Oncologists Cite Lack of Resources and Time as Barriers to Addressing Cost Issues with Patients

Mark Knight

June 2014, Vol 5, No 5 - ASCO 2014 Highlights


Chicago, IL—Although the majority of oncologists believe that discussing the costs of care with the patient is impor­tant, many report a lack of resources available to them to inform cost-benefit decisions and a lack of time to discuss these issues with patients.

Approximately 40% of medical oncologists, oncology radiologists, or surgical oncologists responding to a national survey did not report having cost discussions with their patients, and approximately 33% do not even believe it is their role to do so, according to new survey results presented by Ivy Altomare, MD, Associate Professor of Medicine, Duke University, Durham, NC, during the 2014 American Society of Clinical Oncology (ASCO) meeting.

Dr Altomare and colleagues sought to determine oncologists’ current attitudes about discussing the costs of treatment with patients as part of the medical decision-making process. ASCO now advocates that the physician–patient discussion about cost should be an integral element of high-quality cancer care.

The 15-question, self-administered, electronic survey was randomly sent to 2900 ASCO physician members nationally, with a 15% response rate. “We had a mix of medical oncologists, surgeons, and radiation oncologists,” said Dr Altomare. “Are they discussing the cost of cancer care with their patients among these different specialties? And does that affect their treatment decisions?”

Of the 333 respondents, 67% agreed that doctors should discuss costs of care with patients; 33% disagreed. “The majority (60%) say they are frequently or often having cost discussions with their patients. That means that 40% are rarely or never talking about this,” Dr Altomare said. When the cost of treatment is discussed, the survey results show that 51% of the time, these conversations are initiated by patients.

The 2 most frequently reported barriers to cost discussions were a lack of resources to guide these conversations and a lack of time. Cost-of-care discussions are not taking place routinely, because physicians (58%) do not believe that they have enough information or knowledge of the subject to enter into a dialogue about it. Of those who reported not discussing costs, 44% indicated that they do not have sufficient time. “If they have the information, that’s still not going to change,” noted Dr Altomare.

A total of 36% of those surveyed contended that it was not their role to explain costs. “The physician went to medical school to treat the patient, decide the therapy; not to think about where healthcare in this country is going,” Dr Altomare said. But even most of the physicians who do not discuss the cost of care agree that the cost to the patient should be considered when making treatment decisions, he added.

Oncologists who reported frequent discussions are significantly more likely to prioritize treatments in terms of cost, have a sense of patients’ financial well-being, and assume that their patients are well-informed about cost. They believe that physicians should explain out-of-pocket expenses and, to a lesser extent, the societal costs of care to their patients. The survey results suggest that medical oncologists are 3.75 times more likely to have these conversations with patients than radiation or surgical oncologists.

Although the majority of oncologists believe that cost-of-treatment discussions with their patients are important to quality care, no protocols or resources exist to guide them.

Dr Altomare said, “Cost is so individualized that you need to have a real-time, in-office resource available. I think piloting that type of program is going to be the next step in what we do.”