Chicago, IL—According to a survey presented at the 2014 American Society of Clinical Oncology (ASCO) meeting, the majority of patients with cancer want to have cost-of-treatment discussions with their oncologists. And when they occur, these discussions do not lead to negative feelings in most patients.
However, a separate survey shows that few oncologists feel comfortable discussing costs with patients, according to Ronan J. Kelly, MD, MBA, Assistant Professor of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD.
“We have demonstrated that patients do want to know the costs of their treatment, and that these costs are not being routinely discussed in academic medicine,” said Dr Kelly.
Spending on cancer drugs is projected to increase nearly 40% by 2020, as new cancer diagnoses in the United States continue to increase.
In 2007, the ASCO Cost of Cancer Care Task Force recommended that the cost of chemotherapy should be introduced into the patient–physician discussion from the outset, the investigators noted.
In their study, Dr Kelly and colleagues used the National Comprehensive Cancer Network (NCCN) guidelines and the eviti Advisor platform (a digital library of evidence-based standards for cancer care) during the physician–patient consultation to demonstrate treatment options and to display the costs at the time of prescribing to providers and patients with advanced or metastatic lung, colorectal, or breast cancer.
These consultations took place between February 2013 and October 2013. A total of 18 oncologists were interviewed, and 96 of 107 invited patients receiving treatment at Johns Hopkins participated in the study.
Of the 96 patients, 78 (81%) responded that it is “quite important” or “extremely important” for them to know their out-of-pocket costs. More than 66%, however, have never discussed cost information with their provider.
“Decisional conflict is extremely low by patient report after cost discussions using the eviti Advisor platform, with 81% of patients reporting no negative feelings arising,” according to Dr Kelly.
“For the first time, we show that there are minimal conflicts and no harm to the doctor–patient relationship when costs are introduced,” noted Dr Kelly.
“A greater emphasis on the shared decision-making process involving up-front cost discussions combined with evidence-based outcomes should empower patients to make better educated choices and may ultimately help bend the cost curve downwards,” Dr Kelly maintained.
Of the 18 oncologists, only 5 (28%) feel comfortable when discussing costs with patients, and only 1 (6%) regularly asks patients about their financial well-being. Despite this lack of comfort, 83% of providers believe that the NCCN guidelines should contain cost information.
Between 2000 and 2010, patient responsibility for the cost of care quadrupled to more than $4000 annually.
Dr Kelly suggested that additional training to prepare clinicians for how to discuss costs with their patients is needed.
