ReCAP: Physician Experience and Attitudes Toward Addressing the Cost of Cancer Care [CARE DELIVERY]

QUESTION ASKED:

Because the cost of oncologic care is perpetually rising, we wanted to know how often physicians who treat cancer discuss the cost of care (both out-of-pocket and societal) with their patients, what the nature of those discussions is, and whether such discussions affect treatment decisions.

SUMMARY ANSWER:

Sixty percent of responding physicians reported addressing costs frequently or always in clinic, 40% addressed costs rarely or never, and 36% did not believe it is the doctor's responsibility to explain costs of care to patients. Additional responses are listed in Table 3. The majority of physicians feel their patients are not well informed about costs. "I don't know enough/lack of resources" is the largest reported barrier to cost discussions, and those who reported frequent discussions were significantly more likely to explain costs and to prioritize treatments in terms of cost.

Table 3.

Physician Attitudes Toward Out-of-Pocket Costs Versus Societal Costs

Question or Statement% Response by Attitude Strongly AgreeAgreeNeither Agree nor DisagreeDisagreeStrongly DisagreeDoctors should explain to patients the costs the patient will have to pay for his or her cancer treatment.123221288Doctors should explain to patients the costs society will have to pay for the patient's treatment.517333411When choosing a new treatment, doctors should consider the costs to the patient.15601572When choosing a new treatment, doctors should consider the costs to the insurance company or government.94419216I feel prepared to discuss cost effectiveness of treatments I recommend.113521268I have easy access to quality resources which assist me in cost discussions with my patients.818203916Society should only pay for treatments that improve survival, not those that only improve response or disease control.410154130If two treatments are the same, the doctor should prescribe the cheaper medicine.29501470Every US patient should have access to effective cancer treatments regardless of their cost.244415125The FDA should consider cost effectiveness of the treatment before issuing an approval.203621177METHODS:

A 15-question, study-specific, self-administered anonymous survey was sent electronically to a randomly selected sample of 2,290 ASCO physician members.

BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:

Our overall response rate was somewhat low at 15%, with an adjusted response rate of 25% after adjusting for nonpracticing physician ASCO members. This increased the potential for selection bias, by which the respondents to this survey may not represent the true beliefs and practices of medical, radiation, and surgical oncologists.

REAL-LIFE IMPLICATIONS:

Our study offers a current snapshot of the frequency, nature, and attitudes toward cost discussions among medical, radiation, and surgical oncologists and their patients. Although the majority of responding physicians seem to agree that such discussions are legitimate—and arguably necessary—components of quality cancer care, there remains a substantial proportion who do not discuss costs nor feel it is their duty. Few believe they have adequate resources to discuss costs, suggesting that greater cost transparency, education concerning costs of care, tools to facilitate discussions, and validated interventions are needed.

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