Chicago, IL—Financial distress is prevalent among insured patients with cancer, and although most patients state a desire to talk to their physicians about costs, this discussion rarely occurs, according to a study conducted at Duke University Medical Center, Durham, NC.
Of the 300 insured patients with cancer included in this study, 17% reported “high” or “overwhelming” financial distress, and only 25% of this group discussed costs with their physicians.
“Financial distress increases the burden of living with cancer. Even insured patients may experience considerable financial distress, but little has been known about whether patients want to include cost discussions in treatment decision-making,” said S. Yousuf Zafar, MD, MHS, Assistant Professor, Division of Medical Oncology, Department of Internal Medicine, Duke University Medical Center, who presented the study results at ASCO 2013.
Nearly 50% of patients with cancer dip into their savings to pay for cancer treatment, according to other research by Dr Zafar and colleagues (Oncologist. 2013;18:381-390). Other researchers have shown that patients with a cancer diagnosis are 2.6 times more likely to file for bankruptcy than patients without cancer (Ramsey S, et al. Health Aff [Millwood]. 2013;32:1143-1152).
The researchers conducted a cross- sectional study of 300 insured adults who were treated for at least 1 month for solid tumors. Participants were surveyed in person and were asked about financial distress (via a validated 10-point scale), out-of-pocket costs, discussions about costs with their doctor, and about decision-making.
“We wanted to answer 3 questions,” Dr Zafar said. “Do patients want to discuss costs? Do they want cost to be included in treatment decision-making? And, if these discussions occur, do they result in decreased costs?”
The patients’ mean age was 60 years; 53% were male, 72% had at least a high school education, and 66% were married. The median household income was $60,000. Of the patients, 55% had private insurance and 36% had Medicare. Colorectal cancer was the most common diagnosis, followed by breast, lung, and pancreaticobiliary cancers; 78% of patients had advanced disease.
A Lot of Stress, Little Conversation
High or overwhelming financial distress was reported by 17% of patients.
Approximately 50% of all respondents expressed a desire to talk about cost with their oncologist, but only 19% actually engaged in a cost discussion. Of the 17% of patients with the highest financial distress, only 25% had these discussions. “We found a ‘disconnect’ between a desire to talk about cost and actually having this discussion,” Dr Zafar observed.
Barriers to Cost Discussions
The investigators explored the barriers to discussions about cost, and found that 50% of patients did not talk about cost because they had “no difficulties” with cost, approximately 35% hesitated because they wanted “the best care,” and 20% said that cost was “not my doctor’s job,” or “my doctor can’t help.” Overall, 10% of patients reported that they had talked to someone other than their physician about cost, and 10% said they were “embarrassed” to bring up the topic.
“The fact that many patients said they wanted the best care, regardless of cost, carries the implication that patients link cost to quality, and if they broach the topic of cost, they may receive lesser quality care,” Dr Zafar suggested.
The cohort was evenly split regarding their desire to include cost in decision-making; 21% wanted to “always take cost into account.” Of the 19% of patients who reported having cost discussions with their oncologist, 57% said these discussions resulted in decreased expenses for them.
In an exploratory analysis of the study, white race and a high level of distress were significantly associated with the likelihood of discussing costs.
The majority of patients who actually have cost discussions find them helpful, which indicates that there are “false barriers” to these discussions, Dr Zafar said. “We need to at least identify patients at greatest risk for financial distress. We may not have all the answers, but broaching the topic can go a long way.”