According to a study published Wednesday by the American Society of Clinical Oncology (ASCO), most doctors do not discuss cancer treatment costs with their patients.
The ASCO study taped hundreds of doctor-patient visits at large hospitals where chemo is often provided. The nonprofit organization plans to discuss the findings in June during its annual meeting in Chicago.
The findings revealed physicians, when they did discuss treatment costs, were more likely to spend less than two minutes on the topic, and often only engaged in discourse at the patient’s request.
“That would not occur in any other industry I can think of,” the study’s leader, Dr. Rahma Warsame of the Mayo Clinic, said.
Cancer patients, according to the study, are at least three times more likely than cancer-free people to file for bankruptcy. Many doctors — who are at times in the dark on cancer treatment costs themselves — are not discussing means by which the patient could possibly avoid such financial woes.
Warsame said some families have refused “really life-extending therapies” for fears of bankruptcy. She added discussions about the “financial toxicity” of $100,000-plus cancer procedures are few and far between.
For the study, ASCO researchers recorded 529 visits between doctors and cancer patients at Mayo, Los Angeles County Hospital and the University of Southern California’s Norris campus. The organization said both parties, though not provided a reason, were aware they were being recorded. Out of those 529 visits, only 151 included talks about treatment costs; patients raised the questions in 106 instances, doctors started discussions in 45 cases.
On average, the study found appointments spanned about 15 minutes at the Los Angeles County Hospital and the University of Southern California’s Norris campus.; appointments at Mayo lasted not much longer, with visits typically ending in 30 minutes. Financial discussions regarding cancer treatments, when they happened, lasted a fraction of the visit — about one to two minutes. Doctors referred six patients to social services to seek assistance with treatment expenses.
Karla Mees, a 63-year-old nursing instructor in Minnesota said “maybe a lot of patients don’t know to ask questions” regarding treatment costs. Mees received breast cancer treatments at Mayo.
Mees said doctors warned her about a $4,500 bill for gene testing on her tumor, but they made no mention about chemo and radiation costs — she had to wait for the bills on those.
“I just remember thinking, ‘I need the stuff, I’ll worry about payment later,'” Mees said.
Beth Israel Deaconess Medical Center cancer expert Dr. Lowell Schnipper, who also heads the cancer group’s committee on value in cancer care, said physicians give priority to medical issues over financials since their time with patients is typically short.
“Most of us are not very well skilled in bringing it up,” Schnipper said. “In school you’re trained to simply take the best care you can of your patient and not worry about anything other than doing exactly that.”
Schnipper said the cancer society in 2015 launched a tool which helps doctors and patients determine the value of a cancer drug, weighing both the cost and benefit. He said the tool is a good place to start discussions about cost.
(Source: Marilynn Marchione, Associated Press, May 2017 )