2018 Quality Care: Few Women With Breast Cancer Discuss Costs With Physicians Before Beginning Treatment

Key Points

  • 43% of women reported considering costs when making treatment decisions and 40% preferred that their doctors consider costs when providing medical recommendations.
  • Though 79% of women surveyed preferred to understand costs prior to starting treatment, 78% of them never discussed costs with their cancer care teams.
  • 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.

Findings from a new study reveal that while many women with breast cancer experience significant financial burden and most prefer to discuss the cost of their cancer care before beginning treatment, few are having conversations about treatment costs with their cancer care teams. These findings will be presented by Greenup et al at the 2018 ASCO Quality Care Symposium, to be held September 28–29 in Phoenix (Abstract 207).

“In an era of rising cancer treatment costs, we don’t routinely discuss the financial implications of cancer care with women embarking on treatment,” said lead study author Rachel Adams Greenup, MD, MPH, Director of the Breast Fellowship and Associate Professor of Surgery and Population Health Sciences at Duke University Medical Center. “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.”

In the study, 607 women with a history of breast cancer (stage 0-III) completed an 88-question electronic survey on their experiences with breast cancer treatment costs and their preferences for cost transparency. The majority of women in the study had either private insurance (70%) or Medicare (25%) and reported a higher annual household income (≥ $74,000) than the general U.S. population.

Survey Findings

The survey found that 43% of women reported considering costs when making treatment decisions and 40% preferred that their doctors consider costs when providing medical recommendations. Though 79% of women surveyed preferred to understand costs prior to starting treatment, 78% of them never discussed costs with their cancer care teams.

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.

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.

To see a full list of author disclosures, refer to the study abstract.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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