{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:13:17Z","timestamp":1792782797533,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"The University of Sydney","id":[{"id":"https:\/\/ror.org\/0384j8v12","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cancer can impose substantial financial strain on patients and their families, particularly through high out-of-pocket healthcare costs. This study aims to compare out-of-pocket and catastrophic healthcare expenditures among individuals with cancer, those with non-cancer chronic conditions, and healthy individuals, and to identify socio-demographic and health-related factors associated with higher financial burden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from four waves of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Two-part and random-effects logistic regression models were used to examine associations between cancer status and total out-of-pocket and catastrophic healthcare expenditures, adjusting for socio-demographic characteristics and health service utilisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Cancer patients had significantly higher financial burden than both healthy individuals and those with non-cancer chronic conditions. Compared to healthy individuals, cancer patients had 15% higher out-of-pocket healthcare expenditures (95% CI: 1.09\u20131.22) and 1.05 times higher odds of experiencing catastrophic health expenditure (95% CI: 1.03\u20131.06). When compared to individuals with non-cancer chronic conditions, cancer patients had 11% higher out-of-pocket healthcare expenditure (95% CI: 1.06\u20131.17) and 1.03 times higher odds of experiencing catastrophic spending (95% CI: 1.01\u20131.05). Key factors associated with higher odds of catastrophic healthcare expenditure included older age, long-term disability, lower household income, and higher education attainment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cancer patients had higher out-of-pocket healthcare costs and higher odds of catastrophic healthcare expenditure than comparison groups. These findings highlight the need for targeted supportive care strategies and policy interventions to reduce the financial burden associated with cancer and promote equitable access to care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00520-026-11007-z","type":"journal-article","created":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T06:42:57Z","timestamp":1786171377000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The financial burden of cancer: A longitudinal analysis of out-of-pocket healthcare costs in Australia (2009\u20132021)"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0831-9046","authenticated-orcid":false,"given":"Mohammad Afshar","family":"Ali","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7550-6837","authenticated-orcid":false,"given":"Christine Y.","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"issue":"8","key":"11007_CR1","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1016\/S1470-2045(12)70211-5","volume":"13","author":"F Bray","year":"2012","unstructured":"Bray F et al (2012) Global cancer transitions according to the Human Development Index (2008\u20132030): a population-based study. Lancet Oncol 13(8):790\u2013801","journal-title":"Lancet Oncol"},{"issue":"6","key":"11007_CR2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0199598","volume":"13","author":"P Richard","year":"2018","unstructured":"Richard P, Walker R, Alexandre P (2018) The burden of out of pocket costs and medical debt faced by households with chronic health conditions in the United States. PLoS ONE 13(6):e0199598","journal-title":"PLoS ONE"},{"issue":"9378","key":"11007_CR3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/S0140-6736(03)13861-5","volume":"362","author":"K Xu","year":"2003","unstructured":"Xu K et al (2003) Household catastrophic health expenditure: a multicountry analysis. Lancet 362(9378):111\u2013117","journal-title":"Lancet"},{"issue":"5","key":"11007_CR4","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1002\/cam4.657","volume":"5","author":"MS Landwehr","year":"2016","unstructured":"Landwehr MS et al (2016) The cost of cancer: a retrospective analysis of the financial impact of cancer on young adults. Cancer Med 5(5):863\u2013870","journal-title":"Cancer Med"},{"issue":"6","key":"11007_CR5","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1007\/s40258-021-00672-2","volume":"19","author":"L Doshmangir","year":"2021","unstructured":"Doshmangir L et al (2021) Incidence of catastrophic health expenditure and its determinants in cancer patients: a systematic review and meta-analysis. Appl Health Econ Health Policy 19(6):839\u2013855","journal-title":"Appl Health Econ Health Policy"},{"issue":"1","key":"11007_CR6","volume":"26","author":"L Gordon","year":"2017","unstructured":"Gordon L et al (2017) Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur J Cancer Care 26(1):e12392","journal-title":"Eur J Cancer Care"},{"issue":"6","key":"11007_CR7","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1071\/PY18003","volume":"24","author":"LG Gordon","year":"2019","unstructured":"Gordon LG et al (2019) Patient out-of-pocket medical expenses over 2 years among Queenslanders with and without a major cancer. Aust J Prim Health 24(6):530\u2013536","journal-title":"Aust J Prim Health"},{"key":"11007_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13561-019-0227-9","volume":"9","author":"EJ Callander","year":"2019","unstructured":"Callander EJ, Fox H, Lindsay D (2019) Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system. Health Econ Rev 9:1\u20138","journal-title":"Health Econ Rev"},{"issue":"2","key":"11007_CR9","doi-asserted-by":"publisher","first-page":"e169","DOI":"10.1016\/S2214-109X(17)30429-1","volume":"6","author":"A Wagstaff","year":"2018","unstructured":"Wagstaff A et al (2018) Progress on catastrophic health spending in 133 countries: a retrospective observational study. Lancet Glob Health 6(2):e169\u2013e179","journal-title":"Lancet Glob Health"},{"key":"11007_CR10","unstructured":"Parliament of Australia (2014) Out-of-pocket costs in Australian healthcare. Commonwealth of Australia, Canberra"},{"issue":"7","key":"11007_CR11","doi-asserted-by":"publisher","first-page":"475","DOI":"10.5694\/mja12.11638","volume":"199","author":"F Yusuf","year":"2013","unstructured":"Yusuf F, Leeder SR (2013) Can\u2019t escape it: the out-of-pocket cost of health care in Australia. Med J Aust 199(7):475\u2013478","journal-title":"Med J Aust"},{"key":"11007_CR12","unstructured":"Australian Institute of Health and Welfare (2024) Health expenditure Australia 2022\u201323. AIHW, Canberra"},{"issue":"1","key":"11007_CR13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1071\/PY16005","volume":"23","author":"EJ Callander","year":"2017","unstructured":"Callander EJ, Corscadden L, Levesque J-F (2017) Out-of-pocket healthcare expenditure and chronic disease\u2013do Australians forgo care because of the cost? Aust J Prim Health 23(1):15\u201322","journal-title":"Aust J Prim Health"},{"key":"11007_CR14","unstructured":"Australian Bureau of Statistics (2024) Patient Experiences. 2023-24"},{"issue":"4","key":"11007_CR15","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1080\/14737167.2025.2451140","volume":"25","author":"MA Ali","year":"2025","unstructured":"Ali MA, Noghrehchi F, Lu CY (2025) The short-term impact of copayment reductions for government subsidised medicines in Australia. Expert Rev Pharmacoecon Outcomes Res 25(4):567\u2013576","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"issue":"1","key":"11007_CR16","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1071\/AH14087","volume":"39","author":"T-L Laba","year":"2014","unstructured":"Laba T-L et al (2014) Co-payments for health care: what is their real cost? Aust Health Rev 39(1):33\u201336","journal-title":"Aust Health Rev"},{"issue":"8","key":"11007_CR17","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1002\/hec.3376","volume":"26","author":"CY Wong","year":"2017","unstructured":"Wong CY et al (2017) The rise and fall in out-of-pocket costs in Australia: an analysis of the strengthening Medicare reforms. Health Econ 26(8):962\u2013979","journal-title":"Health Econ"},{"issue":"1","key":"11007_CR18","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1515\/bejeap-2014-0016","volume":"15","author":"J Du","year":"2015","unstructured":"Du J, Yagihashi T (2015) Health care use, out-of-pocket expenditure, and macroeconomic conditions during the Great Recession. B E J Econ Anal Policy 15(1):119\u2013156","journal-title":"B E J Econ Anal Policy"},{"issue":"6","key":"11007_CR19","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1016\/j.jpolmod.2018.02.006","volume":"40","author":"N Grigorakis","year":"2018","unstructured":"Grigorakis N et al (2018) Macroeconomic and financing determinants of out of pocket payments in health care: evidence from selected OECD countries. J Policy Model 40(6):1290\u20131312","journal-title":"J Policy Model"},{"issue":"6","key":"11007_CR20","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1002\/pon.4239","volume":"26","author":"J Boyages","year":"2017","unstructured":"Boyages J et al (2017) Financial cost of lymphedema borne by women with breast cancer. Psychooncology 26(6):849\u2013855","journal-title":"Psychooncology"},{"issue":"1","key":"11007_CR21","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1093\/swr\/svy027","volume":"43","author":"RJ McNeil","year":"2018","unstructured":"McNeil RJ et al (2018) Financial challenges of cancer for adolescents and young adults and their parent caregivers. Soc Work Res 43(1):17\u201330","journal-title":"Soc Work Res"},{"issue":"10","key":"11007_CR22","doi-asserted-by":"publisher","first-page":"3543","DOI":"10.1007\/s00520-018-4205-2","volume":"26","author":"JC Newton","year":"2018","unstructured":"Newton JC et al (2018) Out-of-pocket expenses experienced by rural Western Australians diagnosed with cancer. Support Care Cancer 26(10):3543\u20133552","journal-title":"Support Care Cancer"},{"key":"11007_CR23","unstructured":"Consumers Health Forum (2018) Out of pocket pain: research report. Deakin"},{"issue":"2","key":"11007_CR24","doi-asserted-by":"publisher","first-page":"94","DOI":"10.5694\/mja2.52367","volume":"221","author":"DE Goldsbury","year":"2020","unstructured":"Goldsbury DE et al (2020) Out\u2010of\u2010pocket health care expenses for people with and without cancer, New South Wales, 2020: a cross\u2010sectional study. Med J Aust 221(2):94\u2013102","journal-title":"Med J Aust"},{"key":"11007_CR25","doi-asserted-by":"crossref","unstructured":"Donato R, Scotton R (2020) The Australian health care system. In: Economics and Australian health policy. Routledge, pp 20\u201339","DOI":"10.4324\/9781003115441-2"},{"key":"11007_CR26","unstructured":"Australian Institute of Health and Welfare, Health system overview. (2024)."