To tell or not to tell: the community wants to know about expensive anticancer drugs as a potential treatment option.
OBJECTIVE
Many new cancer treatments are available only at significant financial cost to the patient. We previously reported that Australian medical oncologists commonly do not discuss unsubsidized, expensive anticancer drugs (EACD) because of concern about causing distress. We argued that this position was not consistent with modern ethical principals but wanted to seek the community viewpoint.


METHODS
A cross-sectional telephone survey of the Australian general public was performed. Respondents' views were sought about three hypothetical scenarios in which they were diagnosed with incurable cancer and an EACD treatment (out-of-pocket cost US$25,000) was available.


RESULTS
Responses were obtained from 1,255 respondents (response rate, 43%). One hundred thirty-seven (11%) had a prior cancer diagnosis. Ninety-one percent of respondents wanted to be told by their doctor about an EACD that could improve survival by an additional 4 to 6 months, with 51% prepared to pay for it. People were more willing to pay if the drug could improve quality of life (71%) or if there was no effective standard treatment (76%). Sixty-eight percent believed the government should pay. Cost would be a significant financial burden for 31% of those willing to pay. Those more likely to want to be informed were younger, employed, better-educated, or had higher income levels (P < .05). Responses did not vary with the person's personal experience of cancer. Of the 9% who did not wish to be informed, half of these were concerned about the information causing distress.


CONCLUSIONS
The Australian general public wants to be informed about EACD as potential treatment options, even if they are not willing or readily able to pay for them.
Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria, Australia. Linda.Mileshkin@petermac.org
Linda
L
Mileshkin
Penelope E
PE
Schofield
Michael
M
Jefford
Emilia
E
Agalianos
Michele
M
Levine
Alan
A
Herschtal
Julian
J
Savulescu
Jacqui Ann
JA
Thomson
John R
JR
Zalcberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000191:economics*; D001315:Australia; D005252:Fees, Pharmaceutical; D005260:Female; D005382:Financing, Personal; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000523:psychology; D057240:Patient Preference; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D055815:Young Adult
D000970:Antineoplastic Agents