Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses.
BACKGROUND
We lack comprehensive information about the extent of out-of-pocket costs after diagnosis of early breast cancer and their effects on the family's financial situation.


METHODS
This longitudinal study assessed out-of-pocket costs and wage losses during the first year after diagnosis of early breast cancer among Canadian women and spouses. Out-of-pocket costs for treatments and follow-up, consultations with other practitioners, home help, clothing, and natural health products were estimated, with information collected from telephone interviews. Generalized linear models were used to identify women at risk of having higher costs and the effects of out-of-pocket costs on perceptions of the family's financial situation.


RESULTS
Overall, 829 women (participation, 86.2%) and 391 spouses participated. Women's median net out-of-pocket costs during the year after diagnosis were $1002 (2003 Canadian dollars; mean = $1365; SD = $1238), and 74.4% of these costs resulted from treatments and follow-up. Spouses' median costs were $111 (mean = $234; SD = $320), or 9% of couples' total expenses. In multivariable analyses, the percentage of women with out-of-pocket costs of $1773 or more (upper quartile) was statistically significantly associated with higher education, working at diagnosis, living more than 50 km from the hospital where surgery was performed, and having two and three different types of adjuvant treatment (all 2-sided P values ≤ .01). However, when considered simultaneously with wage losses, out-of-pocket costs were not associated with perceived deterioration in the family's financial situation; rather, wage losses were the driving factor.


CONCLUSIONS
Overall, out-of-pocket costs from breast cancer for the year after diagnosis are probably not unmanageable for most women. However, some women were at higher risk of experiencing financial burden resulting from these costs.
Unité de recherche en santé des populations (URESP), Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, QC, Canada, G1S 4L8. elizabeth.maunsell@uresp.ulaval.ca
Sophie
S
Lauzier
Pascale
P
Lévesque
Myrto
M
Mondor
Mélanie
M
Drolet
Douglas
D
Coyle
Jacques
J
Brisson
Benoît
B
Mâsse
Louise
L
Provencher
André
A
Robidoux
Elizabeth
E
Maunsell
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000473:pathology*; D002170:Canada; D017281:Cost of Illness; D004522:Educational Status; D004651:Employment; D005260:Female; D005102:Health Expenditures; D061889:Healthcare Financing; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D012456:Salaries and Fringe Benefits; D018454:Spouses