One quarter of cancer patients are paying more than $20,000 in up-front doctors’ fees for their treatment, a new study suggests.

Australian researchers linked data from 452 patients with melanoma and breast, prostate, lung and colorectal cancer to Medicare data on every consultation, tests, imaging, procedure and medication billed through the healthcare system.

The study, published in the MJA, found one-quarter of patients – who were participants in the QSkin Sun and Health Study – paid upfront doctors’ fees of more than $20 000 over two years.

“Over 2 years, total provider fees were highest for those with lung (median, $22 011) or breast cancer (median, $21 581) and lowest for those with melanoma (median, $5248),” wrote lead author, health economist Associate Professor Louisa Gordon and her colleagues from the QIMR Berghofer Medical Research Institute.

The median proportion of provider fees covered by Medicare subsidies was 63%, while a total of 74% of the sampled cancer patients had private health insurance.

Out-of-pocket costs across the five cancers studied were largest for therapeutic procedures ($670), professional attendances ($414) and medications ($288).

The median provider fee was $9821 and the median Medicare subsidy was $6280.

“The finding of higher out-of-pocket costs for patients with breast cancer corroborates a recent report on nearly 2000 Australian women that included direct and indirect medical costs and found that three-quarters of the patients had incurred up to $17 200 in out-of-pocket expenses during the 5 years after diagnosis,” the study authors wrote.

“The consequences can be devastating for individuals experiencing financial hardship, including serious impacts such as delays of or non-adherence to therapy and increased morbidity.

“Practical solutions for alleviating the financial burden on patients with cancer would include lower medical fees and greater transparency in charging,” they concluded.