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Cancer Care-Patient's Time Costs Studied

According to a new study in the January 3 issue of the Journal of the National Cancer Institute, the overall cost of patients' time spent on cancer care in 2005 was $2.3// billion in the first year after diagnosis.

Several studies have estimated the direct medical costs of cancer care, but few have attempted to include a patient's time associated with cancer care, such as time spent traveling to and from care, waiting for appointments, and receiving services and treatments, all of which represent time not spent working or pursuing day-to-day activities.

In the new study, Robin Yabroff, Ph.D., of the National Cancer Institute, and colleagues quantified the patient time costs associated with cancer care. They used information from the Surveillance, Epidemiology, and End Results–Medicare database on more than 760,000 patients with 11 different types of cancer and from 1.1 million Medicare enrollees without cancer.

Using data from 1995 to 2001, they estimated each patient's time spent at physician and emergency room visits, chemotherapy treatments, radiation therapy, hospitalizations, outpatient surgeries, and imaging procedures. They then estimated how long each patient spent traveling to, waiting for, and receiving care. The net costs were calculated using a dollar value of $15.23 per hour, the median U.S. wage rate in 2002.

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) 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 varied, ranging 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 diagno sis, they found that net patient time costs 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.

They 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.


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