'Biggest factors in having cancer were costs and no entitlement to compensation'-The determinants of out-of-pocket costs for cancer care through the lenses of rural and outer metropolitan Western Australians.

OBJECTIVE The aim of this qualitative analysis was to determine patients' perceptions of the impact of cancer-related costs. DESIGN A qualitative inductive content analysis of the comment sections of surveys completed by participants in a cross-sectional study of cancer-related expenses. SETTING Residents of 4 regional/rural and 2 outer metropolitan areas in Western Australia. PARTICIPANTS Adults diagnosed with breast, prostate, colorectal or lung cancer participated in the study between 1 April 2014 and 31 April 2017. MAIN OUTCOME MEASURES This study identified the key factors contributing to the cost experiences reported by the participants. RESULTS Participant comments were organised into 4 main categories perceived to incorporate the key factors contributing to the cost experiences reported by 300 participants: 1) health care system factors (access to care in the public or private sector, availability of services close to home, gap payments, cost of travel) 2) financial factors (impact of cancer on employment, ability to work, and career; and strategies for improving financial difficulties) 3) social and community support provided by the government and not-for-profit organisations and 4) understanding of the health care system. CONCLUSION There is a need for cost transparency, initiatives for no- or low-fee billing providers, access to care close to home, development of financial assistance schemes and return to work programs to alleviate the financial hardship experienced by cancer patients and their families.