Nearly one in four oncologists report rarely or never discussing the costs of genomic testing with their patients, according to a new study led by American Cancer Society investigators. The study, published by Yabroff et al in the Journal of the National Cancer Institute, found that oncologists trained in genomic testing or working in practices with electronic medical record (EMR) alerts for genomic tests were more likely to have discussions about cost of the testing with their patients.
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With the costs of cancer care rising in the United States, and high patient out-of-pocket costs for cancer treatment an increasing concern, the study set out to find how often discussions about expected costs of genomic testing and related treatments were happening. Those discussions may inform treatment decision-making and help patients prepare for high expenses. Little is known about how often oncologists discuss costs of testing and treatment, or about the physician and practice factors associated with those discussions.
Methods and Results
To learn more, investigators analyzed data from 1,220 oncologists who reported discussing genomic testing with patients who had cancer from the 2017 National Survey of Precision Medicine in Cancer Treatment, a survey.
They found that among oncologists who discussed genomic testing with patients, 50% reported often discussing the likely costs of testing and related treatments; 26.3% reported sometimes discussing costs; and 23.7% reported never or rarely discussing costs.
In adjusted analyses, oncologists with training in genomic testing or working in practices with EMR alerts for genomic tests were more about twice as likely to have cost discussions sometimes or often (odds ratio = 2.1 and odds ratio = 2.2, respectively) compared to rarely/never. Other factors associated with more frequent cost discussions were treating solid tumors (rather than only hematologic cancers); using next-generation sequencing gene panel tests; having higher patient volume; and working in practices with higher percentages of patients insured by Medicaid or who are self-paid or uninsured (all P < .05).
“Initiating a discussion about the expected out-of-pocket costs of genomic testing and related treatment is a necessary first step but is not sufficient to ensure that patients and their families can make fully informed decisions about treatment options,” wrote the authors. “In the context of rising costs of cancer care, interventions targeting modifiable physician and practice factors may help increase the frequency of physician-patient cost discussions, contributing to more informed patient decisions and higher-quality cancer care.”
Disclosure: For full disclosures of the study authors, visit academic.oup.com/jnci.
