How Important Are Out-of-pocket Costs to Rural Patients' Cancer Care Decisions?

Objective: We examined the importance of 5 items (stage of illness, personal feelings, travel costs, drug costs and child care costs) in the cancer treatment decisions of urban and rural residents after they had started treatment for their cancer.

Methods: We surveyed 484 adults who presented for care at cancer clinics in Newfoundland and Labrador from September 2002 to June 2003. Respondents rated the importance of each of the 5 items in their cancer care decisions on a 5-point Likert scale, which was later collapsed into 2 categories, "important" and "not important." We used chi2 tests and multiple logistic regression to compare the responses of urban and rural residents.

Results: In our sample of 484 respondents, there were 258 (53.3%) urban and 226 (46.7%) rural residents. After controlling for other significant predictors, we found that rural residents were more likely to report that travel costs (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.21-2.63), drug costs (OR 1.69, 95% CI 1.13-2.23) and child care costs (OR 2.33, 95% CI 1.09-4.96) were "important" in cancer treatment decisions compared with urban residents. Stage of disease and personal feelings were equally important to urban and rural residents.

Conclusion: Financial impediments disproportionately affect rural residents' decisions about cancer care and highlight the need to ensure that centralized specialist care, such as cancer treatment, is accessible.