title: Out-of-pocket costs for accessing adjuvant radiotherapy among Canadian women with breast cancer.
abstract: OBJECTIVE
  Patients with breast cancer incur out-of-pocket costs when they receive adjuvant radiation. These treatments are administered in dedicated centers on a daily basis over 4 to 5 weeks. We assessed the extent of out-of-pocket costs to access radiotherapy and identified women at risk of experiencing higher costs.
  
  
  METHODS
  This prospective study was conducted among 800 women from eight Quebec hospitals (participation, 86%), of whom 693 women received adjuvant radiotherapy. Costs to access treatment (transportation, parking, lodging, and meals) were estimated on the basis of information collected by telephone interviews. Generalized linear models were used to identify women at risk of having higher costs.
  
  
  RESULTS
  Mean and median total costs (including financial aid received) to access radiotherapy were 445 Canadian dollars (Can$; standard deviation, Can$407) and Can$311, respectively. Women who lived at home but far from the radiotherapy center had the highest risk of experiencing weekly costs of at least Can$122 (highest quartile; prevalence ratio [PR], 5.8; 95% CI, 4.7 to 7.1) followed by women who lived away from home and farther from the center (PR, 4.5; 95% CI, 3.4 to 6.0) and by women who lived away from home and closer to the center (PR, 2.14; 95% CI, 1.3 to 3.5). When women stayed at a cancer lodge during treatment, costs were reduced by 80%.
  
  
  CONCLUSIONS
  Considered in and of themselves, out-of-pocket costs for access to radiotherapy appeared relatively modest. Financial assistance initiatives for women who lived away from home during treatments contributed to a substantial reduction of access costs. These efforts should be maintained, but financial assistance should also target patients with cancer who live at home during treatments but have to travel relatively long distances on a daily basis.
authors.affiliation: Centre Hospitalier Affilié Universitaire de Québec, Québec, Québec, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lauzier
authors.forename: Pascale
authors.initials: P
authors.lastname: Levesque
authors.forename: Mélanie
authors.initials: M
authors.lastname: Drolet
authors.forename: Douglas
authors.initials: D
authors.lastname: Coyle
authors.forename: Jacques
authors.initials: J
authors.lastname: Brisson
authors.forename: Benoît
authors.initials: B
authors.lastname: Mâsse
authors.forename: André
authors.initials: A
authors.lastname: Robidoux
authors.forename: Jean
authors.initials: J
authors.lastname: Robert
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Maunsell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D002170:Canada; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011792:Quebec; D018714:Radiotherapy, Adjuvant / Q000191:economics; D055815:Young Adult