Patients With Cancer Engaging in Administrative Payment Tasks May Choose to Delay or Not Adhere to Treatment


Patients with cancer and survivors of cancer that had engaged in administrative tasks to effectively estimate costs or pay for care was associated with an 18% increase in cost-related treatment delays or treatment nonadherence.

In many ways, despite the multifaceted communication between patients, their health care providers, and insurance companies, the US health care system is not set up to help patients navigate the financial aspects of treatment, according to study investigators who published their research in Cancer Epidemiology, Biomarkers & Prevention. The burden of learning about the costs of care and the correction of billing and financial errors primarily falls on patients.

Female patient with cancer receiving chemotherapy treatment

Image credit: RFBSIP |

“It’s fairly unique to our for-profit US health care system for the consumer to be responsible for acquiring the knowledge and skills needed to effectively use those goods or services and to ensure they’re of high quality,” said lead study author Meredith Doherty, PHD, LCSW, assistant professor at the University of Pennsylvania School of Social Policy and Practice, in a press release. “In the United States, health care is largely treated as a consumer product, so the onus is on the consumer.”

Previous research has indicated that US health care patients feel the administrative burdens of navigating the health care system affects the overall care that they receive. Doherty and the current study authors examine this among patients with cancer and patients who had survived cancer to further define the relationship between administrative tasks and delays in or nonadherence to treatment.

The recent cross-sectional study gathered information from both patients who survived cancer and patients with cancer about their engagement in payment-related administrative tasks, as well as their experience with treatment delays or nonadherence due to cost-related issues. A total of 510 responses were gathered from patients with breast, colorectal, lung, or prostate cancer, patients with other cancers, and survivors of cancer.

The participants recorded if they never, rarely, sometimes, often, or always dealt with administrative burdens associated with their care (eg, estimated the out-of-pocket costs prior to agreeing to treatment and found out about out-of-pocket costs prior to filling prescriptions and receiving lab tests or scans, appealed a denial of benefits from their insurance company, or asked insurance company for assistance understanding coverage) and treatment delay or nonadherence behaviors (eg, postponed or skipped doctor’s appointments, follow-up testing, bloodwork, and filling prescriptions, or skipped doses of prescribed drugs).

The survey results indicated that 55% of participants had never or rarely engaged in administrative tasks. Adjustments were made to take participants’ age and estimated monthly out-of-pocket care costs into consideration, and each unit increase of administrative burden (additional tasks or increasing frequency of tasks) was associated with a 32% higher occurrence of treatment delays or nonadherence.

Furthermore, monthly out-of-pocket costs and age, race and ethnicity were more strongly associated with delays in treatment or nonadherence compared to administrative burden. Compared to other racial groups, African American patients were more likely to engage in administrative tasks and experience treatment delays or nonadherence. The data suggests that administrative burdens may impair existing health disparities within these marginalized populations.

“For those who do engage [with this administrative burden], there’s frustration, exhaustion, and I think a sense of alienation,” said Doherty in the press release. “If you send me a bill erroneously and can’t help me correct it, you’re showing me you don’t care about me.”

The study did not include uninsured patients, did not classify patients by insurance type, and did not attempt to measure and account for health care literacy. Another limitation includes the voluntary survey design, which allows the possibility for selection bias and recall bias, particularly among those with a larger duration of time between their initial cancer diagnosis and survey participation.

Doherty notes that this work has the potential to help offshoot further studies and conversations about how to begin simplifying the system. “I think we’re at a place now where we may want to quantify how much improvement in outcomes we might see if we alleviated some of these administrative burdens,” she said in the press release.


American Association for Cancer Research. Engaging in Administrative Payment Tasks May Correlate With Treatment Delays and Nonadherence in Cancer Care. [In email] News release. August 30, 2023. Accessed August 28, 2023.

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