'More than just money' -- widening the understanding of the costs involved in cancer care.
OBJECTIVE
This paper examines the literature relating to the wider concept of cost in cancer care and the implications this has for the development of services particularly within the changing context of cancer care.


BACKGROUND
Cancer remains a major cause of morbidity and mortality in the United Kingdom (UK), treatment is often complex and expensive; both in financial and human terms. Service patterns for cancer care are shifting away from traditional inpatient, hospital settings towards short stay/day-care and home care models. This is in response to developments in health care policy, but it is also because of the availability of better tolerated treatments and demand for more patient-focused health care.


METHODS
The databases of Cinhahl and Medline were accessed using the keywords of costs, treatment, outpatients, home care and cancer. Additional sources of literature were also accessed through hand searching key journals. The paper explores the literature in three themes. First, the cost-effectiveness of cancer treatment; second, the often invisible indirect or 'out of pocket' costs incurred by patients and their families during cancer treatment and finally, the 'human costs' of a cancer diagnosis and cancer therapy.


CONCLUSIONS
In view of recent calls to improve the effectiveness of cancer care in the UK, we suggest that research is needed to address all the dimensions of cost. It is only by exploring total costs from this broad perspective that appropriate, effective and holistic services can be planned for the future.
Practice Development and Research, Cancer Care, Meyerstein Institute of Oncology, UCL Hospitals, London, UK. susie.pearce@uclh.org
S
S
Pearce
D
D
Kelly
W
W
Stevens
D000553:Ambulatory Care / Q000458:organization & administration; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D005382:Financing, Personal; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006285:Health Planning; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D009017:Morbidity; D020380:Needs Assessment / Q000458:organization & administration; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D018802:Patient-Centered Care / Q000458:organization & administration; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology