KEY POINTS
- This retrospective single-health-system study included 14,774 adults treated with radiotherapy during fiscal years 2023–2024 across one tertiary centre and six affiliated community sites.
- Overall, 61.1% of patients paid radiotherapy-related out-of-pocket costs, with a median payment of $182.80; 2.7%had unpaid debt sent to collections, with a mean outstanding balance of $1,109.90.
- Debt sent to collections was independently associated with being single or otherwise unpartnered (odds ratio 1.32, 95% confidence interval 1.06–1.64), current smoking (2.20, 1.56–3.05), and commercial rather than government insurance (1.95, 1.50–2.54).
- Risk increased progressively with neighborhood deprivation, reaching an odds ratio of 2.54 (95% confidence interval 1.84–3.56) in the most disadvantaged quartile compared with the least disadvantaged quartile.
- An out-of-pocket threshold of $49.10, combined with age, sex, and insurance type, was associated with more than twice the odds of debt collection (odds ratio 2.36, 95% confidence interval 1.81–3.14; area under the curve 0.724).
CLINICAL TAKEAWAY
Routine administrative data available before or during radiotherapy may help identify patients who warrant early financial counselling or navigation. However, the study was retrospective, limited to one United States health system, and lacked cancer stage, treatment complexity, and wider household-debt data, so the proposed threshold requires external validation before clinical adoption.
SOURCE
International Journal of Radiation Oncology, Biology, Physics