Out-of-pocket expenses experienced by rural Western Australians diagnosed with cancer

Jade C. Newton, Claire E. Johnson, Harry Hohnen, Max Bulsara, Angela Ives, Sandy McKiernan, Violet Platt, Ruth McConigley, Neli S. Slavova-Azmanova, Christobel Saunders

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37 Citations (Scopus)


Purpose: Out-of-pocket expenses (OOPE) can have a significant impact on patients’ experiences of cancer treatment. This cross-sectional study sought to quantify the OOPEs experienced by rural cancer patients in Western Australia (WA), and determine factors that contributed to higher OOPE. Methods: Four hundred people diagnosed with breast, lung, colorectal or prostate cancer who resided in selected rural regions of WA were recruited through the WA Cancer Registry and contacted at least 3 months after diagnosis to report the medical OOPE (such as surgery or chemotherapy, supportive care, medication and tests) and non-medical OOPE (such as travel costs, new clothing and utilities) they had experienced as a result of accessing and receiving treatment. Bootstrapped t tests identified demographic, financial and treatment-related factors to include in multivariate analysis, performed using log-linked generalised linear models with gamma distribution. Results: After a median 21 weeks post-diagnosis, participants experienced an average OOPE of AU$2179 (bootstrapped 95% confidence interval $1873–$2518), and 45 (11%) spent more than 10% of their household income on these expenses. Participants likely to experience higher total OOPE were younger than 65 years (p = 0.008), resided outside the South West region (p = 0.007) and had private health insurance (PHI) (p < 0.001). Conclusions: Rural WA cancer patients experience significant OOPE following their diagnosis. The impact these expenses have on patient wellbeing and their treatment decisions need to be further explored.

Original languageEnglish
Pages (from-to)3543-3552
Number of pages10
JournalSupportive Care in Cancer
Issue number10
Publication statusPublished - Oct 2018


  • Cancer
  • Cross-sectional study
  • Financial toxicity
  • Health expenditure
  • Western Australia

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