OBJECTIVES : To identify out-of-pocket expenses and income loss incurred by patients as a result of a cancer diagnosis. The extent of informal (unpaid ) care was also explored. Medical costs covered by the government are outside the study scope.

METHODS : A self-administered questionnaire-based study. The questionnaire was informed by literature review, discussions with health professionals, and interviews with patients. Adult solid cancer patients on chemotherapy for at least 3 months were recruited from one teaching hospital in Riyadh, Saudi Arabia. The study received ethical approval and patients provided signed informed consent. Costs were converted to the Euro (€) using the exchange rate of 1€ = 4.25 Saudi Riyals.

RESULTS : 181 patients completed the paper-based questionnaire (118, 66% female). 107 use their own car for transportation to and from the hospital to receive chemotherapy (median travel distance 42 Km). 41% of respondents are from outside Riyadh and rent accommodation during chemotherapy sessions for a median cost of €59 per day. 47 respondents were employed when they were diagnosed and 15 of them reported some loss of income due to cancer. Over the last 4 weeks, 21% bought medications, 18% visited a physician, and 8% visited a physiotherapist spending a median cost of €24, €118, and €235, respectively. 69% reported buying more fruits and organic food than before diagnosis at a median cost of €24 per week. 17% reported residence changes at a median cost of €529. The opportunity cost of informal care is evident. 85% of respondents are accompanied by a carer during chemotherapy session. 64%, 31%, 61%, 43%, and 28% reported receiving support from a carer in housework, child care, shopping, medicine taking, and personal care, respectively. The reported average hours per week spent by the carer looking after patient is 47.

CONCLUSIONS : The economic impact of cancer on patient is considerable.