Better physician–patient communication needed about costs of cancer care

Physicians’ willingness to communicate with patients about the cost of cancer care appeared associated with improved patient satisfaction and lower out-of-pocket expenses.

However, these conversations do not occur regularly, according to a review published in Cancer.

Ya-Chen Tina Shih

“There was a higher likelihood of medication nonadherence among patients when physicians communicated about the costs of cancer care,” Ya-Chen Tina Shih, PhD, professor of health economics, chief of the section of cancer economics and policy in the department of health services research at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “The exact reason and possible causal pathway influencing [this] observation remain enigmatic.”

Shih and colleagues sought to assess how the role of communication about costs plays in cancer care. They performed a literature search of the PubMed and Web of Science databases, and they identified 15 articles about cost communication that discussed patient attitudes, physician acceptance and associated outcomes.

Results showed more than 50% of patients desired some communication about costs, but fewer than one-third of patients reported actually discussing costs with their physicians. Meanwhile, 75% of physicians considered discussions with patients about out-of-pocket costs to be their responsibility, yet fewer than 30% said they felt comfortable with such communication.

HemOnc Today spoke with Shih about the findings, as well as how physicians can feel more comfortable having these conversations with their patients.

Question: How did the idea for this study come about?

Answer: Initially, we were invited to do a review article looking at cost transparency in cancer. Once we started to look into the literature, we realized there were not a lot of studies that discussed interventions to improve cost transparency. So, we took a step back and tried to figure out what happened to the cost communication guidance statement recommended by ASCO’s Task Force on the Cost of Cancer Care in 2009. We reframed the question a bit for our review article to focus on cost communication, and to look at how patients and providers feel about these discussions, to see if there are associations between cost communication and outcome measurements.

Q: What did the overall findings suggest?

A: There were differences in what patients and providers were reporting. For example, when studies asked patients or physicians if they felt positive about cost communication, most would state that they do feel positive about it. However, when studies asked if they actually had a cost communication talk with the physician or patient, the responses were interesting: 47% of providers reported that they had cost communication with their patients, but less than 30% of patients said they had cost communication talk with their provider.

Both physicians and patients reported it was difficult to get the correct cost information in the context of out-of-pocket expenses because the exact amount really depends on insurance benefits, which vary widely across patients. This is the type of cost information patients are most interested in, and the lack of readily accessible and accurate data on out-of-pocket expenses creates a large barrier for cost communication.

Q: What are the tangible benefits of patient physician communication about costs?

A: From the patient side, when given the financial cost information up front, it allowed them to have a better idea of what the likely financial commitment is that they would have to make after they complete their cancer treatment. From the physician side, they really want patients to stick with their treatments, so if they started out with something that works and is more affordable for patients, it is more likely that patients would adhere to their recommended treatment regimen.

Q: Are there any drawbacks to these types of discussions?

A: It is difficult to find accurate cost information for out-of-pockets expenses. Because there is a lack of accurate information, physicians might not feel comfortable discussing this with their patients. From the patient side, they sometimes feel that if they had the conversation with their physician, especially if they are not financially well off, they may be worried that they will not receive the best treatments.

Q: How can physicians become more comfortable speaking with their patients about this topic?

A: ASCO has suggested ways to help physicians talk to their patients about costs. Another option is to have other people in the physician’s office receive training on how to discuss costs with patients so that the encounter between patients and physicians will focus primarily on the treatment management. Yet, this is based upon the individual patient. For some patients, cost would be an important element when making treatment decisions, and they would like to have this discussion with the physician.

Q: Do you have a takeaway message for our readers?

A: Be aware that the treatment you prescribe may affect patients financially. Offer patients the opportunity of cost communication, either with physicians or staff. When detecting the possibility of financial hardship as a result of expensive treatment, either connect patients to programs that offer financial assistance or offer other cheaper options with similar clinical benefits. – by Jennifer Southall

References :

Schnipper LE. J Oncol Pract. 2009;doi:10.1200/JOP.091023.

Shih T, et al. Cancer. 2016;doi:10.1002/cncr.30423.

For more information:

Ya-Chen Tina Shih, PhD, can be reached at The University of Texas MD Anderson Cancer Center, T. Boone Pickens Academic Tower, 9th Floor, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030; email: yashih@mdanderson.org.

Disclosure: Shih reports no relevant financial disclosures.

