Cancer can take a toll on patients – physically, mentally, emotionally, and financially.
A study presented at the 2017 American Society of Clinical Oncology (ASCO) conference by Rahma Warsame, MD, of the Mayo Clinic indicates that while doctors and patients are comfortable speaking about the burdens associated with cancer treatment, the cost of treatment is seldom discussed.
Considering that the cost of cancer per year is more than $124 billion (2010 estimate) and expected to be reach $157 billion by 2020, that could be considered surprising.
Warsame and her team recorded conversations from 5/3/2012 - 11/20/2013 between adult patients with any solid tumor malignancy and physicians in 1 of 3 outpatient medical oncology clinics between the Upper Midwest and Southern California.
Dr Warsame explained to the packed audience at ASCO, “Essentially, in this study, we were ears in the room without any input on what was being said.”
A total of 525 recordings were reviewed; among them, only 151 (28%) contained any mention of cost. In most of 101 of 151 cases, it was the patient who initiated the conversation.
In cases where the subject of cost of care was brought up, clinicians verbally acknowledged the subject matter in only 60% of cases. And in those 60% of cases, action was taken by the clinician only a quarter of the time.
The average time spent discussing costs was less than 2 minutes.
Dr Warsame noted 4 themes when it came to the 'cost of care' conversations: 1) drug costs, 2) disability, 3) medical bills, and 4) insurance coverage. During the presentation, she included a few examples of the conversations to illustrate the patients’s concerns and the doctors responses (or lack thereof):
Theme: Drug Costs
Patient: “We have been stock piling Sutent from before in case we need to use it again. If we go back to prior regimen Dr. said that we could trade or have a bartering system if we need to switch.”
Clinician: “How many do you have?”
Patient: “Enough for awhile, we do not know what will happen in the future in drugs costs or coverage. We get a months worth but I only take 7 days on and 14 days off.”
Clinician: “ Hmmmm.”
Patient: “I’m afraid of losing my job and not having health insurance since no one else will take someone with a later stage cancer unless the National Health Care plan comes into effect. But Wisconsin has a Well Woman program, and, um, if I’m on disability I can get on that. Would I even qualify for disability at this stage?”
Clinician: “I couldn’t sign something, and I don’t know.”
Patient: “Okay, it doesn’t, unless my cancer comes back.”
Clinician: “Yeah, which we don’t want it to come back.”
Theme: Medical bills
Clinician: “Your insurance did not cover anything?”
Patient: “I have never had insurance and I have to deal with that other hospital and I do not know what to do.”
Clinician: “Oh, gosh!”
Patient: “The surgeon really hurt my morale. The surgeon said that I should go to another hospital. He wanted to throw me out of here, he said do you know how much are these rooms here? Like $2500 per night. And I was like, I am here because of an emergency.”
Theme: Insurance coverage
Patient: “The first thing he would do is put a stop to the Federal funding for that. And without that I’m screwed – like, literally. I can’t get insurance. I had to go on the state insurance after my husband passed away because at that time my employer didn’t offer insurance. And then after finding out I have cancer there’s no insurance that’s going to not consider that a preexisting condition. So without that, it is like…”
Clinician: “Hmmm, I cannot comment on the politics. I wish health care was not so difficult.”
As costs of care will likely continue to rise along with the complexity of the health insurance coverage, clinicians are encouraged to be more familiar and open to discussing financial options with patients undergoing cancer treatment.
Warsame RM, Jatoi A, Kimball B, et al. How costs get discussed (or not) in routine oncology practice. J Clin Oncol 2017;35: (suppl; abstr 6512).