September 2014, Vol 3, No 6

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Patients Want But Aren’t Getting Up-Front Discussions About the Cost of Their Cancer Therapy

Ronan J. Kelly, MD

Value-Based Cancer Care

Most cancer patients want cost-of-treatment discussions. When they do take place, these discussions do not lead to negative feelings in most patients, according to a survey of cancer patients. Unfortunately, few oncologists participating in a separate survey felt comfortable when discussing cost with patients, found Ronan J. Kelly, MD, and colleagues.

They presented their research during a poster session at the 50th annual meeting of the American Society of Clinical Oncology (ASCO).

“We have demonstrated that patients do want to know the costs of their treatment, and that these costs are not routinely being discussed in academic medicine,” according to Kelly, director of the Gastroesophageal Cancer Therapeutics Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore.

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 Care Task Force recommended that the cost of chemotherapy should be introduced into the patient–physician discussion from the outset, the authors note. It is unknown if these discussions are occurring in academic institutions and what, if any, impact they have on the physician/patient relationship.

In their study, the National Comprehensive Cancer Network (NCCN) guidelines and the eviti Advisor platform (a digital library of evidence-based standards for cancer care) were jointly used 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. The consultations took place between February 2013 and October 2013.

Eighteen oncologists were interviewed and 96 of 107 invited patients attending Johns Hopkins participated in the study. More than 80% (78/96) responded that it is “quite important” or “extremely important” for them to know their out-of-pocket costs. More than two-thirds, 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 Kelly.

Only 5 of 18 (28%) oncologists reported feeling comfortable when discussing costs with patients, and only 1 (6%) regularly asked patients about their financial well-being. Despite this lack of comfort, 83% of providers believed that the NCCN guidelines should contain cost information.

Between 2000 and 2010, patient responsibility for the cost of care quadrupled to more than $4000.

“For the first time, we show that there are minimal conflicts and no harm to the doctor-patient relationship when costs are introduced,” notes 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.”

“Additional training to prepare clinicians for how to discuss costs with their patients is needed,” he said.

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