AT THE WORLD CONGRESS OF PSYCHO-ONCOLOGY
WASHINGTON (FRONTLINE MEDICAL NEWS) – A substantial proportion of cancer patients say they want more information than they are getting about the costs of their care, investigators report.
Of 176 patients currently receiving treatment for cancer, 40.8% said they wanted more information than they were given on the cost of their treatment to society, and 48.7% said they weren’t given enough information about the costs to themselves, said Ashley Varner, manager for psycho-social oncology at the DeCesaris Cancer Institute, Anne Arundel Medical Center in Annapolis, Md.
“It’s very important for clinicians to be thinking that patients may want to know the costs of care, and that patients deserve to have that knowledge as part of the shared decision-making process,” she said in an interview.
It’s no secret that the costs of cancer care are high and climbing ever higher, with annual U.S. expenditures on cancer expected to reach $158 billion by 2020. The strains on budgets are felt by providers and patients alike, with 42%-50% of cancer patients reporting high financial distress, Ms. Varner and colleagues reported in a poster presentation at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.
To see which factors predicted patients’ desires for information about the costs of their care, the investigators surveyed a convenience sample of 176 patients from the ages of 28 through 87 years (median age 63) who were currently undergoing cancer treatment at a community medical center.
What’s it to you?
The patients were asked with structured questionnaires about their preferences for information and degree of control over medical decisions, and about the information they received from their oncologists, including about the costs of their care. The patients were also asked to estimate their monthly out-of-pocket treatment costs and were screened for psychological distress with the four-item Patient Health Questionnaire on anxiety and depression.
A majority of patients reported that their preferences were met with regard to the information they received about diagnosis (77%), treatment side effects (71.6%), and treatment effectiveness (75%). Similarly, most patients felt they were adequately informed about the chance of cure (65.6%) and life expectancy (56.3%).
But when it came to costs, just over half (52.2%) said they had been given sufficient information about the costs of their care to society, and less than half (47.4%) reported satisfaction with the information they got about the cost of care to them.
People with partners were significantly more likely to want more information about costs than singles, and younger people were significantly more likely to ask to know more than older people (P less than .05 for both comparisons).
“A nuanced assessment of each patient’s psychosocial characteristics, including control preferences and psychological and financial distress is warranted in order to anticipate and meet specific information preferences,” the investigators said.
Asked how clinicians can pluck financial information from the morass of health plan data, Ms. Varner explained that at her center, when a treatment has been decided on – whether chemotherapy, radiation, surgery, targeted agents, or a combination – financial coordinators contact each patient’s insurance company and develop written estimates which they offer to share with the patient at his or her discretion.
“That allows us then to put into place drug replacement programs or other types of assistance. For example, we know that patients who have Medicare only with no supplemental plan are at very high financial risk – they’re going to owe 20% of the cost of care, which is substantial. But there are often some resources that we can tap into if we know that ahead of time,” Ms. Varner said.
