title: Out-of-pocket costs for cancer survivors between 5 and 10 years from diagnosis: an Italian population-based study.
abstract: OBJECTIVE
  To illustrate the out-of-pocket (OOP) costs incurred by a population-based group of patients from 5 to 10 years since their cancer diagnosis in a country with a nationwide public health system.
  
  
  METHODS
  Interviews on OOP costs to a sample of 5-10 year prevalent cases randomly extracted from four population-based cancer registries (CRs), two in the north and two in the south of Italy. The patients' general practitioners (GPs) gave assurance about the patient's physical and psychological condition for the interview. A zero-inflated negative binomial model was used to analyze OOP cost determinants.
  
  
  RESULTS
  Two hundred six cancer patients were interviewed (48 % of the original sample). On average, a patient in the north spent €69 monthly, against €244 in the south. The main differences are for transport, room, and board (TRB) to reach the hospital and/or the cancer specialist (north €0; south €119). Everywhere, OOP costs without TRB costs were higher for patients with a low quality of life.
  
  
  CONCLUSIONS
  Despite the limited participation, our study sample's characteristics are similar to those of the Italian cancer prevalence population, allowing us to generalize the results. The higher OOP costs in the south may be due to the scarcity of oncologic structures, obliging patients to seek assistance far from their residence. Implications for cancer survivors Cancer survivors need descriptive studies to show realistic data about their status. Future Italian and European descriptive studies on cancer survivorship should be based on population CRs and involve GPs in order to approach the patient at best.
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Baili
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy. francesca.disalvo@istitutotumori.mi.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Salvo
authors.affiliation: Federazione italiana delle Associazioni di Volontariato in Oncologia - FAVO, Via Barberini 11, 00187, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: de Lorenzo
authors.affiliation: Centro Studi Investimenti Sociali (CENSIS), Piazza di Novella 2, 00199, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maietta
authors.affiliation: Medical Oncology, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy.|Italian Association of Medical Oncologists (AIOM), Via Noè 23, 20133, Milan, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Pinto
authors.affiliation: Centro Studi Investimenti Sociali (CENSIS), Piazza di Novella 2, 00199, Rome, Italy.
authors.forename: Vera
authors.initials: V
authors.lastname: Rizzotto
authors.affiliation: Inter-institutional Epidemiology Unit, AUSL Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.|Arcispedale Santa Maria Nuova, IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Vicentini
authors.affiliation: Inter-institutional Epidemiology Unit, AUSL Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.|Arcispedale Santa Maria Nuova, IRCCS, Viale Umberto I 50, 42123, Reggio Emilia, Italy.
authors.forename: Paolo Giorgi
authors.initials: PG
authors.lastname: Rossi
authors.affiliation: Ragusa Cancer Registry, Azienda Sanitaria Provinciale Ragusa, Via Dante 109, 97100, Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Ragusa Cancer Registry, Azienda Sanitaria Provinciale Ragusa, Via Dante 109, 97100, Ragusa, Italy.
authors.forename: Patrizia Concetta
authors.initials: PC
authors.lastname: Rollo
authors.affiliation: Varese Cancer Registry, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Tagliabue
authors.affiliation: Varese Cancer Registry, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Contiero
authors.affiliation: Trapani Cancer Registry, Via Ammiraglio Staiti 95, 91100, Trapani, Italy.
authors.forename: Pina
authors.initials: P
authors.lastname: Candela
authors.affiliation: Trapani Cancer Registry, Via Ammiraglio Staiti 95, 91100, Trapani, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Scuderi
authors.affiliation: Federazione italiana delle Associazioni di Volontariato in Oncologia - FAVO, Via Barberini 11, 00187, Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Iannelli
authors.affiliation: Italian Association of Medical Oncologists (AIOM), Via Noè 23, 20133, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cascinu
authors.affiliation: Associazione Senza Limiti, Via dei Carracci 2, 20149, Milan, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Aurora
authors.affiliation: Breast Surgery Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Agresti
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Turco
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Milena
authors.initials: M
authors.lastname: Sant
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Meneghini
authors.affiliation: Analytic Epidemiology and Health Impact Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.|Scientific Direction, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via Venezian 1, 20133, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Micheli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000401:mortality; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors
keywords: Cancer prevalence; Cancer registry; Cancer survivorship; Out-of-pocket costs