The Cost Conversation: How Are We Doing?

September 12, 2017
ASCO Staff

ASCO Perspective
“Numerous studies have documented the negative impact of financial toxicity brought on by the need to cover costs for routine cancer care. In 2009, ASCO published a guidance statement on the cost of cancer care that urged oncologists to discuss this issue when planning cancer treatments because of its importance to the well-being of the patient and his/her family. New research indicates that this advice is beginning to gain traction. Oncologists are increasingly aware of the necessity of raising cost as a discussion point and suggesting strategies to deal with it that do not compromise care. However, there is much work to be done. While an improvement over earlier studies, ASCO believes that the financial implications of recommended cancer treatments must become more routinely incorporated into the oncologist-patient dialogue with strategies for problem-solving close at hand.”

  • Lowell E. Schnipper, MD, FASCO, ASCO Expert and Chair of the ASCO Value in Cancer Care Task Force​

Healthcare-related financial distress remains a prevalent issue in the United States. Financial distress is common among patients with cancer who may face significant out-of-pocket costs. Further, this distress is not only an economic concern for the patient and their family, but has also been associated with lower quality of life.

A new study published in the Journal of Oncology Practice (JOP) analyzed cost conversations between oncologists and their patients with breast cancer over a period of three years. 

The analysis was based on transcribed dialogue from 677 outpatient appointments among 56 oncologist nationwide from 2010 to 2013. This study represents the largest investigation of cost conversations in the oncology setting to date.

Cost conversations took place in only 22% of the visits and lasted an average of 33 seconds. Doctors initiated 59% of these cost conversations and most commonly addressed the cost of anti-neoplastic agents. The conversations initiated by patients frequently focused on the cost of tests.

When cost conversations did occur, nearly a third of those discussions included cost-reducing strategies, which could be further broken down into various categories of cost saving tactics. Some popular ways to reduce costs included discussions on:

  • Switching to a lower-cost intervention including less expensive anti-emetics and diagnostic tests
  • Switching to a generic formulation of the medications
  • Altering the logistics of the intervention including changes to the timing, location, or source
  • Facilitating copay assistance or coupons

The study authors note that while the average conversation may have been short, many of the physicians in the study displayed skill in re-affirming their commitment to their patient in the midst of addressing difficult cost and coverage barriers. Many oncologists also displayed a detailed awareness of drug pricing and a strong knowledge of local and national resources that could provide their patients with financial assistance.

ASCO’s 2009 guidance statement on the cost of cancer care identifies cost conversations as a key component of high-quality cancer care and encourages oncologists to talk with their patients about the cost of their care. This recent study suggests that not only are both patients and oncologists willing and able to discuss cost, but these conversations can effectively be accomplished in short, focused discussions that can help assess financial toxicity and lead to cost saving measures.