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Neli S Slavova-Azmanova, Jade C Newton, Christobel M Saunders Out-of-pocket expenses for cancer care are of growing concern for patients, clinicians, service providers, non-governmental organisations, private insurers, and politicians. Contrary to popular belief, there is no direct link between the cost and quality of care. Out-of-pocket expenses are a particular problem for patients who live further from treatment centres, are younger, or have later stage disease. 1

Adults (18 years or older) with pathologically confirmed colorectal, lung, prostate or breast cancer from four rural (Midwest, South West, Great Southern, Goldfields) and two outer metropolitan (Joondalup/Wanneroo and Rockingham/Peel) regions of Western Australia were identified in the WA Cancer Registry. Between 1 April 2014 and 31 April 2017, eligible patients were invited to complete questionnaires requesting demographic, financial, and treatment information, including all costs during treatment, as reported previously. 2 We used log-linked generalised linear models with gamma distribution, adjusted for age and sex, to estimate out-of-pocket expenses (with 95% confidence intervals [CIs]) for participant characteristics found to be significantly associated with out-of-pocket expenses in univariate analyses (online Supporting Information). The study was approved by the WA Country Health Service Ethics Committee (reference, 2014: 10) and the Department of Health WA Human Research Ethics Committee (reference, 2014/26).