Physicians’ willingness to communicate with patients about the cost of cancer care appeared associated with improved patient satisfaction and lower out-of-pocket expenses.

However, these conversations do not occur regularly, according to a review published in Cancer.

Ya-Chen Tina Shih

“There was a higher likelihood of medication nonadherence among patients when physicians communicated about the costs of cancer care,” Ya-Chen Tina Shih, PhD, professor of health economics, chief of the section of cancer economics and policy in the department of health services research at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “The exact reason and possible causal pathway influencing [this] observation remain enigmatic.”

Shih and colleagues sought to assess how the role of communication about costs plays in cancer care. They performed a literature search of the PubMed and Web of Science databases, and they identified 15 articles about cost communication that discussed patient attitudes, physician acceptance and associated outcomes.

Results showed more than 50% of patients desired some communication about costs, but fewer than one-third of patients reported actually discussing costs with their physicians. Meanwhile, 75% of physicians considered discussions with patients about out-of-pocket costs to be their responsibility, yet fewer than 30% said they felt comfortable with such communication.

HemOnc Today spoke with Shih about the findings, as well as how physicians can feel more comfortable having these conversations with their patients.

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Question: How did the idea for this study come about?

Answer: Initially, we were invited to do a review article looking at cost transparency in cancer. Once we started to look into the literature, we realized there were not a lot of studies that discussed interventions to improve cost transparency. So, we took a step back and tried to figure out what happened to the cost communication guidance statement recommended by ASCO’s Task Force on the Cost of Cancer Care in 2009. We reframed the question a bit for our review article to focus on cost communication, and to look at how patients and providers feel about these discussions, to see if there are associations between cost communication and outcome measurements.

Q: What did the overall findings suggest?

A: There were differences in what patients and providers were reporting. For example, when studies asked patients or physicians if they felt positive about cost communication, most would state that they do feel positive about it. However, when studies asked if they actually had a cost communication talk with the physician or patient, the responses were interesting: 47% of providers reported that they had cost communication with their patients, but less than 30% of patients said they had cost communication talk with their provider.

Both physicians and patients reported it was difficult to get the correct cost information in the context of out-of-pocket expenses because the exact amount really depends on insurance benefits, which vary widely across patients. This is the type of cost information patients are most interested in, and the lack of readily accessible and accurate data on out-of-pocket expenses creates a large barrier for cost communication.

Q: What are the tangible benefits of patient physician communication about costs?

A: From the patient side, when given the financial cost information up front, it allowed them to have a better idea of what the likely financial commitment is that they would have to make after they complete their cancer treatment. From the physician side, they really want patients to stick with their treatments, so if they started out with something that works and is more affordable for patients, it is more likely that patients would adhere to their recommended treatment regimen.

Q: Are there any drawbacks to these types of discussions?

A: It is difficult to find accurate cost information for out-of-pockets expenses. Because there is a lack of accurate information, physicians might not feel comfortable discussing this with their patients. From the patient side, they sometimes feel that if they had the conversation with their physician, especially if they are not financially well off, they may be worried that they will not receive the best treatments.

Q: How can physicians become more comfortable speaking with their patients about this topic?

A: ASCO has suggested ways to help physicians talk to their patients about costs. Another option is to have other people in the physician’s office receive training on how to discuss costs with patients so that the encounter between patients and physicians will focus primarily on the treatment management. Yet, this is based upon the individual patient. For some patients, cost would be an important element when making treatment decisions, and they would like to have this discussion with the physician.

Q: Do you have a takeaway message for our readers?

A: Be aware that the treatment you prescribe may affect patients financially. Offer patients the opportunity of cost communication, either with physicians or staff. When detecting the possibility of financial hardship as a result of expensive treatment, either connect patients to programs that offer financial assistance or offer other cheaper options with similar clinical benefits. – by Jennifer Southall

References :

Schnipper LE. J Oncol Pract. 2009;doi:10.1200/JOP.091023.

Shih T, et al. Cancer. 2016;doi:10.1002/cncr.30423.

For more information:

Ya-Chen Tina Shih, PhD, can be reached at The University of Texas MD Anderson Cancer Center, T. Boone Pickens Academic Tower, 9th Floor, 1515 Holcombe Blvd., Unit 1444, Houston, TX 77030; email: yashih@mdanderson.org.

Disclosure: Shih reports no relevant financial disclosures.