August 2014, Vol 3, No 5

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Oncologists Want to Discuss Cost of Treatments With Patients but Believe They Are Not Well Equipped to Do So

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Oncologists responding to a national electronic survey overwhelmingly believe that discussing out-of-pocket costs of therapy with patients is important, and that both out-of-pocket costs as well as societal cost of therapy will play a larger role in cancer treatment decisions over the next 5 years.

Results of the survey were reported by Laura L. Tenner, MD, during a poster presentation at the 50th annual ASCO meeting.

The attitudes and perceptions by US oncologists 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.

“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 Tenner, who was an oncology fellow at Indiana University, Indianapolis, when she presented these data and is now a faculty member in the department of oncology at the University of San Antonio Cancer Institute and Research Center.

The survey generated a 16% response rate, with responses from oncologists from 35 states. Forty-one percent of respondents were in private practice, 30% were employed at a university medical center, 17% at a community hospital, and 5% at a health maintenance organization.

“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,” Tenner said. “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 found that physicians are communicating with patients about cost at about the same rate as they did 5 years previously – 43% in 2008 versus 48% in 2013. “What has changed is that physicians are wanting 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.”

Some 89% of respondents strongly or somewhat strongly agreed that it was important to discuss out-of-pocket costs with patients, and 66% strongly or somewhat strongly agreed that discussing healthcare system costs with patients was important.

Seventy percent reported that out-of-pocket costs of therapy influence their treatment decisions, and 60% agreed that out-of-pocket costs and healthcare system costs of cancer treatments 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.

Eighty-seven percent said that more comparative effectiveness research is needed, and 91% desired more cost-effectiveness research. Eighty-five percent agreed that communicating the cost of therapies with patients was needed.

Two-thirds responded that physicians are the ones who should decide the value of certain drugs, while only 4% said that government should decide good value. Slightly more than half (53%) favored more government price controls of health resources. Almost two-thirds (62%) 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 Tenner.

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