Hospital parking fees contribute to financial toxicity for cancer patients

Transportation to and from cancer centers for outpatient cancer treatments has been identified as one of the two most impactful out-of-pocket costs that cancer patients and their families incur, along with food costs. In an upcoming issue of the Journal of Medical Imaging and Radiation Sciences, published by Elsevier, a team of radiation oncology resident physicians and a biostatistician from the University of Alberta performed a crosssectional study to assess the parking fees for regional and community cancer centers located in Western Canada to demonstrate correlations between city-specific indices and the cost of parking at cancer centers in western Canadian provinces. They found that hospital parking fees may contribute to suboptimal health outcomes for cancer patients.

Clinicians often fail to recognize and under address financial toxicity, which is an increasingly important aspect of cancer care. It refers to the financial stress and strain experienced by patients and caregivers because of out-of-pocket expenses incurred during cancer treatment. It has been observed that patients alter their decisions regarding the treatment options available to them if there was a financial consequence. In fact, one study found ”hidden” non-medical costs such as parking and transport contributed to an estimated wage loss of around Can$ 3.18 billion for newly diagnosed cancer patients and their families.

For this study, the public parking fees for 115 cancer centers in Western Canada were obtained, including the provinces of Alberta, Manitoba, Saskatchewan, and British Columbia. These were compared against median household income statistics, city-specific cost of living data, and address specific transit scores for each city, as well as the parking fees (or lack thereof) for each center. The authors demonstrated in this study that daily cost of parking significantly correlates with cancer center address transit score and city cost of living across Western Canada. Results from the study were indicative that cities with a higher cost of living have less free parking, which further aggravates the economic burden on patients.

One way to ameliorate this loss of income would be to provide patients who will receive protracted chemotherapy or radiation therapy treatment regimens with subsidized parking or access to transportation vouchers. Another way to mitigate the impact of parking costs on patients would be to implement validated financial toxicity screening scales administered by medical professionals such as radiation therapists, nurses, physicians, and social workers prior to starting their treatment courses. Through early and accurate screening and identification of individuals at high risk of experiencing financial toxicity, patients can then benefit from waived or subsidized parking.

“What’s remarkable about our study is that to our knowledge this is the first time that someone has found significant correlations between daily cost of parking at cancer centers and city-specific indices in Canada. The findings of our study should inform stakeholders and decision-makers to consider the impact of parking-related financial toxicity on vulnerable cancer patients,” explained lead author Mustafa Al Balushi, MD, Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada.

The authors conclude that interventions and strategies on provincial and federal levels should be initiated to address this increasingly problematic burden on oncologic patients. Policy makers and stakeholders should be cognizant of this interplay between the various city-specific indices and parking fees for patients with cancer that impacts the quality of care provided to the patients as well as their cancer outcomes. In addition, increasing awareness among oncology healthcare professionals and the implementation of strategies to capture the patients who are risk of financial toxicity due to parking with the subsequent interventions should be considered.

---

Notes 

The article is “Evaluation of Parking-related Financial Toxicity Associated with Cancer Treatments in Western Canada,” by Mustafa Al Balushi, Michael (Yiming) Zhu, Fan Yang, Yugmel Nijjar, Jordan Hill, and Sunita Ghosh (https://doi.org/10.1016/j.jmir.2022.11.006).It appears online in advance of the Journal of Medical Imaging and Radiation Sciences, volume 54, issue 1 (March 2023), published by Elsevier.

This article is openly available at https://www.jmirs.org/article/S1939-8654(22)00610-5/fulltext.

About the authors

Dr. Mustafa Al Balushi is a final year radiation oncology resident physician at the University of Alberta. He is passionate about affordability and accessibility in cancer care and global oncology. He led a team of radiation oncology resident physicians and a biostatistician at the University of Alberta to undertake this trainee-driven research study. Other projects with which the team is involved include examining the cost implications of a shorter course of radiation for brain cancer patients and the involvement of Canadian radiation medicine professionals in global oncology initiatives.

About the Journal of Medical Imaging and Radiation Sciences (JMIRS)

The Journal of Medical Imaging and Radiation Sciences (JMIRS) is the official bilingual, peer-reviewed journal of the Canadian Association of Medical Radiation Technologists (CAMRT). We aim to influence practice within the rapidly evolving fields of radiological, nuclear medicine, MRI, and ultrasound technologists and radiation therapists, grounded in our circular tagline “research informing practice - informing research.” JMIRS provides an essential platform for Canadian and international medical radiation technologists and therapists to publish and discover their own body of knowledge to define and inform their practice, enabling translation to a global audience. Published by Elsevier, JMIRS is included in MEDLINE and CINAHL. www.jmirs.org

About the Canadian Association of Medical Radiation Technologists (CAMRT)

The Canadian Association of Medical Radiation Technologists (CAMRT) is the national professional association and certifying body for radiological, nuclear medicine and magnetic resonance imaging technologists and radiation therapists. Recognized at home and internationally as a leading advocate for the profession of medical radiation technology, the CAMRT is an authoritative voice on the critical issues that affect its members and their practice. Established in 1942, the CAMRT today represents over 12,000 members. www.camrt.ca

About Elsevier
As a global leader in information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making for customers across the global research and health ecosystems.

In everything we publish, we uphold the highest standards of quality and integrity. We bring that same rigor to our information analytics solutions for researchers, health professionals, institutions and funders.

Elsevier employs 8,700 people worldwide. We have supported the work of our research and health partners for more than 140 years. Growing from our roots in publishing, we offer knowledge and valuable analytics that help our users make breakthroughs and drive societal progress. Digital solutions such as ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath support strategic research management, R&D performance, clinical decision support, and health education. Researchers and healthcare professionals rely on our over 2,700 digitized journals, including The Lancet and Cell; our over 43,000 eBook titles; and our iconic reference works, such as Gray’s Anatomy. With the Elsevier Foundation and our external Inclusion & Diversity Advisory Board, we work in partnership with diverse stakeholders to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com.

-----

IMAGE CAPTION: 

Hospital parking fees may contribute to suboptimal health outcomes for cancer patients. Financial toxicity in the context of cancer care refers to the distress and hardship experienced by patients and caregivers as a result of out-of-pocket expenses incurred during cancer treatment(Credit: iStock.com/Pollyana Ventura).