Patients and Physicians Can Discuss Costs of Cancer Treatment in the Clinic

As one solution to reducing costs and medical bank- ruptcies, experts have suggested that patients and physicians should discuss the cost of care up front. Whether these discus- sions are possible in an oncology setting and what their effects on the doctor-patient relationship are is not known. Methods: We used the National Comprehensive Cancer Network (NCCN) Guidelines and the eviti Advisor platform to show patients with metastatic breast, lung, or colorectal cancer the costs associated with their chemotherapy and/ or targeted therapy options during an oncology consulta- tion. We measured provider attitudes and assessed patient satisfaction when consultations included discussion of costs. Results: We approached 107 patients; 96 (90%) enrolled onto the study, three (3%) asked if they could be interviewed at a later date, and eight (7%) did not want to participate. Onlyfive of 18 oncologists (28%) felt comfortable discussing costs, and only one of 18 (6%) regularly askedpatientsaboutfinancialdifficulties.Themajorityofpatients(80%) wanted cost information, and 84% reported that these conversations wouldbeevenmoreimportantiftheirco-paysweretoincrease.Intotal, 72% of patients responded that no health care professional has ever discussed costs with them. The majority of patients (80%) had no negative feelings about hearing cost information. Conclusion: In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients. Additional training to pre- pare clinicians for how to discuss costs with their patients is needed.