title: Self-reported financial burden and satisfaction with care among patients with cancer.
abstract: BACKGROUND
  Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction.
  
  
  METHODS
  This was an observational, cross-sectional, survey-based study assessing patient-reported financial burden (FB). Eligible patients were ≥ 21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for ≥ 1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale.
  
  
  RESULTS
  Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction (coefficient: -.29), satisfaction with technical quality (coefficient: -.26), and satisfaction with financial aspects of care (coefficient: -.62). Older age was associated with higher scores in all satisfaction subscales except patient-physician communication and financial aspects. Annual household income of <$20,000 was associated with lower satisfaction scores in all subscales except time spent with doctor. High FB was not associated with patient satisfaction scores for accessibility and convenience, communication, interpersonal manner, or time spent with doctor.
  
  
  CONCLUSIONS
  FB is a potentially modifiable correlate of poor satisfaction with cancer care including general satisfaction and satisfaction with the technical quality of care. Addressing cancer-associated FB may lead to improved satisfaction, which in turn can influence adherence, outcomes, and quality of life.
authors.affiliation: School of Medicine, Duke Cancer Institute, Sanford School of Public Policy, Department of Bioinformatics and Biostatistics, and Center for Learning Health Care, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Fumiko
authors.initials: F
authors.lastname: Chino
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Peppercorn
authors.forename: Donald H
authors.initials: DH
authors.lastname: Taylor
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
authors.forename: Gregory
authors.initials: G
authors.lastname: Samsa
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics*; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011788:Quality of Life; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Cost of illness; Economics; Health insurance; Neoplasms; Patient satisfaction