For cancer patients, the road from diagnosis to survival is like a never-ending parade of medical appointments: surgeries, blood tests, chemotherapy, radiotherapy, scans. The routine is long and expensive. So when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized.
Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after being treated at another hospital for a brain tumor.
The medical news was good: his stage 2 tumor was stable. The financial news was not. As he sat down at the front desk to check in, Leon was confronted with a bold, red lettered sign on the back of his computer that read, “WE ARE NOT VALIDING PARKING.”
Below that all-capitalized statement was a list of parking rates, starting with $ 2 for a 30-minute visit and going up to $ 28 per day. Have you lost your ticket? Then you could pay $ 27 for an hour.
“To this day, I remember that sign,” Leon, 40, said of the 2017 date, which he posted on Facebook. “These patients were people who came for various types of cancer treatment. These were people who were keenly aware of their own mortality, and yet the sign called out to them, “We are not validating the parking”. Hospital officials did not respond to requests for comment on their parking policy.
JulieAnn Villa, who was diagnosed in March with her third episode of cancer, estimates that she spent “thousands of dollars” on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she travels to Northwestern Memorial Hospital in Chicago from her apartment. Should she take public transport? Call a pandemic surge rate Uber? Have a friend drive it? Or pay $ 12 to $ 26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?
She was hospitalized for several days in April after spending 23 hours alone in an overcrowded emergency room because she didn’t want friends paying to wait with her. “I almost drove myself, and I’m so glad I didn’t,” Villa said. “It would have been expensive.”
Long a source of frustration for patients, parking costs during cancer treatment are finally gaining national attention from oncology researchers and even some hospital administrators.
Some patients say, “That’s the reason I didn’t participate in a clinical trial, because I couldn’t afford to park.
“If you want to piss off patients, caregivers, or family members, just bring up the parking fees,” said Dr. Fumiko Chino, radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies “financial toxicity. »Cancer treatment including costs not covered by insurance, such as parking costs.
Chino, who enrolled in medical school after her husband died of rare neuroendocrine cancer in 2007, added: “For people who have to pay between $ 15 and $ 18 each time, what I think remember paying is really the last straw, frankly – like kicking you when you’re down. ”
Public transportation is possible for some cancer patients in large cities, but not for those who are too ill or immunocompromised. Others have accessibility issues. Many have to travel for treatment, which makes driving the best option.
Parking fees can have implications for more than the patient.
“Some patients say, ‘This is the reason I didn’t participate in a clinical trial, because I couldn’t afford the parking,” said Chino.
At a time when hospitals and pharmaceutical companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said.
There are pilot programs to improve access to drug trials, and some charities, such as the Leukemia & Lymphoma Society, offer travel grants, but accessibility remains a significant barrier to cancer care, a said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which provides financial aid to patients and advocates in Washington, DC, for “patient-centered” health policies.
“The real definition of a patient-centered health care system,” Franklin said, is one that empowers patients to choose the best form of transportation. “It doesn’t force them into debt because they had to pay a ton of money to park every time they go to the clinic or hospital.”
Chino and his colleagues published a short study in July showing that some cancer patients pay $ 1,680 over treatment.
According to readership statistics released in late March, the study was JAMA Oncology’s most read and downloaded article last year, and it continues to garner a lively response on social media. A thread on Reddit recorded more than 1,100 comments, many of which patients from other countries expressed surprise at US parking policies.
The researchers calculated the cost of parking at 63 cancer centers designated by the National Cancer Institute while receiving the standard number of treatments for each of the three types of cancer: lymph node positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate the costs of follow-up appointments, blood tests, routine tests and immune boosting injections.
They found that while 20 of the hospitals offered free parking for all cancer patients, the remaining 43 had widely varying fees.
“The range was $ 0 to $ 800 for breast cancer,” Chino said. “It’s huge, and it’s not like the person paying $ 800 is necessarily getting better treatment.” The maximum cost for standard treatment for head and neck cancer was $ 665 and for AML $ 1,680.
Practices should change, said Chino, “to alleviate this stress for our patients. “
Of the 63 hospitals, including those where parking is free for cancer patients, 54 percent offered free parking for chemotherapy and 68 percent for radiation therapy.
According to the researchers, the highest daily parking rate is $ 40 at Mount Sinai Hospital in New York City. A spokesperson for Mount Sinai declined to comment.
Chino’s own institution, Memorial Sloan Kettering, is not far behind; parking in one of its main garages starts at $ 12 per hour and tops out at $ 36 per day. A spokesperson for the hospital said some places offer free parking and all patients can apply for help with parking costs.
A few colleagues scoffed when Chino said she was researching parking fees, she said, but a growing number of oncologists, mostly younger, are worried about the indirect costs that contribute to the financial toxicity of cancer.
“It seems ethically incorrect to nickel-and-dime patients for parking fees,” wrote a trio of doctors last year in an editorial published by the American Society of Clinical Oncologists. They recognize that most large cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate garages. “Nonetheless, in 2020, with our multibillion-dollar cancer center budgets, we as health care systems should be doing all we can to help patients and caregivers,” the editorial states. .
The City of Hope National Medical Center in Los Angeles is one of 20 NCI-designated hospitals that do not charge patients for parking. Dr Vijay Trisal, a surgical oncologist who serves as the Chief Medical Officer of City of Hope, is proud of this honor.
“Charging cancer patients to park is like a knife in the back,” he said. “We can’t control the copay, but we can control what patients pay for parking.”
While Trisal would never want a patient to choose City of Hope for free parking alone, he recognizes that the policy gives his hospital a competitive edge.
“You wouldn’t believe how many patients have told me, ‘Thank you for not charging for parking,’ he said.