Self-reported financial burden and satisfaction with care among patients with cancer

Abstract

Background: Health care-related costs and satisfaction are compelling targets for quality improvement in cancer care delivery; however, little is known about how financial burden affects patient satisfaction.

Methods: This was an observational, cross-sectional, survey-based study assessing patient-reported financial burden (FB). Eligible patients were ≥ 21 years with solid tumor malignancy and were receiving chemotherapy or hormonal therapy for ≥ 1 month. The Patient Satisfaction Questionnaire Short-Form assessed patient satisfaction with health care. Subjective FB related to cancer treatment was measured on a 5-point Likert scale.

Results: Of 174 participants (32% response rate), 47% reported significant/catastrophic FB. Participants reported highest satisfaction with interpersonal manner and lowest satisfaction with financial aspects of care. In adjusted analysis, high FB was negatively associated with general satisfaction (coefficient: -.29), satisfaction with technical quality (coefficient: -.26), and satisfaction with financial aspects of care (coefficient: -.62). Older age was associated with higher scores in all satisfaction subscales except patient-physician communication and financial aspects. Annual household income of <$20,000 was associated with lower satisfaction scores in all subscales except time spent with doctor. High FB was not associated with patient satisfaction scores for accessibility and convenience, communication, interpersonal manner, or time spent with doctor.

Conclusion: FB is a potentially modifiable correlate of poor satisfaction with cancer care including general satisfaction and satisfaction with the technical quality of care. Addressing cancer-associated FB may lead to improved satisfaction, which in turn can influence adherence, outcomes, and quality of life.

Keywords: Cost of illness; Economics; Health insurance; Neoplasms; Patient satisfaction.

Figure 1.

CONSORT diagram.

Figure 2.

Location of participants by state. No participants from Alaska or Hawaii.

Figure 3.

Patient-reported financial burden (n = 174): 46.6% reported catastrophic or significant financial burden; 50.0% reported moderate, minor, or no financial burden.

Figure 4.

Satisfaction with the Financial Aspects of Care subscale of the Patient Satisfaction Questionnaire Short-Form, by level of financial distress, Likert scale 1–5 (coefficient: −.62; lower to upper bound: −.94 to −.31; p < .01).