Counting the cost of cancer: out-of-pocket payments made by colorectal cancer survivors.
Cancer places a significant cost burden on health services. There is increasing recognition that cancer also imposes a financial and economic burden on patients but this has rarely been quantified outside North America. We investigate out-of-pocket costs (OOPCs) incurred by colorectal (CRC) survivors in Ireland.



CRC survivors (ICD10 C18-20) diagnosed 6-30 months previously were identified from the National Cancer Registry Ireland and invited to complete a postal questionnaire. Cancer-related OOPC for tests, procedures, drugs, allied medications and household management in approximately the year following diagnosis were calculated. Robust regression was used to identify predictors of OOPC; this was done for all survivors combined and stratified by age (<70 and ≥70 years) and employment status (working and not working) at diagnosis.



Four hundred ninety-seven CRC survivors completed questionnaires (response rate = 39%). Almost all (90%) respondents reported some cancer-related OOPC. The average total OOPC was €1589. Stage III at diagnosis was associated with significantly higher OOPCs than other stages in the all-survivor model, in those not working in the employment model and in those under 70 years in the age-stratified model. In all-survivor model, those under 70 also had higher OOPCs, as did those in employment. Having one or more children was associated with significantly lower OOPCs in those under 70 years.



Almost all CRC survivors incur cancer-related OOPCs; for some, these are not insignificant. Greater attention should be paid to the development of services to help survivors manage the financial and economic burden of cancer.
National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland. a.oceilleachair@ncri.ie.
Alan
A
Ó Céilleachair
National College of Ireland, IFSC, Dublin 1, Ireland.
Paul
P
Hanly
National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
Máiréad
M
Skally
National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Cork, Ireland.
Eamonn
E
O'Leary
National University of Ireland, Galway, Ireland.
Ciaran
C
O'Neill
School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin 4, Ireland.
Patricia
P
Fitzpatrick
School of Economics and Geary Institute, University College Dublin, Dublin 4, Ireland.
Kanika
K
Kapur
School of Nursing and Human Sciences, Dublin City University, Dublin 9, Ireland.
Anthony
A
Staines
Institute of Health & Society, Newcastle University, Newcastle, UK.
Linda
L
Sharp
D015179:Colorectal Neoplasms / Q000191:economics*; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*
Colorectal cancer; Outcomes; Patient costs; Survivorship