Financial Toxicity: Even Well-insured Patients Want to Discuss Cost Before Care

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Results of a new study reveal that many women with breast cancer experience significant financial burden. Most of these women, 8 out of 10, prefer to discuss the cost of their cancer care at the time of their diagnosis and before beginning treatment, But only a limited number of these patients are having real conversations about treatment costs with their cancer care teams.

And even when these patients had good health insurance coverage, they still reported having financial worries related to their care.

The findings highlight the importance of considering medical costs as women face breast cancer treatment decisions.

“Overwhelmingly, women cared about the cost of their breast cancer care and almost half reported considering costs when making treatment decisions,” said Rachel Adams Greenup, MD, MPH, Director of the Breast Fellowship and Associate Professor of Surgery and Population Health Sciences at Duke University Medical Center, who is presenting the findings September 29, 2018 at the ASCO Quality Care Symposium held in the JW Marriott Phoenix Desert Ridge in Phoenix, Arizona.

“Despite this, 78% reported never discussing costs with their medical team,” Greenup added.

One of the reasons is, Greenip explains, is that “in an era of rising cancer treatment costs, we don’t routinely discuss the financial implications of cancer care with women embarking on treatment.”

How to compare cost
“Many treatment options for breast cancer are comparable in their effectiveness, but their costs can vary. As women consider various cancer treatment options, information about costs could help them make more informed decisions about which therapies are best for them.”

While most women (79%) said that they prefer knowing the costs of treatment prior to embarking on cancer care, only 40% preferred that doctors consider costs when making medical treatment recommendations.

“Doctors and patients should be open to discussing the financial implications of treatment,” Greenup noted.

In their study, the Duke team surveyed more than 750 women with a history of breast cancer (stage 0-III) from the Army of Women and Sisters Network, a national organizations of women after breast cancer. All were women with a median age of about 50.

The majority of these women had either private insurance (70%) or Medicare (25%). They reported a higher annual household income (≥$74,000) than the general U.S. population.

In the study, 607 women completed an 88-question electronic survey on their experiences with breast cancer treatment costs and their preferences for cost transparency.

Even within this group, which is financially better off than many cancer patients, nearly 16% reported significant to catastrophic financial burden.

Financial burden
The survey also asked women to characterize their financial burden using one of five categories: none, slight, somewhat, significant, and catastrophic. Approximately 15% of women reported significant to catastrophic financial burden. Patients’ median out-of-pocket (OOP) costs were $3,500; 25% of women reported OOP costs greater than or equal to $8,000; 10% reported OOP costs greater than or equal to $18,000; and 5% reported OOP costs greater than or equal to $30,000.

Women who had more extensive surgery or were diagnosed with more advanced stages of breast cancer were more likely to report financial harm. Women who were older, further out from breast cancer diagnosis, had higher household income, or had a greater percentage of their care covered by insurance were less likely to experience financial harm. Women who discussed costs during their medical visit were also more likely to report financial harm, which, according to the study’s authors, may be because patients who proactively raised the issue with their providers faced greater financial vulnerability. The 16% of women who reported discussing costs with their cancer care teams were more likely to have stage II or III breast cancer (56% vs. 40%), were less likely to be depressed (24% vs. 30%), and had less insurance coverage compared to those who did not have discussions about treatment costs.

Study limitation
One limitation of the study is that the majority of women who participated in the survey were well-insured, well-educated, and white. According to the study’s authors, this suggests that women with breast cancer in the United States may experience even greater risk of financial harm than the study participants.

“Cost transparency could improve the quality of treatment decisions patients make and has the potential to reduce the risk of financial harm,” Greenup concluded.

The ASCO Quality Care Symposium brings together top leaders in the field to share strategies and methods for improving the measurement and implementation of quality and safety in cancer care. The two-day program will include presentations on Quality Interventions, Patient-Centered Care, Innovations in Care Delivery, and Addressing Disparities in Cancer Care.


Last Editorial Review: September 24, 2018

Featured Image: Doctor talking money from his patient. Courtesy: © 2010 – 2018 Fotolia. Used with permission.

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