Source: www.healio.com
Author: John DeRosier

Parking costs at cancer treatment centers — including those with the highest standard of care — can be a source of financial toxicity for patients and caregivers, according to a research letter published in JAMA Oncology.

“When my husband was treated for cancer, we paid over $15 a day for parking,” Fumiko Chino, MD, radiation oncologist at Memorial Sloan Kettering Cancer Center, told Healio. “These costs were just a small fraction of our total costs for his care, but they seemed unusually cruel. I felt like we were being nickeled-and-dimed when we were at our most vulnerable.

“Many of my patients have told me similar stories; for some of them, parking costs can determine whether they will participate in a clinical trial or will get the recommended treatment for their cancer,” Chino added.

Chino and colleagues obtained parking fees from the 63 NCI-designated cancer treatment centers through online searches or phone calls between September and December 2019 to determine parking costs for the treatment duration of certain cancers.

Researchers documented city cost-of-living score — with New York City as the base city with a score of 100 — median city household income, center address transit score (0-24 = minimal transit options; 90-100 = world-class public transportation) and discount availability. They used a zero-inflated negative binomial model to evaluate associations between parking costs and city variables, and Pearson correlation for binary variables.

Researchers estimated parking costs for treatment of node-positive breast cancer (12 daily rates plus 20 1-hour rates), definitive head and neck cancer (35 1-hour rates), and acute myeloid leukemia (42 daily rates).

Results showed median cost of living score of 75 (interquartile range [IQR], 70.1-83.5), median city household income of $55,295 (IQR, 46,696-60,879) and median transit score of 61 (IQR, 50.8-72.5).

Twenty-five (40%) NCI-designated cancer centers did not provide comprehensive information about parking costs online.

Median parking costs were $2 per hour (IQR, 0-5) and $5 per day (IQR, 0-10).

Twenty centers (32%) offered free parking all day for all patients, and 23 offered free parking for at least the first hour. Forty-three centers (68%) offered free parking for radiation appointments and 34 (54%) had free parking available for chemotherapy appointments.

Median estimated parking costs, including discounts for a course of treatment, were $0 (range, 0-800) for breast cancer and $0 (range, 0-665) for head and neck cancer, and were $210 (range, 0-1,680) for hospitalization for AML.

Researchers found positive associations between daily parking costs — but not hourly parking costs — and city cost of living (coefficient = -0.1; standard error, 0.04; P = .03) and transit scores (coefficient = -0.04; standard error, 0.22; P = .04).

City cost of living appeared negatively correlated with free daily parking ( = -0.33; P = .02), as well as free parking during radiation treatment ( = -0.46; P < .001) or chemotherapy ( = -0.4; P = .003). Transit score also appeared negatively correlated with free daily parking ( = -0.31; P = .03) and free parking during radiation treatment ( = -0.33; P = .02) or chemotherapy ( = -0.34; P = .01).

Median city household income did not appear correlated with any assessed variables.

The potential inaccuracy of costs gathered through phone calls served as a limitation to the study.

“I really do believe that eliminating parking fees is a good way to move forward,” Chino said. “Free parking — or free metro or ride share in cities like New York — would do a lot to improve accessibility to care for some of our patients. It seems silly that something small like parking can make this big of a difference, but it really does cause financial toxicity for vulnerable families.”

For more information:
Fumiko Chino, MD, can be reached at Memorial Sloan Kettering Monmouth, 480 Red Hill Road, Middletown, NJ 07748; email: chinof@mskcc.org.

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