According to a research letter published in JAMA Oncology, approximately one-third of patients with cancer with health coverage expressed that treatment was far costlier than expected, and patients who are the most distressed often are underinsured and may pay up to one-third of their income in treatment-related costs.

Study authors conducted a cross-sectional survey of cost expectations and financial distress among 300 patients with cancer receiving therapy at 3 rural oncology clinics, and collected data on the cancer diagnosis, patient socioeconomic data, and multiple financial metrics as they pertained to cost of care.

The results of the study showed that median relative cost of care (defined as out-of-pocket costs divided by income) was 11%. The relative cost of care was 31% in patients with high or overwhelming distress vs 10% for patients with average, low, or no financial distress.

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Thirty-nine percent of patients expressed that the financial burden of cancer therapy was higher than expected. Being unmarried, unemployed/not retired, nonwhite, younger, having lower household income, lower quality of life, higher costs, and colorectal/breast cancer diagnosis, were factors associated with unexpected burden.

The results of an adjusted analysis revealed that patients who had higher than expected financial burden were less likely to pay for their care, and also experienced high or overwhelming financial distress.

The authors conclude saying “future studies should test interventions for cost mitigation through shared decision making.”


Chino F, Peppercorn JM, Rushing C, et al. Out-of-pocket costs, financial distress, and underinsurance in cancer care [published online August 10, 2017]. JAMA Oncol. doi: 10.1001/jamaoncol.2017.2148