Patients with Cancer Eager to Discuss Costs of Care with Their Oncologists

September 2015, Vol 6, No 8

Gone are the days when patients with cancer were, for the most part, protected from healthcare costs by their medical insurance. According to a recent study sponsored by the National Comprehensive Cancer Network and conducted by Ronan J. Kelly, MD, MBA, MBBCh, Assistant Professor of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, and colleagues, with high deductibles, escalating copayments, and cost-sharing requirements becoming the status quo, patients with cancer are now, more than ever, feeling the effects of financial toxicity, particularly young patients who are especially susceptible to filing for medical bankruptcy (Kelly RJ, et al. J Oncol Pract. 2015;11:308-312).

The issue is further compounded by the fact that patients with cancer who cannot pay for their treatment have worse outcomes than patients who can afford their treatments.

Although physicians are responsible for helping patients control their treatment costs, the majority of physicians are not prepared to discuss the treatment costs of cancer, because they lack knowledge about the costs or proper training. Dr Kelly and colleagues examined whether discussions about treatment costs are feasible in an oncology setting, and assessed the effects of cost discussions on physician–­patient relationships.

“My coauthors and I had looked in the literature, and we could not really find very much, in any branch of medicine, where patients were given the costs of treatment and were asked to discuss these with their doctors, so this study was one of the first to do that,” Dr Kelly told Value-Based Cancer Care.

Dr Kelly and his team approached 107 patients who had received treatment for metastatic breast, lung, or colorectal cancer, of whom 96 enrolled in the study. The participants completed a baseline questionnaire to assess their need for information about the cost of their cancer treatment before consultations with their physicians.

The 18 participating oncologists were all specialized in the treatment of these malignancies and were faculty members of the Johns Hopkins Cancer Center. To help initiate cost discussions with their patients, the oncologists received a standardized script and were tasked with finding out whether their patients had any financial difficulties related to their treatments.

Addressing Costs with Patients

The oncologists presented their patients with cancer treatment costs using the Web-based eviti Advisor oncology decision support platform, which shows the outcomes and costs per cycle of the evidence-based regimens that are appropriate for the cancer type, pathology, biomarkers, treatment intent, and line of treatment.

“We didn’t give patients the final take-home cost burden,” Dr Kelly said. “What we did was show them the cost of chemotherapy per regimen as generated by the eviti software. We thought that we could use that as a way to introduce cost discussions into the doctor–patient relationship, which could spur additional conversations between doctors and patients about treatment costs and hopefully ascertain if patients were suffering from burdensome financial toxicities.”

Oncologists Avoid Cost Discussions

Dr Kelly and colleagues measured patient–physician satisfaction with cost discussions, as well as the need for cost information, using questionnaires.

The findings confirmed that physicians are not regularly discussing cancer treatment costs with their patients. Specifically, only 5 of 18 (28%) oncologists felt comfortable discussing treatment costs with their patients, and only 1 of 18 (6%) of the oncologists asked their patients about financial difficulties. It is not surprising, therefore, that 72% of patients have never discussed treatment costs with their healthcare providers.

Dr Kelly emphasized that to overcome the reluctance of physicians to discuss treatment costs with their patients, educating and training physicians about treatment costs should begin early.

“What we need to do is start educating the new generation of doctors, perhaps in medical school, about how to have cost of treatment conversations with their patients,” Dr Kelly said. “What we saw here is that the vast majority of doctors are not having cost discussions, because they did not feel adequately informed or trained on how to introduce the topic,” he explained.

Patients Eager to Discuss Costs

The results also showed that the majority (80%) of patients wanted to participate in cost discussions with their clinicians, and 84% said this is especially the case if their copayments or deductibles were to increase.

“The patients told us, ‘If I’m going to be burdened with big costs of treatment, then I want to have a discussion with a healthcare provider about the pros and cons of each treatment,’” Dr Kelly said.

Furthermore, 80% of patients expressed that these cost discussions would not have a negative impact on their patient–physician relationship.

Cost Discussions Are Important

“The key message that I wanted to figure out in the study was, if we introduced cost discussions between patients and doctors in the clinic, would it impact negatively on the patient? It was interesting, because the vast majority of patients didn’t have any negative feelings at all when we talked about costs, suggesting that costs can be introduced in a nonthreatening way,” Dr Kelly said.

Integrating cost discussions during physician visits is increasingly being recognized as an essential component of the shared decision-making process. Initiatives that help to delineate the value of various cancer treatments will further assist patients in making informed decisions about their treatments.

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