Studies have found that most oncologists rarely discuss the financial implications of cancer treatments with their patients. However, given that today's very expensive new therapies can produce copayments upward of $10,000 a month, many in the oncology community feel it is no longer appropriate to ignore costs when talking with patients about care. Cancer Care & Economics (CC&E) recently spoke with Anthony Back, MD, professor of oncology at the University of Washington, and a medical oncologist at Seattle Cancer Care Alliance, about the need to break down communication barriers around costs of care.
CC&E: Given the increasing costs of delivering cancer care, should today's oncologists discuss the financial realities of oncology treatment with their patients?
DR. BACK: On a case-by-case basis, yes. As a specialist in gastrointestinal and colon cancer, I care for many patients with advanced disease who need to understand potential trade-offs they can make when faced with significant out-of-pocket expenses. With the variation in insurance coverage and the tremendous expense of new medicines, it's important to talk about costs of care that impact the treatment and quality-of-life decisions for an individual patient.
Patients who have significant copays need to discuss whether they will be able to continue a certain therapy or should seek an alternative. Moreover, offering patients information about coverage and financial issues that they might be unfamiliar with helps them make informed decisions about their care.
CC&E: It could be off-putting to cancer patients for their oncologist to talk about money in the same context as treatment. How do you approach such a delicate subject?
DR. BACK: I always discuss the therapeutic options first, but if necessary I raise the issue of costs early in the discussion. Quite frankly, some of my patients are shocked when they find out the cost of their copay, or that a certain medication will not be covered by their insurance plan. I explain that we will check their insurance to see what percentage of the costs they would be liable for out-of-pocket, and assure them that, if it turns out to be an unmanageable amount, we'll have another visit to talk about different options. Most patients really value that kind of honest, open-ended discussion as long as they are confident that their care won't be compromised.
Conversations of this nature take a certain level of skill, and, in some cases, it's important to involve other members of the care team, such as an oncology nurse, social worker, or practice manager.