title: Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care.
abstract: OBJECTIVE
  We aimed to describe the perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care.
  
  
  METHODS
  We conducted semi-structured interviews with 21 cancer care providers (nurses, social workers, oncologists, surgeons, pharmacists, and dieticians) in Newfoundland and Labrador.
  
  
  RESULTS
  Patients try to minimize costs by substituting or rationing medications, choosing radical treatments, lengthening the time between follow-up appointments, choosing inpatient care, and working during treatment to minimize loss of income. Providers respond to the financial concerns of patients by helping them to access financial assistance programs, by changing chemotherapy and supportive drug prescriptions, and by shortening radiation treatment protocols. They admit patients to hospital and arrange follow-up with physicians closer to a patient's home.
  
  
  CONCLUSIONS
  Out-of-pocket costs resulting from cancer care are incurred at all phases of treatment and follow-up. These costs are substantial concerns for some patients and their health care providers. Encouraging communication between patients and their providers is needed to identify individuals at risk and to safely modify care plans. Tele-oncology and public drug, medical travel, and leave programs are needed to ensure that patients are better able to afford the costs related to cancer care.
authors: Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St. John's, NL. mmathews@mun.ca
authors: M
authors: M
authors: Mathews
authors: S
authors: S
authors: Buehler
authors: R
authors: R
authors: West