Oncologists Want More Education on How to Discuss Cost of Treatment with Patients

August 2014, Vol 5, No 6 - Economics of Cancer Care

Chicago, IL—Oncologists responding to a national electronic survey believe that discussing out-of-pocket (OOP) costs of therapy with patients is important, and that OOP costs and societal cost of therapy will play a larger role in cancer treatment decisions over the next 5 years. These results were reported by Laura L. Tenner, MD, a hematologist/oncologist at Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, at the 2014 American Society of Clinical Oncology meeting.

US oncologists’ attitudes and perceptions about the cost of cancer care in the wake of the implementation of the Affordable Care Act (ACA) were assessed through an electronic questionnaire deployed over 4 months in 2013.

“Back in 2008, about 40% of physicians said that they communicated to their patients about costs of therapy most of the time or always, and we wanted to see if that has changed because of the ACA coming in,” Dr Tenner said.

“Because of the competing obligations placed on physicians by the ACA, physicians may have to become adept at engaging in shared decision-making and communication concerning cost and resource distribution,” said Dr Tenner.

Survey Results
A total of 135 (16%) of the oncologists contacted in 50 states responded to the survey, representing 35 states. Of these, 41% of the oncologists are in private practice, 30% are employed at a university medical center, 17% at a community hospital, and 5% at an HMO.

“Under the ACA, physicians will only be able to do what has proven to be efficacious, so they’re going to have to start having those difficult discussions with patients,” she added.

Dr Tenner and colleagues found that physicians are communicating with patients about cost at a similar rate as they did 5 years ago, 43% in 2008 versus 48% in 2013. “What has changed is that physicians want more cost-effectiveness and comparative effectiveness data to be able to make those decisions,” she said. “They feel like they don’t have the resources right now to be able to effectively communicate with patients about cost of therapies and decision-making.”

A total of 89% of respondents strongly or somewhat strongly agreed that it was important to discuss OOP costs with patients, and 66% strongly or somewhat strongly agreed that discussing healthcare system costs with patients was important.

In all, 70% of respondents reported that OOP costs of therapy influence their treatment decisions, and 60% agreed that OOP costs and healthcare system costs of treatment for cancer were likely or extremely likely to have a larger effect on their decisions regarding which cancer treatments to recommend to patients in the future under the ACA.

Some 87% of the oncologists said more comparative effectiveness research is needed, and 91% desired more cost-effectiveness research. In all, 85% of the respondents agreed that communicating the cost of therapies with patients was needed.

Approximately 66% of respondents noted that physicians are the ones who should decide the value of certain drugs, whereas only 4% said that government should decide good value. A total of 53% favored more government price controls of health resources, and 62% of respondents thought that the health system cost of therapy would have a larger effect on treatment decisions.

“These data suggest that educational efforts aimed at improving oncologists’ tools for communication about the costs of cancer care would be valuable,” said Dr Tenner.