Calculating the burden of cancer is not simple, especially when it comes to nonmedical costs such as patient time lost to cancer care. A study from the January 3 Journal of the National Cancer Institute (JNCI) estimated that in 2005 the value of patient time lost to cancer care was nearly $2.3 billion in the first year following diagnosis alone. This estimate was based on just over 1 million newly diagnosed cancer patients in 2005, millions of hours traveling to and from, waiting for, and receiving treatment, and a median wage rate of $15.23 per hour.

"To our knowledge, this study is the first to estimate net patient time costs over the full course of cancer care, for 11 of the most common cancer sites," said the study's lead author, Dr. Robin Yabroff, an epidemiologist in NCI's Division of Cancer Control and Population Sciences (DCCPS). She and her colleagues used a phase-of-care approach, which distinguishes three clinically relevant phases of care: the initial year after diagnosis, the last year of life, and the continuing or monitoring phase, which includes the time between the initial year and last year of life.

They found that the amount of patient time in the first year after diagnosis varied by tumor site. Many of the cancers that can be screened for, detected early, and treated effectively - such as breast, prostate, and skin cancer - involved less time than did lung, ovarian, and gastric cancers, which are often diagnosed at later stages of disease. These differences by site persist (though are somewhat smaller) in the last year of life.

"Researchers and policy makers tend to forget that time costs are a very real and very human component of the total economic burden of cancer," wrote Drs. Larry G. Kessler of the Food and Drug Administration and Scott D. Ramsey of the Fred Hutchinson Cancer Center, in an accompanying editorial.

The study used Medicare claims from more than 760,000 cancer patients aged 65 and older in the SEER cancer registry between 1995 and 2001 to establish the amount and type of care patients received, including hospitalizations, imaging procedures, office visits, emergency room visits, chemotherapy, radiation therapy, and ambulatory surgeries. Estimates of the time required for each type of service were also developed, using established measures where possible.

The amount and type of care for each category were also estimated for more than 1 million matched Medicare enrollees without cancer. Subtracting those hours from the hours that cancer patients spent resulted in a picture of the burden attributable to cancer.

However, Dr. Yabroff emphasized, these estimates almost certainly underestimate the actual time patients spend receiving cancer care in the U.S. "We only evaluated care and estimated time in individuals aged 65 and older, which we think underestimates time spent by younger patients," she said.

Drs. Kessler and Ramsey agreed, pointing out that younger patients tend to undergo more intensive therapy, and their relative burden is increased because their healthy counterparts spend less time and money on health care when younger. Also excluded from this analysis were time at home preparing for and recovering from treatments, and time spent by family and caregivers.

"Patient time spent receiving cancer care in the United States is substantial," said Dr. Yabroff. "These estimates represent just one component of the burden of cancer, however. In addition to direct medical costs, other components, such as quality of life and lost productivity due to early cancer death are important to our understanding of cancer burden."

By Addison Greenwood