Clinical Oncology Letters
Clinical Oncology Letters
Estudo Piloto

Out-of-pocket costs for cancer patients treated at the Brazilian public health system (SUS) and for their caregivers: A pilot study

Custos adicionais para pacientes tratados pelo sistema público de saúde brasileiro (SUS) e seus cuidadores: Um estudo piloto

Zaremba G, Pispico BC, Assis WB, Hayek TK, Matushita TT, Garcia MA, Camargo CR, Inyoung Noh, Trufelli DC, del Giglio A

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Background: The economic burden of cancer care extends beyond public or private payors to patients and caregivers. Additional out-of-pocket costs (OPC) include drugs, supplies, transportation, in addition to lost hours of work. Our goal was to evaluate the amount and nature of these costs from the perspective of caregivers and patients treated at the Brazilian Public Health System (SUS). Patients and Methods: We conducted this cross-sectional study at the oncology clinics of the ABC Foundation School of Medicine. We included patients older than 18 years with a confirmed diagnosis of cancer and their caregivers who responded to a questionnaire that assessed the time spent and financial costs incurred with transportation, medicines, food and other supplies. Results: From February to May 2015, we included 57 non-consecutive patients with various types of tumors and their 47 caregivers. The average age of patients was 57 years (23-92) and of caregivers 46 years (21-83). The average monthly income of both groups was approximately two times the minimum wage (R$ 1,576.00). We estimated that the mean OPC for patients was R$290,41 and R$312,65 for their caregivers (One US dollar = R$2.89). In multivariate analysis, the only variables related to higher patient OPC were younger age (p = 0,0079) and receipt of active treatment (p = 0.0321). We also observed significant correlation between the OPC incurred by patients and caregivers (p = 0.0022) Conclusion: patients and caregivers OPC represent a substantial portion of their income. Public health officials need to recognize and cover OPC, especially for low-income patients.


Cancer, health expenditures, healthcare economics and organizations, caregivers, costs and cost analysis


1. Inca. Estimativa 2014 - Incidência de Câncer no Brasil [Internet]. Available from: Acessed: 24 May 2015.

2. Sharp L, Timmons A. The financial impact of a cancer diagnosis.; 2010; Available from: Acessed: 24 May 2015.

3. Houts PS, Lipton A, Harvey HA, et al. Nonmedical costs to patients and their families associated with outpatient chemotherapy. Cancer. 1984 Jun 1;53(11):2388–92.

4. Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011 May 21;377(9779):1778–97.

5. Sharp L, Carsin A-E, Timmons A. Associations between cancer-related financial stress and strain and psychological well-being among individuals living with cancer. Psychooncology. 2013 Apr;22(4):745–55.

6. Timmons A, Gooberman-Hill R, Sharp L. “It’s at a time in your life when you are most vulnerable”: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One. 2013 Nov 11;8(11):e77549.

7. Zafar SY, Peppercorn JM, Schrag D, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist. 2013 Feb 26;18(4):381–90.

8. Bestvina CM, Zullig LL, Rushing C, et al. Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract. 2014 May;10(3):162–7.

9. Mahal A, Karan A, Fan VY, Engelgau M. The economic burden of cancers on Indian households. PLoS One. 2013 Aug 12;8(8):e71853.

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