FCRP Policy Statement

The costs to families when one of its members has cancer can be substantial. According to findings from the Family Caregiver Research project at Michigan State University, which has followed 191 family caregivers and their patients with cancer, virtually all families experience some personal costs associated with cancer care. The costs are in addition to those paid for by their insurance. Four categories of cost are described:

1. Out-of-Pocket expenses not paid for by insurance: hospital, physician, nursing home, medications, Visiting Nurse, home health aid, special equipment, special supplies, special foods/supplements, all other care-related expenditures.
2. Estimated labor costs of caregiver services: hours spent caregiving during 3 months multiplied by $10.00 (estimated market value of "typical" caregiving services per hour - U.S. Department of Mental Health)
3. Estimated labor costs of services of all other family members: hours performing caregiving tasks during 3 months by family members multiplied by $10.00
4. Estimated loss of wages and salaries by patient and caregiver:
   • For non-spouses: patient and/or caregiver income divided by 52 weeks and multiplied by weeks without payment during 3-month period
   • For spouses: couple's income divided according to the following: both work full-time or both part-time = 50%/50%; only one spouse works = 100%/0%; one spouse full time, the other part-time = 70%/30%; weighted income is then used

Table: A 3-Month Average Out-of-Pocket Costs to Family (N = 191)

Number of dependencies in Activities of Daily Living (eating, bathing, dressing, toileting, transferring chair to bed) were related significantly to all four categories of expenses. Out-of-pocket expenses were NOT related to site of the cancer or to type of treatment. Thus, family costs for care were related to patients' loss of function, which required family care. Living arrangements had a significant impact upon the category of out-of-pocket expenditures: 1) when caregiver and patient live apart, total out-of-pocket expenditures are greatest; 2) when caregiver and patient live alone, total out-of-pocket costs are lowest and most costs are due to caregiver labor; and 3) when caregiver, patient, and children (under 18) live together, lost income is highest. Thus, age, living arrangements, and loss of patient function are key predictors of the impact of cancer on family costs of care.

This research supported by grant #PBR-32A, Family Homecare for Cancer Patients and by grant #RO1 NR01915, Family Homecare for Cancer - A Community-Based Model. Correspondence should be addressed to Dr. Charles W. Given, Department of Family Practice, B108 Clinical Center, or Dr. Manfred Stommel, College of Nursing, A230 Life Sciences Building, Michigan State University, East Lansing, MI 48824-1213.