Cross-sectional studycited by the Tayebat archiveabstract only checked A-CHM-19 standard review
Cancer treatment costs strain even insured US patients
The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience.
Overview
Zafar SY et al.. Oncologist 2013 · PMID 23442307 · DOI 10.1634/theoncologist.2012-0279
42% reported a heavy financial burden and many skipped medicines to save money.
Does the study support the specific claim? Yes · Methodological quality: low
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Describe financial toxicity.
- How was the study done?
Survey.
- How many people, animals or samples were studied?
254.
- What was actually found?
High burden.
- How large was the observed effect?
42% significant burden.
- What do the results mean in everyday life?
Ask about financial support services.
- What are the study's limitations?
Selected sample.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Low.
- What can explicitly not be concluded from this study?
Situation in Germany/Egypt.
Scientific in-depth review
1. Full reference
- Authors
- Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP
- Journal
- Oncologist
- Year
- 2013
- Identifier
- PMID 23442307 DOI 10.1634/theoncologist.2012-0279 · PMC3639525
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Disclosures of potential conflicts of interest may be found at the end of this article.
2. Research question
Out-of-pocket burden among insured cancer patients seeking copayment assistance.
3. Study design and population
- Study design
- Cross-sectional study – Survey-based pilot study (baseline and follow-up)
- Population
Insured US cancer patients contacting a copay foundation plus academic-centre comparison
- Country
USA
- Period
not stated
- Sample size
254
- Inclusion and exclusion criteria
Insured cancer patients
4. Methods and endpoints
- Exposure / intervention
Out-of-pocket costs
- Comparator
Non-applicants
- Endpoints
Subjective financial burden; cost-coping behaviours
- Statistical methods
Descriptive; adjusted analysis
5. Actual results
- Results
42% significant/catastrophic burden; 20% took less medication than prescribed; 19% partially filled; 24% did not fill prescriptions; 98% vs 78% used >=1 cost-coping strategy.
- Absolute risks
not applicable
- Authors' conclusion
Insurance does not eliminate financial distress; patients alter care to save money.
6. Strengths
- Documents a real problem
7. Weaknesses
- Pilot, selected sample
- US-specific
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- high
- Rationale
Selected sample seeking aid.
9. Assessment of the statistical interpretation
Descriptive.
10. Relevance to the specific claim
Financial toxicity.
11. Independent contrary findings
12. Transferability to Germany and Europe
Low (statutory health insurance in Germany; different system in Egypt).
13. Overall methodological judgement
Valid but setting-specific.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | low |
| Risk of bias | high |
| Precision of results | low |
| Directness | direct |
| Reproducibility | unknown |
| Consistency with the overall evidence | unknown |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
Data for Egypt.
15. Linked fact checks
- Cancer treatment causes 'financial toxicity' even for insured patients, leading some to skip medication. – Studies supporting the claim
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
Listed in bibliography (financial toxicity).
- A. What was actually studied?
Financial burden.
- B. What did the authors find?
High burden; non-adherence for cost.
- C. What conclusions do the authors themselves draw?
Insurance not enough.
- D. What does the archive derive from it?
Cost burden of treatment.
- E. Is this derivation scientifically justified?
Yes for the US; limited transferability to Germany or Egypt.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete