Patients and Physicians Can Discuss Costs of Cancer Treatment in the Clinic

Abstract

Purpose: As one solution to reducing costs and medical bankruptcies, experts have suggested that patients and physicians should discuss the cost of care up front. Whether these discussions are possible in an oncology setting and what their effects on the doctor-patient relationship are is not known. Methods:We used the National Comprehensive Cancer Network (NCCN) Guidelines and the eviti Advisor platform to show patients with metastatic breast, lung, or colorectal cancer the costs associated with their chemotherapy and/ or targeted therapy options during an oncology consultation. We measured provider attitudes and assessed patient satisfaction when consultations included discussion of costs. Results:We approached 107 patients; 96 (90%) enrolled onto the study, three (3%) asked if they could be interviewed at a later date, and eight (7%) did not want to participate. Only five of 18 oncologists (28%) felt comfortable discussing costs, and only one of 18 (6%) regularly asked patients about financial difficulties. The majority of patients (80%) wanted cost information, and 84% reported that these conversations would be even more important if their co-pays were to increase. In total, 72% of patients responded that no health care professional has ever discussed costs with them. The majority of patients (80%) had no negative feelings about hearing cost information. Conclusion:In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment

“…For example, the study by Kelly et al touched on both patients’ and physicians’ attitudes toward cost communication and the associated outcomes. 17 …”

“…15, 16 Over half of these studies recruited participants from cancer patients currently or previously treated in academic cancer centers or their affiliated oncology clinics. 10, 13, 14, 17-20 Three studies focused on breast cancer 10, 15, 16, 22 , one on prostate cancer 19 , and others did not focus exclusively on a specific cancer. Most studies were not restricted to a particular cancer stage, except for one that focused on metastatic cancers.…”

Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

“…Some studies show that patients want to discuss treatment costs with their physicians, 22 and most physicians report that they frequently discuss cost with their patients. 23 However, other research has found that physicians often are hesitant about initiating cost discussions [24][25][26] and rarely fully engage with patients to resolve their financial concerns. 27 Several studies suggest that discussions of treatment costs in patient-physician clinical interactions are rare.…”

“…15, [24][25][26]28,29 Given the potential importance of cost-related discussions in cancer care, this study systematically assessed the extent and nature of actual cost discussions that occur between a sample of African American patients and their oncologists. This study focused on African Americans because, on average, African Americans are more likely than whites to have low annual household incomes 30 and, thus, may be at greater risk to incur economic hardship as a result of a cancer diagnosis.…”

A Touchy Subject: Can Physicians Improve Value by Discussing Costs and Clinical Benefits With Patients?

“…Yet, very little harm likely results from these discussions. Kelly et al assessed patient satisfaction after the cost of chemotherapy was introduced into the doctor-patient relationship [25]. Chemotherapy and targeted-therapy costs were provided to the patient by their oncologist during the consultation, using an Internet-based decision-support platform.…”