title: Patients and Physicians Can Discuss Costs of Cancer Treatment in the Clinic.
abstract: OBJECTIVE
  As one solution to reducing costs and medical bankruptcies, experts have suggested that patients and physicians should discuss the cost of care up front. Whether these discussions are possible in an oncology setting and what their effects on the doctor-patient relationship are is not known.
  
  
  METHODS
  We used the National Comprehensive Cancer Network (NCCN) Guidelines and the eviti Advisor platform to show patients with metastatic breast, lung, or colorectal cancer the costs associated with their chemotherapy and/or targeted therapy options during an oncology consultation. We measured provider attitudes and assessed patient satisfaction when consultations included discussion of costs.
  
  
  RESULTS
  We approached 107 patients; 96 (90%) enrolled onto the study, three (3%) asked if they could be interviewed at a later date, and eight (7%) did not want to participate. Only five of 18 oncologists (28%) felt comfortable discussing costs, and only one of 18 (6%) regularly asked patients about financial difficulties. The majority of patients (80%) wanted cost information, and 84% reported that these conversations would be even more important if their co-pays were to increase. In total, 72% of patients responded that no health care professional has ever discussed costs with them. The majority of patients (80%) had no negative feelings about hearing cost information.
  
  
  CONCLUSIONS
  In an era of rising co-pays, patients with cancer want cost-of-treatment discussions, and these conversations do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA.
authors.forename: Ronan J
authors.initials: RJ
authors.lastname: Kelly
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Forde
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA.
authors.forename: Shereef M
authors.initials: SM
authors.lastname: Elnahal
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA.
authors.forename: Arlene A
authors.initials: AA
authors.lastname: Forastiere
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Rosner
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and eviti, Philadelphia, PA tsmit136@jhmi.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000191:economics*; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D003142:Communication; D003669:Deductibles and Coinsurance; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000473:pathology; D008297:Male; D008495:Medical Oncology / Q000193:education; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000191:economics*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations
chemical_list: D000970:Antineoplastic Agents