In Reply We thank Drs Ramagopalan and Sammon for their comments regarding our study on parking fees at National Cancer Institute–designated cancer centers1 and want to underscore their point that financial toxicity driven by indirect costs is not isolated to the US. A study from Australia found that nonmedical costs for those in rural areas were primarily driven by travel and totaled more than $800 (US) in the first 6 months of cancer treatment.2 Another study from Iran found that patients with cancer travel on average 282 miles (455 km) to receive care at the National Cancer Institute, which increases the burden on patients and caregivers.3
Lee A, Shah K, Chino F. Parking Costs—A Family Affair—Reply. JAMA Oncol. 2021;7(2):307. doi:10.1001/jamaoncol.2020.6368
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