title: Out-of-pocket costs and burden among rural breast cancer survivors.
abstract: Little is known about out-of-pocket (OOP) costs incurred for medical and health needs by rural breast cancer survivors and what factors may be associated with higher OOP costs and the associated economic burden. Data were examined for 432 survivors participating in the Rural Breast Cancer Survivor Intervention trial. OOP costs were collected using the Work and Finances Inventory survey at baseline and four assessments every 3 months. Mean and median OOP costs and burden (percent of monthly income spent on OOP costs) were reported and factors associated with OOP costs and burden identified with generalized linear models fitted with over-dispersed gamma distributions and logarithmic links (OOP costs) and with beta distributions with logit link (OOP burden). OOP costs per month since the end of treatment were on average $232.7 (median $95.6), declined at the next assessment point to $186.5 (median $89.1), and thereafter remained at that level. Mean OOP burden was 9% at baseline and between 7% and 8% at the next assessments. Factors suggestive of contributing to higher OOP costs and OOP burden were the following: younger age, lower income, time in survivorship from diagnosis, and use of supportive services. OOP costs burden rural breast cancer survivors, particularly those who are younger and low income. Research should investigate the impact of OOP costs and interventions to reduce economic burden.
authors.affiliation: Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Maria
authors.identifier: 0000-0001-9329-3268
authors.initials: M
authors.lastname: Pisu
authors.affiliation: Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.|School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Andres
authors.initials: A
authors.lastname: Azuero
authors.affiliation: School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Rachel
authors.initials: R
authors.lastname: Benz
authors.affiliation: Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.|School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.|Kirchner Group, Birmingham, Alabama.
authors.forename: Patrick
authors.initials: P
authors.lastname: McNees
authors.affiliation: Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.|School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Karen
authors.initials: K
authors.lastname: Meneses
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D012424:Rural Population; D011795:Surveys and Questionnaires; D017741:Survivors
keywords: Burden; Cancer; costs; economics; out-of-pocket costs; rural; survivorship