Discussions About the Cost of Cancer Care Are Still Uncommon

Get Permission

Ronan J. Kelly, MD, MBA

We have demonstrated that patients do want to know the costs of the treatment, and that these costs are not being routinely discussed in academic medicine.

—Ronan J. Kelly, MD, MBA

Patients with cancer are extremely interested in discussing the cost of treatment, especially their share of the cost, but some oncologists are still hesitant to enter into these conversations, according to a study reported at the National Comprehensive Cancer Network (NCCN) 2014 Conference.1

“We have demonstrated that patients do want to know the costs of the treatment, and that these costs are not being routinely discussed in academic medicine,” said lead author Ronan J. Kelly, MD, MBA, of Johns Hopkins School of Medicine. “For the first time, we show that there are minimal conflicts and no harm to the doctor-patient relationship when costs are introduced.”

Is Cost of Care Being Discussed in the Clinic?

In 2007, the ASCO Cost of Care Task Force was established to deal with the soaring costs of cancer treatment in the United States. One of the key recommendations was that the cost of chemotherapy should be introduced into the patient-physician discussion from the outset.

“It is unknown if these discussions are occurring in academic institutions and what, if any, is the impact on the doctor/patient relationship,” said Dr. Kelly.

The prospective study included patients attending Johns Hopkins for the management of advanced or metastatic lung, colorectal, or breast cancer in 2013. During the clinical encounter between physician and patient, the NCCN Guidelines and the eviti® advisor platform (a digital library of evidence-based standards for cancer care) were jointly used during the consultation to demonstrate treatment options and display the costs at the time of prescribing to providers and patients alike.

Questionnaires measured the oncology providers’ attitudes to cost discussions and assessed their satisfaction with the shared decision-making process when costs were introduced into the discussion. Patients were interviewed before and after their consultation to measure their satisfaction with the process, including their attitudes to cost discussions and shared decision-making as it pertained to cost and outcomes.

Cost of Care an Important Issue to Patients

Of 18 oncologists interviewed for the study, only 5 (28%) reported feeling comfortable when discussing costs with patients and only one (6%) regularly asked patients about their financial well-being. Despite this, 83% of providers felt that the NCCN guidelines should contain cost information.

Of 107 patients asked to participate in the study, 96 (90%) gave written consent. More than 80% of respondents reported that it is “quite important” or “extremely important” for them to know the amount they will be personally responsible for paying. Interestingly, in spite of their desire for information, 72% of patients noted that no health-care professional has ever discussed costs with them. The majority of patients—80%—had no negative feelings to hearing cost information.

“In an era of rising copays, patients want cost-of-treatment discussion and these do not lead to negative feelings in the majority of patients,” Dr. Kelly said. “Additional training to prepare clinicians for how to discuss costs with their patients is needed.” ■

Disclosure: Dr. Kelly reported no potential conflicts of interest.


1. Kelly RJ, Forde PM, Bagheri A, et al: Measuring the impact of chemotherapy cost discussions between patients and providers at the time of prescribing. 2014 NCCN Annual Conference. Presented March 2014.