A substantial proportion of patients with breast cancer did not feel clinicians adequately addressed their concerns about financial toxicity, study data showed.
“We found that even though many doctors reported that they routinely make services available to their patients to help with financial concerns, many patients still reported unmet needs,” Reshma Jagsi, MD, DPhil, professor, deputy chair and residency program director in the department of radiation oncology at University of Michigan, said in a press release. “Efforts must now turn to confront the financial devastation that many patients face, particularly as they progress into survivorship.”
Jagsi and colleagues conducted a survey of surgeons (n = 370), medical oncologists (n = 306), radiation oncologists (n = 160) and patients (n = 2,502) identified through population-based sampling of two different SEER regions.
Questionnaires included questions for clinicians about how often a representative from the participant’s practice discussed financial burdens with patients, how aware clinicians were of financial burdens of treatment and how important it was for clinicians that their patients save money. For patients, the questionnaires asked about lost income due to cancer diagnosis, out-of-pocket medical expenses and out-of-pocket nonmedical expenses.
Slightly more than half (50.9%) of medical oncologists reported that someone from their practice discussed financial burden with patients, compared with fewer than half (43.2%) of radiation oncologists and just 15.6% of surgeons.
Forty percent of medical oncologists believed they were quite or very aware of out-of-pocket costs of the tests and treatments they recommend, as did 27.3% of surgeons and 34.3% of radiation oncologists.
More than half of medical oncologists (57%) and radiation oncologists (55.8%) said it was quite or extremely important to save their patients money, compared with 35.3% of surgeons.
Financial toxicity appeared common among patients, although prevalence varied by race (P < .01).
Debt from treatment occurred among 27.1% of white patients, 58.9% of black patients, 33.5% of Latina patients and 28.8% of Asian patients.
Seventeen percent of patients reported spending at least 10% of their household income on out-of-pocket medical expenses.
Also, 21.5% white patients reported having to cut down on their spending for food, as did 22.5% of Asian patients, 35.8% of Latina patients and 45.2% of black patients.
Patients frequently reported wanting to talk to clinicians about financial burden across races (15.2% of white patients, 31.1% of black patients, 30.3% of Latina patients; 25.4% of Asian patients).
However, of the 945 women who reported worrying about their finances, most (n = 679; 72.8%) responded that they did not receive help from clinicians or their staff.
Further, although 523 women reported wanting to talk to their clinicians about financial burden, 55.4% (n = 283) reported having no relevant discussion.
“To cure a patient’s disease at the cost of financial ruin falls short of our duty as physicians to serve,” Jagsi said in a press release from University of Michigan. “It’s simply not acceptable to ignore patients’ financial distress any longer.” – by Andy Polhamus
Disclosures: Jagsi reports a consultant role with Amgen, as well as grants from Blue Cross Blue Shield of Michigan, the Doris Duke Charitable Foundation and NCI, all outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.