Screening for financial toxicity should be routine in cancer care, according to investigators.
Less than a quarter of patients with cancer have a documented financial discussion about the costs of their treatment, according to a retrospective, population-based cohort study presented during the 2023 ASCO Quality Care Symposium.1
Specifically, the study demonstrated that in a population of 1767 patients with non–small cell lung cancer (NSCLC) and 689 patients with melanoma, 20.3% vs 24.0%, respectively, had a documented cost discussion in their medical record.
“Three-fourths of patients with stage III/IV non-small cell lung cancer or melanoma did not have a documented cost discussion in their medical records,” Robin Yabroff, PhD, said in a presentation of the findings.
The study also showed that cost-of-care discussions were less likely among those with private insurance (OR, 0.54; 95% CI, 0.37-0.80), in hospitals without a residency program (OR, 0.64; 95% CI, 0.42-0.98), and among those who were not receiving systemic therapy (OR, 0.39; 95% CI, 0.19-0.81).
Moving forward, Yabroff noted that there may be opportunities to improve cost discussions and documentations, including better training and price transparency.
“Frequently, the cost of a specific care to a specific patient is not always available,” Yabroff, who is scientific vice president of health services research with the American Cancer Society, said.
“However, we do know that if patients have health insurance coverage, we know what their out-of-pocket maximum will be for that year. That information may be very useful for patients.”
As Yabroff explained, new approvals in oncology have offered patients new systemic treatments—however, they often come with high price tags and high out-of-pocket costs.
Medical financial burden is also common, and patients with financial hardship during treatment are more likely to experience symptom burden, worse health-related quality-of-life outcomes, and face an increased mortality risk.
Since the early 2000s, the median monthly price of new cancer drugs has been higher than the median monthly household income. In 2017, the median annual price of a new anti-cancer drug was $172,199. By 2021, this number had increased to $250,775.
Despite these high price tags, discussions around cost remain rare. Investigators therefore designed this study to examine the rate of cost discussions in individuals who just received a diagnosis of either advanced NSCLC and melanoma, as these cancers have the high-cost treatment options.
To do so, investigators looked at the 2017 and 2018 NCI patterns of care studies, this included 12 population-based Surveillance, Epidemiology, and End Results Program (SEER) registries. Data was collected about patient demographics, their cancer type, and the characteristics of the hospital where they were receiving treatment.
Of note, certain limitations may have impacted the study results, according to Yabroff. Specifically, it is possible that cost-of-care discussions happened that were not recorded. Also, this study looked at patients diagnosed between 2017 and 2018, yet more recent expensive treatments have since been approved. The records used for data collection did not offer any information about treating clinicians or contact with patients.
As Veena Shankaran, MD, MS, pointed out, the phrase “cost-of-care conversation” is vague.2
“What is a cost of care conversation?” she said in a postpresentation discussion of the findings. "The content of these conversations really can't be captured in an electronic medical record and, undoubtedly, there will be quite a bit of heterogeneity."
Shankaran, who is a professor in the cancer prevention program with the Fred Hutchinson Cancer Center, as well as co-director of the Hutchinson Institute for Cancer Outcomes Research, went on to argue that there is certainly value in providing this intervention, and that it could be pushed further.
“We have the opportunity to start thinking about who benefits most and why,” she said. “Out-of-pocket cost estimates, for example, may not help a Medicaid patient who simultaneously has very little to no cost sharing for treatment, yet also may face significant challenges for many other reasons.”
She also proposed that moving forward, research should be centered less on reactive models than proactive ones. According to Shankaran, financial hardship is often identified late into treatment, when screening should be conducted both upfront and longitudinally.
“Many questions in the field around financial screening, including who to screen and how often, [remain],” she said. “[But] I think the consensus is that we need to screen everybody, and we need to screen them longitudinally.”
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