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 cross sectional 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.