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Cancer Patients Often Shy Away From Talking About Costs
Date:6/5/2013

By Barbara Bronson Gray
HealthDay Reporter

TUESDAY, June 4 (HealthDay News) -- Although most cancer patients want to talk about the price tag of cancer treatment, they don't actually do it, a new study has found. Many patients are afraid the discussion could compromise the quality of their care.

Those who do bring up their financial concerns, however, frequently find that the discussion ends up reducing their costs, the research revealed.

The findings, from a survey of about 300 insured patients treated at Duke Health and affiliated clinics in rural North Carolina, suggest that physicians can help bridge the communication gap and reduce patients' level of stress about the financial impact of cancer -- if they're willing to bring up the topic of money. And if physicians don't bring up the topic, the study suggests that patients should.

Coping with financial issues can make dealing with a difficult disease even more challenging and may influence a patient's decisions, said study lead author Dr. Yousuf Zafar, an assistant professor at the Duke Cancer Institute. "Even my patients with insurance were asking for less expensive medications and less frequent visits [since they couldn't afford the travel costs]. There's this undercurrent of expenses that patients are facing that often goes unseen."

The study found that although almost 60 percent of the participants had private insurance, the average out-of-pocket cost for patients was nearly $600 a month.

Although more than half the participants said they wanted to talk about cost with their physicians, only 19 percent had actually done so. Yet 57 percent of those who did broach the subject of financial problems felt that having the discussion helped decrease costs. More than 50 percent of the participants wanted their doctors to consider cost before recommending treatment. Those with the most "financial distress" were the most willing to discuss costs.

The study was scheduled for presentation this week at the American Society of Clinical Oncology meeting in Chicago. Data and conclusions of studies presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Why the hesitancy to bring up money? "Our data found that patients who didn't want to talk about costs wanted to be sure they got the best care regardless, which implies they feared that talking about money would get them less care," Zafar said.

Doctors don't want to discuss financial issues either, Zafar said. Although they receive training about how to talk to patients about tough topics like end-of-life issues and end-stage disease, they aren't taught how to help patients deal with cost overload. "I think physicians realize that cost is a problem, but we approach the topic cautiously because we don't have good answers," he said.

Zafar noted that, as a gastrointestinal oncologist, he can offer patients options that could cut costs without reducing the quality of their care. For example, he can ask whether people have prescription medication coverage. If they don't, he may avoid giving them an oral chemotherapy drug and offer them intravenous chemotherapy instead, which would typically be covered by insurance.

"[Physicians] think talking about money will send us into a deep dive," he said, but there are some practical solutions to many of the financial issues patients face.

The study included patients between ages 27 and 86 who had solid tumors and had been on chemotherapy for a month or longer. Of these, 52 percent were men, 71 percent were white and 78 percent had incurable cancer. Researchers asked the participants about their level of financial distress (using a questionnaire commonly used in financial planning), out-of-pocket costs and whether they had discussed costs and treatment options with their physician.

Based on the results, Zafar suggested the following:

  • Patients and physicians should not hesitate to bring up the topic of money. The first step is acknowledging there is a problem and talking about it. "We can't always fix the problem, but that doesn't mean we can't talk about it," Zafar said.
  • Those having problems with costs should give physicians particular examples, such as, "I can't afford my prescription co-payment," or "The travel back and forth and hotel costs are adding up." Zafar suggested that people be as specific as possible.
  • Patients should realize that it's often virtually impossible to make broad cost estimates. Because so much of cancer care is multidisciplinary, involving physicians with different specialties and a wide variety of testing and treatment approaches, the total price tag for care can be hard to pin down, Zafar said. "Even within our own practices, many of us can't tell people how much their treatment is going to cost," he said.

A large study appearing in the June issue of the journal Health Affairs showed that those diagnosed with cancer are almost three times more likely to declare bankruptcy than are people without the disease.

Dr. Scott Ramsey, lead author of that study and director of the Hutchinson Institute for Cancer Outcomes Research, in Seattle, said Zafar's new study "provides more evidence that cancer patients -- even those with health insurance -- commonly experience financial difficulties during treatment."

Ramsey said it is possible that knowing more about out-of-pocket costs might help patients make better decisions about their potential treatment.

More information

Learn more about the cost of cancer treatment from the American Cancer Society.

SOURCES: Yousuf Zafar, M.D., M.H.S., assistant professor, Duke Cancer Institute, and Duke Clinical Research Institute, Durham, N.C.; Scott Ramsey, M.D., Ph.D., director, Hutchinson Institute for Cancer Outcomes Research, and professor, School of Medicine, University of Washington, Seattle; June 3, 2013, presentation, American Society of Clinical Oncology meeting, Chicago


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