Chemotherapy-induced toxicities often adversely affect patients’ health
and treatment plans, and can result in large costs for treatment and care. In
addition to the costs associated with direct medical care, a large amount of
indirect and out-of-pocket costs can be incurred.
However, to date, there is surprisingly limited literature on the total
costs of care associated with cancer chemotherapy-related toxicities. Most of
the studies in this area have evaluated the costs paid by the insurer (direct
medical costs), and few have attempted to assess the indirect costs that are
often borne by the patient, family, and caregivers.
Assessing these costs requires detailed and comprehensive information about
patient and caregiver work loss, changes in work productivity, and the value of
resources used to care for patients with such toxicities. This indirect cost
information cannot be abstracted directly from patients’ charts and usually
requires input directly from the patient and family and friends who assist in
In a pilot study examining the costs of treatment for 83 ovarian cancer
patients, we attempted to evaluate the feasibility of assessing the total
direct and indirect costs incurred. Comprehensive cost information was
collected for each patient via questionnaires that were filled out at regular
intervals regarding the resources used for treatment and patient care for each
episode of toxicity (Calhoun EA, Chang C-H, Welshman EE, et al: Evaluating the
total costs of chemotherapy-induced toxicity: Results from a pilot study with
ovarian cancer patients. The Oncologist 6:441-445, 2001).
Collection of Data
Ovarian cancer patients who experienced neutropenia (n = 26),
thrombocytopenia (n = 15), or neurotoxicity (n = 42) reported information about
hospitalizations, medications, laboratory tests, physician visits, phone calls,
home visits, medical devices, lost productivity, and caregivers’ expenditures
resulting from toxicity occurrence.
Patients were contacted within 1 month of experiencing the toxicity episode
and were followed for a period of time during which the toxicities were likely
to have had an effect on the patient’s life, as determined by gynecologic
oncologists. Patients experiencing hematologic toxicities were asked to supply
follow-up information after 3 months, while patients experiencing neurotoxicity
were given follow-up interviews every 3 months for 9 months.