 11 cancers studied.

Early studies have estimated the direct medical cost for cancer treatments, but none has attempted to estimate the personal cost associated with cancer care. The personal time cost considered in this study include time spent traveling to and from care, waiting for appointments and receiving service and treatments, but exclude time spent on working or pursuing day-today activities.

The current study led by Robin Yabroff, Ph.D., of the National Cancer Institute, and colleagues quantified the time costs patients spent associated with cancer care.

The researchers went through data on more than 760,000 patients with 11 different types of cancer whose records are in the Surveillance, Epidemiology, and End Results Medicare database and from 1.1 million Medicare enrollees without cancer.

Using data from 1995 to 2001, they estimated the time each patient spent at physician and emergency room visits, chemotherapy treatments, radiation therapy, hospitalizations, outpatient surgeries, and imaging procedures.

They then estimated how much time each patient spent traveling to, waiting for, and receiving care. The net time costs were calculated at the rate of $15.23 per hour, the median U.S. wage rate in 2002.

It was found that during the first 12 months after diagnosis, the average length of time for hospitalization was highest for patients with gastric and ovarian cancers (21.1 and 20.8 days respectively) and shortest for patients with melanoma (2.2 days), prostate cancer (3.8 days) and breast cancer (4.0 days).

Compared to similar people without cancer, cancer patients' net time associated with medical care ranged from 17.8 hours for melanoma to 351.3 hours for gastric cancer and 368.1 hours for ovarian cancer.

When the researchers applied the dollar costs to time spent on medical care in the first 12 months after diagnosis, they found that net time cost for cancer patients were lowest for melanoma ($271) and prostate cancer ($842) and highest for gastric ($5,348) and ovarian ($5,605) cancer.

In the last year of life, hospitalization time was longest for patients with gastric (35.4 days), lung (32.4 days), and ovarian (31.9 days) cancer. Estimates of patients' net time spent on medical care were lowest for melanoma (99.1 hours) and highest for ovarian (485.3 hours), lung (488.3 hours), and gastric (512.2 hours) cancer.

The researchers calculated that the net patient time costs during the last year of life ranged from $1,509 for melanoma to $7,799 for gastric, $7,435 for lung, and $7,388 for ovarian cancer. Hospitalizations were the largest component of patient time costs in both the initial year after diagnosis and in the last year of life.

"For 2005, the estimated cost for the initial phase of care alone was approximately $2.3 billion," the authors write. These estimates could be combined with estimates of direct and indirect costs to better understand the overall burden of cancer in the United States, the authors write.

The time costs patients spent to get cancer care are substantial and they indicate the ineffectiveness of a particular treatment. "A lot of economists recommend that patient costs be included in determining cost effectiveness," said study author Robin Yabroff, an epidemiologist at the National Cancer Institute, quoted by Healthday.com.

The time cost colorectal cancer patients spent accounted for 19 percent of total medical costs in the first year of diagnosis, rising to 37 percent in the last year, the researchers found.

"What we see here is a measure of the patient's burden of commitment--measured in dollars--associated with receiving today's cancer therapy," write Larry G. Kessler, Sc.D., of the U.S. Food and Drug Administration and Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, in an accompanying editorial.

"We hope that policy makers recognize the substantial economic burden of cancer in the United States and that this cost derives from many sources."

The editorial writers also note that these calculations do not address the emotional cost cancer patients and their families endure. Even accounting for patient time costs, "we know we have greatly underestimated the true cost of the disease," they write.

Nevertheless, Kessler and Ramsey conclude, new treatments that reduce patient time costs should be encouraged, and manufacturers should quantify these benefits and then convey them to patients, providers, and health insurers.



Article: Yabroff KR, David WW, Kamont EB, Lamont EB, Fahey A, Topor M, et al. Patient time costs associated with cancer care. J Natl Cancer Inst 2007; 99: 14-23.

Editorial: Kessler LG, Ramsey SD. The forest and the trees: the human costs of cancer. J Natl Cancer Inst 2007; 99: 2-3.

Acknowledgement: The article contains content from a news release by the National Cancer Institute.

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