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 patient care.
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.