},{"key":"11007_CR27","unstructured":"Department of Human Services (2019) Medicare safety net 2019 table of thresholds"},{"key":"11007_CR28","doi-asserted-by":"crossref","unstructured":"Watson N (2021) Finding your way around the HILDA survey data. Aust Econ Rev 54(4): 554\u2013564","DOI":"10.1111\/1467-8462.12437"},{"issue":"1","key":"11007_CR29","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s12939-022-01712-6","volume":"21","author":"N Sheikh","year":"2022","unstructured":"Sheikh N et al (2022) Disease-specific distress healthcare financing and catastrophic out-of-pocket expenditure for hospitalization in Bangladesh. Int J Equity Health 21(1):114","journal-title":"Int J Equity Health"},{"issue":"6","key":"11007_CR30","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.clgc.2023.05.016","volume":"21","author":"BV Stone","year":"2023","unstructured":"Stone BV et al (2023) The risk of catastrophic healthcare expenditures among prostate and bladder cancer survivors in the United States. Clin Genitourin Cancer 21(6):617\u2013625","journal-title":"Clin Genitourin Cancer"},{"issue":"3","key":"11007_CR31","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/j.1475-4991.1997.tb00222.x","volume":"43","author":"K de Vos","year":"1997","unstructured":"de Vos K, Zaidi MA (1997) Equivalence scale sensitivity of poverty statistics for the member states of the European community. Rev Income Wealth 43(3):319\u2013333","journal-title":"Rev Income Wealth"},{"key":"11007_CR32","unstructured":"Reserve Bank of Australia (2024) Measures of consumer price inflation"},{"issue":"8","key":"11007_CR33","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1002\/hec.1653","volume":"20","author":"B Mihaylova","year":"2011","unstructured":"Mihaylova B et al (2011) Review of statistical methods for analysing healthcare resources and costs. Health Econ 20(8):897\u2013916","journal-title":"Health Econ"},{"issue":"7243","key":"11007_CR34","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1136\/bmj.320.7243.1197","volume":"320","author":"SG Thompson","year":"2000","unstructured":"Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320(7243):1197\u20131200","journal-title":"BMJ"},{"issue":"6","key":"11007_CR35","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1002\/cncr.27848","volume":"119","author":"AJ Davidoff","year":"2013","unstructured":"Davidoff AJ et al (2013) Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer 119(6):1257\u20131265","journal-title":"Cancer"},{"key":"11007_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-017-2047-0","volume":"17","author":"AA Molla","year":"2017","unstructured":"Molla AA, Chi C, Mondaca ALN (2017) Predictors of high out-of-pocket healthcare expenditure: an analysis using Bangladesh household income and expenditure survey, 2010. BMC Health Serv Res 17:1\u20138","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"11007_CR37","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1089\/jwh.2023.0121","volume":"33","author":"UE Okoro","year":"2024","unstructured":"Okoro UE et al (2024) Trends in health care coverage and out-of-pocket cost barriers: a gender comparison. J Womens Health (Larchmt) 33(4):473\u2013479","journal-title":"J Womens Health (Larchmt)"},{"issue":"1","key":"11007_CR38","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0262900","volume":"17","author":"AR Sarker","year":"2022","unstructured":"Sarker AR et al (2022) Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh. PLoS ONE 17(1):e0262900","journal-title":"PLoS ONE"},{"issue":"1","key":"11007_CR39","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12889-015-1393-2","volume":"15","author":"F Yuan","year":"2015","unstructured":"Yuan F et al (2015) Analysis of awareness of health knowledge among rural residents in Western China. BMC Public Health 15(1):55","journal-title":"BMC Public Health"},{"issue":"5","key":"11007_CR40","doi-asserted-by":"publisher","first-page":"2422","DOI":"10.3390\/ijerph18052422","volume":"18","author":"A Bygrave","year":"2021","unstructured":"Bygrave A et al (2021) Australian experiences of out-of-pocket costs and financial burden following a cancer diagnosis: a systematic review. Int J Environ Res Public Health 18(5):2422","journal-title":"Int J Environ Res Public Health"},{"key":"11007_CR41","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.112364","volume":"235","author":"AS Kumara","year":"2019","unstructured":"Kumara AS, Samaratunge R (2019) Relationship between healthcare utilization and household out-of-pocket healthcare expenditure: evidence from an emerging economy with a free healthcare policy. Soc Sci Med 235:112364","journal-title":"Soc Sci Med"},{"key":"11007_CR42","doi-asserted-by":"publisher","first-page":"4739","DOI":"10.1007\/s00520-016-3323-y","volume":"24","author":"C Paul","year":"2016","unstructured":"Paul C et al (2016) The impact of cancer diagnosis and treatment on employment, income, treatment decisions and financial assistance and their relationship to socioeconomic and disease factors. Support Care Cancer 24:4739\u20134746","journal-title":"Support Care Cancer"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11007-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-11007-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-11007-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:02:08Z","timestamp":1790362928000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-026-11007-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,8]]},"references-count":42,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["11007"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-11007-z","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,8]]},"assertion":[{"value":"12 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"835"}}