Cancer patients want to talk costs—but don't know how

Doctor: Help patients cope with the 'financial toxicity' of cancer

Most cancer patients want to ask their physicians about treatment costs, but only a fraction of those patients actually broach the issue because of anxiety over how the discussion might affect their care, American Medical News reports.

According to research presented at the American Society of Clinical Oncology's (ASCO) annual meeting, more than half of about 500 cancer patients surveyed wanted to have conversations about costs with their physician. However, only 19% of patients actually brought up the issue, and most of those patients had lower out-of-pocket costs than patients who did not broach the issue.  

Yousuf Zafar—lead author of the study and an oncologist at Duke University Health System—told American Medical News that patients want the best treatment for their condition, which they often perceive as the most expensive option. Many patients fear that if they bring up finances, their physician will describe a cheaper treatment plan that may not be as effective.

Oncologists debate ethics of cost discussions

According to American Medical News, members of the oncology community have only recently endorsed financial conversations between physicians and their patients. In the past, physicians have been divided on whether talking about cost is ethical when treating someone with a potentially fatal condition, says Lowell Schnipper of Beth Israel Deaconess Medical Center.

Now, more physicians are familiar with effective cancer treatments at a wide range of costs and are more comfortable talking about it with patients, Schnipper says. In 2009, ASCO released guidance that implored physicians to take into account the "unique needs of each patient when making treatment decisions, including consideration of out-of-pocket costs."

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Doctor: Educate patients about the 'financial toxicity' of cancer

Research shows that patients are more likely to delay treatment if they think they cannot afford it. After patients do seek treatment, they are more than two times more likely to declare bankruptcy than individuals without cancer, according to a recent study in Health Affairs.

Zafar believes that physicians have a duty to educate patients about the "financial toxicity" of cancer, which he compares to the toxicity of chemotherapy. "I can't necessarily prevent that physical toxicity, but if I educate patients about it, I can at least help them through the process, and I don't think anyone can argue that's unhelpful," he says.

He also reassures physicians that it is "OK" to not have all the answers. Instead, patients can be steered towards other resources like financial assistance, clinical trials, social workers, and financial counselors. "This can only help strengthen that doctor-patient relationship and possibly improve the quality of care that we deliver," he says (Dolan, American Medical News, 6/10).

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