title: The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature.
abstract: Advances in cancer diagnosis and treatment have led to increased societal costs and out-of-pocket patient cost. We reviewed the literature on the impact of out-of-pocket cancer care costs on the patient experience, and described efforts made to address these costs. A critical appraisal of articles published in the USA from 2004 to 2014 was performed. The literature revealed that even insured patients receiving anticancer therapy are vulnerable to financial distress, which can impel patients to borrow money, deplete their savings, or engage in cost-coping strategies including nonadherence to prescribed treatment. Additional research is required to define financial distress risk factors, patient-physician communication of the costs of cancer care, and supportive care models for patients and survivors with substantial financial burdens.
authors.affiliation: Duke University Medical Center, 2301 Erwin Road, Room 8254, Durham, NC 27701, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Bestvina
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: S
authors.initials: S
authors.lastname: Yousuf Zafar
mesh_terms: D017028:Caregivers; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D055118:Medication Adherence; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012307:Risk Factors; D013315:Stress, Psychological; D017741:Survivors; D014481:United States / Q000453:epidemiology
keywords: cancer; decision-making; financial distress; healthcare cost; healthcare delivery