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Patient Attitudes Regarding the Cost of Illness in Cancer Care

Meisenberg BR, Varner A, Ellis E, Ebner S, Moxley J, Siegrist E, Weng D.

Oncologist. 2015 Oct;20(10):1199-204

Selected and commented by Dr. Carla Ripamonti and Dr. Raffaele Giusti:

Financial toxicity is increasingly recognized as adversely affecting the quality of life and medication adherence in patients with cancer in the USA and the European Community. Patients might be particularly vulnerable because of high use of novel biological and immunotherapeutic treatments and extended treatment duration (maintenance therapy etc.). Costs of illness in cancer care and the subsequent patient distress is attracting scrutiny.

In the article of this month, Meisenberg et al. have performed a survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center, analyzing:

  1. Prevalence and extent of financial burden;
  2. Level of financial distress;
  3. Attitudes about using costs to influence treatment decisions;
  4. Frequency or desirability of cost discussions with oncologists.

There were 132 patients enrolled in the survey. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about costs. More than 71% of patients did not want either society's or personal costs to influence treatment, and this result did not change based on the degree of financial stress.

The author’s conclusion was that even insured patients have a high degree of financial distress and most of them did not speak often with oncologists about the costs of care.

Patients are not cost sensitive with regard to treatment decisions and oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology. More data are necessary to better investigate coverage thresholds that minimize adverse financial outcomes and identify cancer patients at greatest risk for financial toxicity.

Abstract
 

BACKGROUND AND PURPOSE:

The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions.

METHODS:

A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists.

RESULTS:

A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about cost. More than 71% of patients did not want either society's or personal costs to influence treatment, and this result did not change based on degree of financial stress. Even when asked to assume that lower cost regimens were equally effective, only 28% would definitely want the lower cost regimen. Patients did not believe it was the oncologist's duty to perform costdiscussions.

CONCLUSION:

Even insured patients have a high degree of financial distress. Most, including those with the highest levels of distress, did not speak often with oncologists about costs and were strongly adverse to having cost considerations influence choice of regimen. The findings suggest that patients are not cost sensitive with regard to treatment decisions. Oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology.

IMPLICATIONS FOR PRACTICE:

This study raises important questions regarding optimal communication with patients about costs. If patients are not cost sensitive regarding treatment decisions, they will not be full partners in the desire to reduce financial burden and financial distress by lowering costs. Better patient educational tools are needed to help increase not just cost awareness but also awareness of value. To master this mode of discourse and to help ease patients' financial toxicity, oncologists will need to master a new set of data and develop new skills. This new knowledge and proficiency are as vital to good oncology care as all other clinical acumen.

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