Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2026

Out-of-pocket costs and treatment compromise among Australians affected by cancer: a national mixed-methods study (146154)

Drew Meehan 1 2 , Kate Whittaker 1 , Megan Varlow 1 3 , Amanda McAtamney 1 , Anupriya Agarwal 4 , Deme Karikios 4 5 , Fiona Wiseman 6 , Louisa Collins 7
  1. Cancer Council Australia, Sydney
  2. La Trobe Unversity, Bundoora
  3. Deakin University, Burwood
  4. Sydney Medical School, University of Sydney, Sydney
  5. Nepean Cancer and Wellness Centre, Nepean Hospital, Kingswood
  6. Peter McCallum Cancer Centre, Parkville
  7. Cancer Council Queensland, Fortitude Valley

Background
Financial toxicity is increasingly recognised as a major consequence of cancer care; however, contemporary Australian data describing the breadth of out-of-pocket costs and their impact on treatment decisions remain limited. This study quantified cancer-related out-of-pocket costs, identified key cost drivers, and explored patient experiences of financial burden.

Methods
A national cross-sectional online survey of Australian adults diagnosed with cancer was conducted between November 2024 and January 2025. Quantitative data captured out-of-pocket expenditure across direct and indirect cost categories, healthcare utilisation, and demographic and clinical characteristics. Generalised linear and two-part regression models were used to analyse costs. Free-text responses were analysed using inductive thematic analysis to explore experiences of financial burden and potential treatment modification.

Results
Almost all participants (98.8%) reported cancer-related out-of-pocket costs. Median three-month costs were $1,255 (IQR $400-3,920) for people who reported receiving care in private facilities and/or using private health insurance (private), $515 (IQR $200-1,700) for people who received care exclusively in public hospitals (public), and $970 (IQR $300-3,600) for mixed users. After adjustment, total out-of-pocket costs did not differ significantly by healthcare system. However, private users were more likely to incur specialist care costs (OR 5.88, 95% CI 2.56-14.29) and hospitalisation costs (OR 33.3, 95% CI 5.56-100.0) than public users. Medication costs were common across all groups. Qualitative analysis demonstrated substantial financial burden from income loss, travel, accommodation and treatment-related expenses. Notably, 15.3% of participants reported delaying, reducing or foregoing aspects of recommended care because of financial constraints.

Conclusions
Out-of-pocket costs affect almost all Australians affected by cancer, regardless of healthcare setting. While the drivers of expenditure vary across healthcare pathways, financial burden remains pervasive and may contribute to treatment compromise. These findings highlight the need for improved financial protection, cost transparency and implementation of informed financial consent in cancer care.