Almost one-fifth of U.S. oncologists rarely or never discuss the costs of genomic testing with their patients, despite the expense of treatments and tests and the widely reported challenges with securing insurance coverage, researchers found. The results from the 2017 National Survey of Precision Medicine in Cancer Treatment were reported by scientist co-authors at the American Cancer Society, the National Cancer Institute, and the National Institutes of Health.
The survey initially had 1,281 respondents, and researchers limited their analysis to 1,220 oncologists who reported discussing genomic testing within the past 12 months. Of the 1,220 individuals, half said they often discussed costs with their patients, and 26.3% said they sometimes did.
"At the time of the survey, the costs of genomic testing to inform treatment ranged from $300 to over $10,000 for available tests and the list price of molecularly targeted therapies frequently exceeded $100,000 annually, with some prices higher than $350,000," Robin Yabroff, PhD, senior scientific director at the American Cancer Society, and colleagues noted.
The researchers found, unsurprisingly, that the oncologists who were discussing costs with patients were more likely to have had formal training in genomics and to be involved in treating solid tumors, which are more commonly treated with genetically targeted drugs, compared with hematological cancers. The use of electronic medical record (EMR) systems and having a greater number of patients were also associated with a higher likelihood of cost discussion, according to the JNCI report. Preliminary findings had been presented at medical meetings, including the 2019 International Health Economics Association meeting in Basel, Switzerland.
The authors highlighted the hardships that cancer patients face across the board. Even those with private insurance may face hurdles in the form of high deductibles and coinsurance payments.
"High patient out-of-pocket costs for cancer treatment have been the subject of many discussions in the scientific literature and popular press," Yabroff and colleagues wrote.
"Although oncologists generally agree about their responsibility for cost discussions, these discussions are rare," they added. "Nevertheless, most cancer patients desire discussions about expected out-of-pocket costs, highlighting an unmet need for informed treatment [decision-making] in cancer care."
Training, the use of EMR technology, and the involvement of other professionals who have experience in discussing costs and potential solutions are options that could help improve the flow of information at a time when the pipeline is full of new genetically targeted treatments headed for the market.
"Normalization of cost discussions with all cancer patients, regardless of health insurance coverage or apparent resources, will be necessary to avoid stigmatization as well as under-identification of medical financial hardship, which is prevalent even among those with private health insurance coverage," the authors suggested.
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