title: The utility of cost discussions between patients with cancer and oncologists.
abstract: OBJECTIVE
  Patients with cancer can experience substantial financial burden. Little is known about patients' preferences for incorporating cost discussions into treatment decision making or about the ramifications of those discussions. The objective of this study was to determine patient preferences for and benefits of discussing costs with doctors.
  
  
  METHODS
  Cross-sectional, survey study.
  
  
  METHODS
  We enrolled insured adults with solid tumors on anticancer therapy who were treated at a referral cancer center or an affiliated rural cancer clinic. Patients were surveyed at enrollment and again 3 months later about cost discussions with doctors, decision making, and financial burden. Medical records were abstracted for disease and treatment data. Logistic regression investigated characteristics associated with greater desire to discuss costs.
  
  
  RESULTS
  Of 300 patients (86% response rate), 52% expressed some desire to discuss treatment-related out-of-pocket costs with doctors and 51% wanted their doctor to take costs into account to some degree when making treatment decisions. However, only 19% had talked to their doctor about costs. Of those, 57% reported lower out-of-pocket costs as a result of cost discussions. In multivariable logistic regression, higher subjective financial distress was associated with greater likelihood to desire cost discussions (odds ratio [OR], 1.22; 95% CI, 1.10-1.36). Nonwhite race was associated with lower likelihood to desire cost discussions (OR, 0.53; 95% CI, 0.30-0.95).
  
  
  CONCLUSIONS
  Patients with cancer varied in their desire to discuss costs with doctors, but most who discussed costs believed the conversations helped reduce their expenses. Patient-physician cost communication might reduce out-of-pocket costs even in oncology where treatment options are limited.
authors.affiliation: Duke Cancer Institute, DUMC 3505, Durham, NC 27705. E-mail: yousuf.zafar@duke.edu.
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
authors.forename: Fumiko
authors.initials: F
authors.lastname: Chino
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Christel
authors.initials: C
authors.lastname: Rushing
authors.forename: Gregory
authors.initials: G
authors.lastname: Samsa
authors.forename: Ivy
authors.initials: I
authors.lastname: Altomare
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nicolla
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Jeffery M
authors.initials: JM
authors.lastname: Peppercorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002173:Cancer Care Facilities; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics*; D000072103:Oncologists; D057240:Patient Preference; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents