Patient Attitudes Regarding the Cost of Illness in Cancer Care.
OBJECTIVE
The cost of illness in cancer care and the subsequent distress has attracted scrutiny. Guidelines recommend enhanced discussion of costs, assuming this will reduce both stress and costs. Little is known about patient attitudes about cost considerations influencing treatment decisions.


METHODS
A convenience-sample survey of patients currently receiving radiation and/or intravenous chemotherapy at an outpatient cancer center was performed. Assessments included prevalence and extent of financial burden, level of financial distress, attitudes about using costs to influence treatment decisions, and frequency or desirability of cost discussions with oncologists.


RESULTS
A total of 132 participants (94%) responded. Overall, 47% reported high financial stress, 30.8% felt well informed about costs prior to treatment, and 71% rarely spoke to their oncologists about cost. More than 71% of patients did not want either society's or personal costs to influence treatment, and this result did not change based on degree of financial stress. Even when asked to assume that lower cost regimens were equally effective, only 28% would definitely want the lower cost regimen. Patients did not believe it was the oncologist's duty to perform cost discussions.


CONCLUSIONS
Even insured patients have a high degree of financial distress. Most, including those with the highest levels of distress, did not speak often with oncologists about costs and were strongly adverse to having cost considerations influence choice of regimen. The findings suggest that patients are not cost sensitive with regard to treatment decisions. Oncologists will require improved tools to have meaningful cost discussion, as recommended by the American Society of Clinical Oncology.
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA Meisenberg@AAHS.org.
Barry R
BR
Meisenberg
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
Ashley
A
Varner
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
Erin
E
Ellis
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
Stephen
S
Ebner
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
John
J
Moxley
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
Erika
E
Siegrist
DeCesaris Cancer Institute, Anne Arundel Medical Center, Annapolis, Maryland, USA; Anne Arundel Health System Research Institute, Annapolis, Maryland, USA; Cancer Prevention Fellowship Program, National Cancer Institute, Bethesda, Maryland, USA.
David
D
Weng
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017281:Cost of Illness; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D057240:Patient Preference; D010817:Physician-Patient Relations; D055815:Young Adult
Attitudes; Choice behavior; Cost of illness; Neoplasms