{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:05:39Z","timestamp":1793502339661,"version":"4.5.0"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T00:00:00Z","timestamp":1629763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Reports"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Out\u2010of\u2010pocket costs (OOPC) associated with treatment have significant implications on quality of life and survival in cancer patients. Head and neck cancer patients face unique treatment\u2010related challenges, but to date OOPC have been understudied in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>This study aims to identify and measure OOPC for patients with head and neck cancer (HNC) in Ontario.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>HNC patients between 2015 and 2018 at Princess Margaret Cancer Centre in Toronto were recruited. Participants completed OOPC questionnaires and lost income questions during radiation, post\u2010surgery, and 3, 6, 12, and 24\u2009months after completion of treatment. Associations between OOPC and treatment modality and disease site were tested with multivariable hurdle regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1545 questionnaires were completed by 657 patients. Median estimated OOPC for the total duration of treatment for participants undergoing chemoradiation was $1452 [$0\u201314\u2009616], for surgery with adjuvant radiation or chemoradiation (C\/RT) was $1626, for radiation therapy alone was $635, and for surgery alone was $360. The major expenses for participants at the mid\u2010treatment time\u2010point was travel (mean $424, standard error of the mean [SEM] $34) and meals, parking, and accommodations (mean $617, SEM $67). In multivariable analysis, chemoradiation, surgery with C\/RT, and radiation were associated with significantly higher OOPC than surgery alone during treatment (791% higher, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; 539% higher, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; 370% higher, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001 respectively) among patients with non\u2010zero OOPC. Participants with non\u2010zero OOPC in the laryngeal cancer group paid 49% lower OOPC than those with oropharyngeal cancers in adjusted analysis (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.025).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients undergoing treatment for HNC pay significant OOPC. These costs are highest during treatment and gradually decrease over time. OOPC vary by patient demographics, clinical factors, and, in particular, treatment modality.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cnr2.1528","type":"journal-article","created":{"date-parts":[[2021,8,24]],"date-time":"2021-08-24T13:43:51Z","timestamp":1629812631000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["<scp>Out\u2010of\u2010pocket<\/scp> costs associated with head and neck cancer treatment"],"prefix":"10.1002","volume":"5","author":[{"given":"Mohemmed N.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Otolaryngology \u2010 Head and Neck Surgery Mount Sinai Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Hueniken","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Princess Margaret Cancer Centre  Toronto 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