Discussing cancer costs can reduce treatment expenses

(Reuters Health) - Even brief conversations between oncologists and patients about cancer costs can help reduce treatment expenses, a new study suggests.

“Increasingly in oncology there are many therapeutic options and they all differ slightly from one another. Where there is a huge difference, a doctor is going to recommend the best one that is the best hope for the patient. When there is a small difference and the big issue is cost, I think it’s relevant to discuss it with patients since they are going to bear some financial burden,” said Dr. Richard Schilsky, chief medical officer of The American Society of Clinical Oncology (ASCO).

“I am hopeful that as doctors read about studies like this they realize that it’s feasible to discuss cost in patient encounters,” said Schilsky, who was not involved in the research.

Researchers analyzed 677 transcripts of conversations taped in 2010-2013, between 56 oncologists in private practice clinics across the country and patients with breast cancer. Most patients were 55 to 74 years old and insured.

Cost came up in only 147 conversations, or 22 percent. When it did come up, oncologists were the ones who raised it 59 percent of the time, the research team reported in the Journal of Oncology Practice.

Half of the discussions lasted only about 33 seconds. But even though the discussions were brief, they were substantive enough to lead to helpful and creative solutions for patients in most cases, said lead author Dr. Wynn Hunter of the Duke University School of Medicine in Durham, North Carolina.

After these conversations, oncologists switched patients to lower-cost medications, ordered different diagnostic tests, changed the dose or frequency of medication, facilitated copay assistance, gave patients free samples or changed the logistics of intervention by, for example, rescheduling tests before the patient had to pay a new deductible.

Hunter told Reuters by phone, “Finances have to be a part of the equation when we think about the therapies that we give. One part of the Hippocratic Oath is that we do no harm to patients. If we just treat disease and two or three years later it causes financial hardship and marital strife, then it’s not necessarily a victory.”

In 2009, ASCO recommended that physicians discuss the costs of cancer treatment with patients, because they can become a tremendous financial burden. One-third of working-age cancer survivors go into debt, and 3 percent of patients go bankrupt from cancer care costs.

“This study is encouraging because it documents real doctor-patient encounters that were meaningful and demonstrated that doctors are knowledgeable about how to identify alternatives for patients that are less costly,” Schilsky said in a telephone interview.

Hunter told Reuters Health, “It used to be taboo to talk about finances in the clinic and no one was doing it. This study proves it’s happening more frequently than people thought, and it can be done in a way that’s non-confrontational and non-biased. It can be as simple as asking a patient if they are having any difficulties obtaining their medications.”

Patients also need to be empowered to bring up costs with their oncologist, Hunter emphasized.

In the study, Caucasian patients initiated cost conversations 12 percent of the time while African American patients had these conversations 3 percent of the time.

One of the limitations of the study is that it analyzed cost discussions only for patients with breast cancer. It’s not clear if patients with other cancers engage in similar discussions.

Schilsky said, “One of the challenges is we don’t understand if it’s necessary, appropriate or feasible to have had discussions in all 677 encounters. Sometimes patients have an acute medical problem, and we have to be focused on that. Sometimes there isn’t an issue of cost for the patient. We don’t know what the denominator is in a sense. Is it likely these discussions could be held more frequently? Almost for sure,” he said. “But there are many nuances to this.”

Schilsky warned that one discussion of costs is often insufficient. Multiple discussions with multiple levels of a patient’s health care team are usually needed.

SOURCE: Journal of Oncology Practice, online August 23, 2017.