FCRP Policy Statement

How can health care professionals predict the amount and cost of health care services used by cancer patients? According to a study conducted by researchers at Michigan State University, disability may be an important predictor of cancer patients' out-of-pocket expenses, physician visits, and days of hospitalization.

A sample of 303 cancer patients and their family caregivers was followed for one year to determine the effect of age, income, surviving versus dying during an observation period, days to death, and functional level on the amount and cost of health care services.

The patients selected for the study were between 20 and 80 years of age and, at the time of recruitment, were receiving treatment for cancer. Patients and their family caregivers were interviewed at the start of the study, halfway through the observation period, and at the end of the study. They were questioned about their dependencies in daily living, family out-of-pocket expenditures for health care, and cancer-specific use of physician office services.

RESULTS:

• There was no significant relationship between age and level of disability, survival status, days to death, or use of health care services.
• Among the patients who died, those with annual incomes greater than $40,000 spent more days in the hospital. Among the patients who survived, there was no relationship between income and days of hospitalization.
• Those who died reported higher levels of disability than survivors.
• Survival time was related to greater use of services (physician visits and length of hospital stays) only when patients experienced high levels of disability.
  • Patients who experienced less than three disabilities in daily functioning and who were closer to death spent more on out-of-pocket and physician visits more than those who are further away from death.
  • In patients with three or more disabilities in daily functioning, those who were further from death spent more on care at home and visited their physicians more frequently with cancer-related problems than those who are closer to death.

CONCLUSIONS:

Patients' level of disability in daily functioning is a better predictor of out-of-pocket expenditures, physician visits, and days of hospitalization than age, income, or survival group status.

POLICY IMPLICATIONS:

Patient disability, immobility, and loss of function should be included when attempting to predict use of health care services and personal expenditures for home care during the last year of life for persons with cancer. By taking patients' disability level into account, health care professionals can better predict when family out-of-pocket expenditures will rise, number of physician visits will increase, and hospitalization can be expected. Recognizing the significance of disability will help health care professionals assist those who are providing care to a family member with cancer. Policies need to be available to assist families through this period of time so that costs are contained and patients' function maintained. Individuals and families currently have almost no protection against the high cost of long-term care.

This research was supported by grants #RO1 CA56338, Rural Partnership Linkage for Cancer Care, funded by the National Cancer Institute, and #PBR-32, Family Homecare for Cancer Patients, funded by the American Cancer Society, Barbara A. Given, Principal Investigator. For additional information, please contact Barbara A. Given, A102 Life Sciences, Michigan State University, East Lansing, MI 48824, (517) 355-6526 or Charles W. Given, B100 Clinical Center, Michigan State University, East Lansing, MI 48824, (517) 353-3843, ext. 433.