Patients With Newly Diagnosed NSCLC or Melanoma May Receive Limited Documentation of Treatment Cost Discussions

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Investigators have uncovered that only about 25% of patients newly diagnosed with advanced cancer have documented physician discussions about the costs of care, which may make it more difficult to identify patient needs and track the outcomes of referrals for assistance, according to new findings presented by Yabroff and Halpern at the 2023 ASCO Quality Care Symposium (Abstract 3).


The growing costs of cancer care can result in financial hardship for patients. Many professional organizations have recommended that physicians discuss the expected treatment costs with their patients as part of high-quality care. Documentation of these discussions may be critical, since even privately insured patients may find care unaffordable without additional assistance.

Study Methods and Results

In the new study, the investigators used the population-based National Cancer Institute Patterns of Care study conducted in 12 Surveillance, Epidemiology, and End Results registries to assess the medical records and documented discussions between physicians and patients newly diagnosed with advanced non–small cell lung cancer (NSCLC) and melanoma from 2017 to 2018. The patients’ medical records were then analyzed for information on their age, sex, race and ethnicity, comorbidities, and health insurance coverage.

The investigators found that discussions about treatment costs were documented in the medical records of 24.6% of the patients with NSCLC and 25.5% of the patients with melanoma—in which, “out-of-pocket costs,” “patient assistance plan,” and “inability to pay” were the most commonly used terms.

Further, when documented, discussions regarding treatment costs were most often noted in physician and nursing progress notes and assessment plans. The patients who had private insurance were less likely to have the documented discussions compared with those with public insurance. Cost discussions were also much less common among patients who did not receive systemic therapies or any cancer-directed treatments than those who did receive systemic therapies.


The investigators emphasized that systemic documentation of cost-of-care discussions as part of high-quality care could help ensure informed decision-making for all patients. They concluded that a lack of information in the medical records could limit assessments of patients potentially at risk of financial hardship and whether any patients’ unmet financial needs were addressed.

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