Cost-of-Care Conversations in Cancer Treatment Fall Short, New Study Reveals

New treatments can come with high price tags, and a population-based, retrospective study revealed that fewer than 25% of patients with cancer have a documented conversation about the financial aspects of their treatment.¹ The data, presented at the 2023 American Society of Clinical Oncology (ASCO) Quality Care Symposium, showed that only 1767 (20.3%) patients with non–small cell lung cancer (NSCLC) and 689 (24.0%) with melanoma had a formal discussion recorded in their medical records regarding their treatment costs.¹

“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, MBA, said in a presentation of the findings. Yabroff is the scientific vice president of health services research with the American Cancer Society.

The findings showed that cost-of-care discussions were less likely among patients with private insurance (OR, 0.54; 95% CI, 0.37-0.80), those 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).

Yabroff also noted that there may be opportunities to improve cost discussions and documentation, including better training and price transparency.

“Frequently, the cost of a specific care to a specific patient is not always available,” Yabroff explained. “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 and worse health-related quality-of-life outcomes. They also 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 anticancer drug was $172,199. By 2021, this 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 recently received a diagnosis of either advanced NSCLC or melanoma, as these cancers have high-cost treatment options. Investigators looked at the 2017 and 2018 National Cancer Institute patterns of care studies, this included 12 population-based Surveillance, Epidemiology, and End Results (SEER) Program registries. Data were collected about patient demographics, their cancer type, and the characteristics of the hospital where they were receiving treatment.

Limitations may have impacted the study results, according to Yabroff, with costof-care discussions taking place but not recorded. The study reviewed patients who received a diagnosis in 2017 and 2018, yet more expensive treatments have since been approved. The records used for data collection did not offer any information about treating clinicians or contact with patients.

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 Fred Hutchinson Cancer Center, and codirector of the Hutchinson Institute for Cancer Outcomes Research, went on to argue that there is certainly value in providing this intervention, and 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 may face significant challenges for many other reasons.”

Moving forward, She proposed that research should be centered less on reactive models than on proactive as financial hardship is often identified late into treatment, when screening should be conducted both up front 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 longitudinally.”

REFERENCES

1. Yabroff R, Halpern MT. Cost-of-care discussions for individuals with newly diagnosed advanced non-small cell lung cancer and melanoma: findings from a population-based study. Abstract presented at: ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA.

2. Shanarakn V. Addressing financial burden in the clinical setting. Presented at: ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA.