In Treatment Discussions With Oncologists, Patients Ask 'How Much?'

Two studies presented at this year’s American Society of Clinical Oncology meeting suggest that a significant proportion of patients with cancer want to include the cost of therapy in their discussion of treatment options with their physician, regardless of insurance coverage. Anecdotally, it’s been suggested that oncologists are unsure of whether a discussion about costs is appropriate. That would suggest a disconnect and studies from the Duke Cancer Institute and the University of Wisconsin illustrate that gap.

In the Duke study, the authors examined the relationship between prescription medication adherence and financial distress. The study found that 46% of the 164 participants reported cost-related nonadherence. Nonadherence was defined as either taking less medication than prescribed because of cost, not filling or partially filling a prescription because of cost, or taking medications prescribed for others. The cohort consisted of adults receiving treatment for solid malignancies from the HealthWell Foundation, a national copayment assistance program.

The study also found that 4% of patients took medications prescribed for another person, 22% took less medication than prescribed, 25% filled a partial prescription, and 27% did not fill a prescription because of cost.

Nonadherent patients were more likely than adherent patients to reduce spending on basic necessity items like food and clothing to pay for medication, and borrow or use credit to pay for medications. When the researchers conducted an adjusted analysis, they found that financial distress did not change odds of nonadherence (OR = 1.60; 95% CI). But, being enrolled in a prescription drug plan and older age decreased the odds of nonadherence. However, the research found that being unemployed increased odds of nonadherence.

The findings suggest that even among insured cancer patients, concern about financial distress is evident and that cost does matter.

In a second study, researchers from the University of Wisconsin assessed prostate cancer patients’ views on discussing treatment costs with their oncologists, as well as their views on high-cost drugs (HCDs). Of the 169 patients who participated in the study, 17% reported that they would not want treatment with HCDs even if they had no out-of-pocket expenses. These patients were more likely to be over 70 years of age and have an annual household income of more than $60,000. Another 21% said they would accept treatment only if they had no out-of-pocket expenses. Most patients (79%) agreed that a discussion about costs with their physician is appropriate.

The University of Wisconsin research showed that prostate cancer patients clearly want to have discussions regarding costs-of-care with their oncologists.

Source:

• Zullig LL, Peppercorn JM, Schrag D, et al. Financial Distress, Use of Cost-Coping Strategies, and Adherence to Prescription Medication Among Patients With Cancer. J Oncol Pract. 2013 Aug 20. [Epub ahead of print] http://jop.ascopubs.org/content/early/2013/08/20/JOP.2013.000971.abstract
• Determining value of high cost cancer therapies and discussing cost of cancer care: The patient perspective. Poster discussion session. Saurabh Rajguru, MD. http://meetinglibrary.asco.org/content/84093