title: Do oncologists discuss expensive anti-cancer drugs with their patients?
abstract: BACKGROUND
  In Australia, some anti-cancer drugs are only available at significant financial cost to patients. We sought the views and practices of Australian medical oncologists regarding discussion of high cost drugs (HCDs).
  
  
  METHODS
  A postal survey was mailed to all 274 members of the Medical Oncology Group of Australia. Three clinical scenarios described HCDs associated with either improved overall survival, encouraging response rate in a treatment-refractory cancer, or a scenario with improved treatment tolerability. Participants were asked about their discussion and prescription of HCDs.
  
  
  RESULTS
  There was a 78% response rate. Most respondents were male (71%), worked in a metropolitan practice (87%) and spent more than 50% of their working time in patient care (87%). Forty-eight percent had previously prescribed a HCD. In the three scenarios, respondents would generally prescribe the drug if it were subsidised, however, between 28% and 41% (depending on the scenario) would not mention the HCD if it were not subsidised. Major reasons for not mentioning the HCD were concerns that discussion would 'worry the patient' or that the doctor would 'feel bad'.
  
  
  CONCLUSIONS
  Despite literature suggesting that patients wish to be well informed and active participants in decision making, the practice of a significant percentage of Australian medical oncologists may prevent this.
authors.affiliation: Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Thomson
authors.forename: P
authors.initials: P
authors.lastname: Schofield
authors.forename: L
authors.initials: L
authors.lastname: Mileshkin
authors.forename: E
authors.initials: E
authors.lastname: Agalianos
authors.forename: J
authors.initials: J
authors.lastname: Savulescu
authors.forename: J
authors.initials: J
authors.lastname: Zalcberg
authors.forename: M
authors.initials: M
authors.lastname: Jefford
mesh_terms: D000970:Antineoplastic Agents / Q000191:economics*; D001291:Attitude of Health Personnel; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D010817:Physician-Patient Relations; D000078329:Workforce
chemical_list: D000970:Antineoplastic Agents