Patient time costs associated with cancer care.

Although costs of medical care for cancer have been investigated extensively, patient time costs associated with cancer care have rarely been estimated systematically. In this study, we estimated patient time costs associated with cancer care in patients aged 65 years and older in the United States. We identified 763,527 patients with breast, colorectal, corpus uteri, gastric, head and neck, lung, melanoma of the skin, ovary, prostate, renal, and urinary bladder cancers from linked Surveillance, Epidemiology, and End Results-Medicare files and 1,145,159 noncancer control subjects among Medicare enrollees who were matched by sex, age-group, and geographic location. Frequency of service use was calculated by category for patients and control subjects using Medicare claims data from 1995 to 2001. For each service category, time estimates were combined with service frequency and an hourly value of patient time. Net patient time costs were summed in the initial, continuing, and last-year-of-life phases of care for each tumor site. Net time cost estimates for the initial phase of care were applied to national estimates of numbers of new cancers in 2005 to obtain national time costs for the initial phase of care. Net patient time costs during the initial phase of care ranged from 271 dollars (95% confidence interval [CI] = 213 dollars to 329 dollars) and 842 dollars (95% CI = 806 dollars to 878 dollars) for melanoma of the skin and prostate cancer, respectively, to 5348 dollars (95% CI = 4978 dollars to 5718 dollars) and 5605 dollars (95% CI = 5273 dollars to 5937 dollars) for gastric and ovarian cancers, respectively. Net patient time costs for care during the last year of life ranged from 1509 dollars (95% CI = 1343 dollars to 1675 dollars) for melanoma of the skin to 7799 dollars (95% CI = 7433 dollars to 8165 dollars), 7435 dollars (95% CI = 7207 dollars to 7663 dollars), and 7388 dollars (95% CI = 7018 dollars to 7758 dollars) for gastric, lung, and ovarian cancers, respectively. In 2005, patient time costs for the initial phase of care were 2.3 billion dollars. Patient time costs for cancer care in the United States are substantial and vary by tumor site and phase of care, likely reflecting differences in stage at diagnosis and availability and intensity of treatment.