Patients’ Comfort Level with Discussions on Treatment Costs Exceeds that of Oncologists

June 2011, Vol 2, No 3 -

Chicago, IL—Results of a recent survey presented at ASCO 2011 show that patients with cancer were farmore willing to participate in conversations about their cancer treatment costs than their physicians.

“We were actually surprised by these results,” said Andrea Bullock, MD, Beth Israel Deaconess Medical Center, Boston, MA. “We thought they would be resistant in the same way that oncologists are known to be, but for different reasons.” Past studies have shown that oncologists are reluctant to address this sensitive topic; in 2 large, published surveys, >80% of oncologists reported being uncomfortable discussing costs with patients.

“Our study shows that in looking at patients’ perceptions, the majority of them are willing to talk.” Other studies have suggested that physician-patient communications regarding costs may facilitate a decrease in overall spending, minimizing patient and societal financial burden.

In this survey, a 31-item questionnaire measured cancer patients’ discussion preferences regarding the cost of cancer care, including questions such as:

  • I would like my doctor to talk with me about my out-of-pocket (OOP) costs when he/she recommends a cancer test or treatment
  • I would prefer to discuss the cost of my cancer care with someone other than my doctor
  • My doctor should consider the country’s healthcare costs as he/she makes medical decisions.

Results showed that of the 256 survey respondents, 68% would prefer to have OOP expenses discussed before treatment, with a majority wishing to have that conversation with their treating physicians.

However, 55% of respondents said that healthcare costs in the country at large or the particular patient’s OOP expenses should not influence treatment decision-making. Patients receiving active chemotherapy were less likely to discuss costs.

“We came up with the questions shortly after the [ASCO] Task Force guidelines were published in 2009, which recommended that oncologists begin these conversations,” said Dr Bullock; “frankly, we thought that patients may be resistant to talking about cost out of fear that if it was discussed it may affect how aggressively they are treated.”

Nevertheless, 32% prefer to discuss financial matters with someone other than their physician. Dr Bullock speculates that this is because of the limited time patients have with their physicians, which makes them prefer to focus on issues of care. “That’s the greatest limitation from their perspective, that they are not comfortable enough doing it, they don’t have the knowledge.”

Larger institutions may want to bring advisors on board for these conversations, Dr Bullock suggests, acknowledging that community practices likely do not have the resources for such a position. However, with the costs for cancer care estimated at $124 billion for 2010, it is clearly time to start talking.