Cancer-Related Out-of-Pocket Expenses Among Patients Receiving Chemotherapy at Benghazi Medical Center, Libya: A Cross-Sectional Study

Abstract

Background: Cancer imposes a substantial financial burden on patients in low- and middle-income countries (LMICs). Although cancer treatment is officially provided free of charge in Libya, shortages of essential medicines and limited healthcare services force many patients to incur significant out-of-pocket (OOP) expenses. This study assessed OOP expenditures among patients receiving chemotherapy at Benghazi Medical Center (BMC), Libya.

Methods: A hospital-based cross-sectional study was conducted at BMC between September and October 2025. A total of 300 adult cancer patients were recruited using convenience sampling. Data on OOP expenditures, including medications, private clinic visits, transportation, physiotherapy, food supplements, emergency care, housing, and home modifications, were collected through structured questionnaires and face-to-face interviews.

Results: Most participants were female (63%), and 45.3% were older than 50 years. Nearly all patients purchased prescribed medications privately because of hospital shortages, while most also visited private clinics. Housing or relocation and home modifications represented the largest components of OOP expenditures.

Conclusions: Cancer patients in Benghazi experience substantial OOP expenses despite free public healthcare. Medication shortages, reliance on private services, and treatment-related complications are the main drivers of financial burden. Policy reforms are urgently needed to improve medicine availability and provide effective financial protection for patients.