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.

Copyright © 2015 by American Society of Clinical Oncology.

Figures

Figure 1.

Sample screenshot of first-line treatment options and the costs per chemotherapy cycle for stage IV non–small-cell lung cancer as generated by the eviti Advisor system. The costs include both treatment and supportive care drugs and represent what the patient and/or insurer would be billed for the treatment.

Figure 2.

The frequency, importance, and impact of cost of care discussions between physicians and patients, as indicated by responses to (A) How frequently do you discuss costs of treatment with patients? (B) Level of conflict when discussing costs with providers. (C) Importance of understanding what patient will be responsible for paying. (D) Importance of advance notices for increases in copayment.