A new study says that cancer patients spend $2.3 billion worth of time in waiting rooms, doctors’ offices, hospitals and transportation in the first year after cancer is diagnosed.

Patients with cancers that can be detected early spend least wait time both in the year after diagnosis and in the last year of life.

Medicare patients with gastric and ovarian cancers lost the most time in the initial year, valued around $5,300 and $5,600 per person, compared with costs associated with skin, prostate and breast cancers of around $300, $800 and $1000 each.

Robin Yabroff, Ph.D. and colleagues at the National Cancer Institute looked at records from 764,000 Americans 65 years old or older who had received a diagnosis of 11 common forms of cancer from 1995 to 2001. Their study appears today in The Journal of the National Cancer Institute.

The researchers estimated each patient’s time spent at physician and emergency room visits, chemotherapy treatments, radiation therapy, hospitalizations, outpatient surgeries, and imaging procedures. They then estimated how long each patient spent traveling to, waiting for, and receiving care.

The net costs were calculated using a dollar value of $15.23 per hour, the median U.S. wage rate in 2002. The study did not look at the value of time spent by members of a patient’s family.

The findings challenge the myth of increased costs from early detection. “In general,” the researchers say,” tumor sites among which the majority of patients in our study were initially diagnosed with early-stage disease, such as breast, corpus uteri, melanoma of the skin, prostate and urinary bladder, had the lowest net patient time costs in both the initial and last-year-of-life phases of care. ”

Cancers that could not be found early through screening and were diagnosed in more advanced stages cost more in patient burden of commitment. “Tumor sites among which a sizable portion of patients in our study were initially diagnosed with regional and distant disease, and that are reported to have relative 5-year survival of less than 50%, such as gastric, lung, and ovary (4), had the highest net patient time costs in both the initial and last-year-of-life phases of care. ”

During the first 12 months after diagnosis, the average length of time for hospitalization was highest for patients with gastric and ovarian cancers (21.1 and 20.8 days) and shortest for patients with melanoma (2.2 days), prostate cancer (3.8 days) and breast cancer (4.0 days).

Compared to similar people without cancer, cancer patients’ net time associated with medical care varied, ranging from 17.8 hours for melanoma to 351.3 hours for gastric cancer and 368.1 hours for ovarian cancer. When the researchers applied the dollar costs to time spent on medical care in the first 12 months after diagnosis, they found that net patient time costs were lowest for melanoma ($271) and prostate cancer ($842) and highest for gastric ($5,348) and ovarian ($5,605) cancer.

In the last year of life, hospitalization time was longest for patients with gastric (35.4 days), lung (32.4 days), and ovarian (31.9 days) cancer. Estimates of patients’ net time spent on medical care were lowest for melanoma (99.1 hours) and highest for ovarian (485.3 hours), lung (488.3 hours), and gastric (512.2 hours) cancer. They calculated that the net patient time costs during the last year of life ranged from $1,509 for melanoma to $7,799 for gastric, $7,435 for lung, and $7,388 for ovarian cancer. Hospitalizations were the largest component of patient time costs in both the initial year after diagnosis and in the last year of life.

“What we see here is a measure of the patient’s burden of commitment—measured in dollars—associated with receiving today’s cancer therapy,” write Larry G. Kessler, Sc.D., of the U.S. Food and Drug Administration and Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, in an accompanying editorial. “We hope that policy makers recognize the substantial economic burden of cancer in the United States and that this cost derives from many sources … .”

The researchers note that their calculations do not address financial costs to caregivers. “Our net estimates are likely to understate the amount of time spent receiving care from the perspective of the patients and their families. We did not include preparation time before medical care (e.g., preparation for colonoscopy), posttreatment recovery time spent at home, or time spent addressing health insurance issues in our patient time cost estimates. Family or caregiver time spent traveling and waiting with patients for care was not included, nor were hospice and home health care services. Because patients may require assistance before or after treatment, caregivers frequently accompany patients to care. Finally, hospice and home health services are reported to be used more frequently by cancer patients than patients with other conditions.”

An accompanying editorial points out that the researchers do not attempt to include the emotional cost cancer patients and their families endure. While accounting for patient time costs, the researchers say, “we know we have greatly underestimated the true cost of the disease.”