Nonmedical Costs in Patients Receiving Oral Cancer Surgery: Interim Analysis from the COOLS Trial

Abstract

Objectives:

1) Describe the non-medical financial burden experienced by early-stage oral cancer patients. 2) Analyze constituent costs and discover relevant potential policy levers.

Methods:

The pan-Canadian Optically-guided Oral Lesions Surgical (COOLS) Trial is a multi-center randomized controlled trial evaluating a novel surgical staging method for the treatment of early-stage oral cancer. A survey of 209 participants collected data at baseline, 3 months, and 12 months after surgery on time taken away from work and expenses paid out of pocket.

Results:

Participants were generally able to return to work following surgery, albeit with a slight reduction in self-reported ability to work. Very few patients needed to take time off work or changed their working status (ie, going on medical leave, retiring) following their surgery (n = 4; 10 weeks; range = 5 - 146 days). A majority of trial participants reported out-of-pocket spending at baseline (n = 128; $64.55; 95% confidence interval [CI] $40 - $88), 3 months (n = 108; $82.44; 95% CI $56 - $109), and 12 months after surgery (n = 51; $65.01; 95% CI $13 - $117). Most out of pocket expenses were non-reimbursed travel costs.

Conclusions:

Oral cancer, when treated at an early stage, was not generally a barrier to returning to work in our participant sample. Moderate out-of-pocket expenditure was observed in a large number of patients, mostly related to travelling. Programs to defray the cost of travel may be helpful in many cases, but broader evidence is needed.