The burden of administrative tasks required to pay for cancer care is associated with nonadherence to care among US cancer patients, according to a study published in Cancer Epidemiology, Biomarkers & Prevention.

Researchers found that these administrative tasks, such as calling insurance companies to appeal benefit denials or better understand coverage, are associated with nonadherence to care, such as delaying or skipping appointments, tests, and treatments.

For this study, researchers analyzed survey data from 510 cancer patients. The most common cancers were early-stage breast cancer (22%), prostate cancer (10%), and colorectal cancer (8%). About half of patients (55%) had Medicare, Medicaid, or both; 37% had insurance through their employer; 2.7% had Tricare/Champus Veterans’ Insurance; and the remaining 5.2% had other insurance. 

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About half of patients (55%) reported that they never or rarely engage in administrative payment tasks, but 9% of patients said they engaged in 4 or more. The mean total tasks performed per person was 1 (out of 5).

Of the administrative tasks patients did perform, the most common was finding out the cost of a prescription before filling it (28%). This was followed by finding out the cost of lab tests or scans (20%), estimating the cost of treatment before agreeing to it (20%), and calling the insurance company to either understand coverage (18%) or appeal denial of benefits (17%). 

Each of the administrative tasks was associated with cost-related delays or nonadherence to care.

About one third of patients (33%) said they “sometimes, often, or always” postponed or skipped aspects of care in an attempt to reduce costs. This included delaying or skipping doctor’s appointments (23%), delaying or skipping  follow-up testing (23%), skipping doses of prescribed drugs (20%), delaying or skipping blood work (19%), and cutting pills in half to make them last longer (19%).

When the researchers accounted for patient age, race/ethnicity, education, and out-of-pocket costs, patients who engaged in more administrative tasks had greater odds of cost-related nonadherence to care (b =0.18, 95% CI, 0.12 to 0.24).

This finding was consistent in a generalized linear model that accounted for age and estimated monthly out-of-pocket costs. However, in adjusted 2-part models, age, race/ethnicity, and out-of-pocket costs were more strongly associated with cost-related nonadherence than administrative tasks.

Younger patients, African-American patients, and patients with higher out-of-pocket costs were more likely to report cost-related nonadherence.

“Administrative payment burden should contribute to our understanding of financial toxicity as a domain that represents the time and labor associated with paying for cancer care,” the researchers wrote.

They suggested reducing the administrative complexity of health care through universal, human-centered design could reduce burdens and increase access for patients and caregivers.


Doherty M, Thom B, Gardner D. Administrative burden associated with cost-related delays in care in U.S. cancer patients. Cancer Epidemiol Biomarkers Prev. Published online August 30, 2023. doi:10.1158/1055-9965.EPI-23-0119

This article originally appeared on Cancer Therapy Advisor