Kelvin Kar-Wing Chan, MD, PhD, a medical oncologist and Associate Scientist at Odette Sunnybrook Health Sciences Centre, Toronto, commented that from the patient’s perspective, rising cancer costs can lead to financial hardship, whether material (ie, medical debts and bankruptcy) or psychological (ie, feelings of distress and decreased quality of life). Higher out-of-pocket costs can also lead to coping mechanisms such as skipping or taking less medication and may have impacted the use of other health services, according to Dr. Chan, who noted that in comparison to persons without a history of cancer, cancer survivors have a higher prevalence of high out-of-pocket burden.

“This is a very important study because it’s providing empiric evidence that out-of-pocket cost is associated with reduced survival,” Dr. Chan observed. “Nevertheless, we need to be cautious because the sample size is relatively small, especially when compared with the number of confounding factors that need to be adjusted for.”

“Dr. Goulart quite appropriately pointed out that a larger representative sample confirmation study is required,” continued Dr. Chan. “In addition, it would be interesting to expand this study to other cancer types to see if other cancer drugs with different pricing structures and out-of-pocket costs had the same associations with survival.” ■

DISCLOSURE: Dr. Chan reported no conflicts of interest.