Medical oncologists' views on communicating with patients about chemotherapy costs: a pilot survey

As chemotherapy costs escalate, financial concerns have become relevant for more cancer patients. Yet, little is known about how oncologists communicate with patients about coping with chemotherapy treatment costs.

To understand how medical oncologists view these issues, we developed a survey eliciting their attitudes and behaviors surrounding discussing costs of therapy in the context of treatment decision making. The survey was piloted at a national meeting and then mailed to a random sample of actively practicing 2005 American Society of Clinical Oncology members in the 50 United States. Survey items used a 5-point Likert scale designed to elicit oncologists' practices and attitudes regarding discussion of chemotherapy costs with patients. The first survey wave also included two clinical vignettes about hypothetical patients contemplating treatment with high-cost regimens.

Of 530 mailed surveys, 167 were returned for an overall response rate of 31.5%. Most oncologists reported knowledge of their patients' financial well-being: 15% all of the time, 39% most of the time, 33% some of the time, and 13% rarely/none of the time. There was substantial variation in oncologists' attitudes toward discussing chemotherapy costs with patients: 42% did so always or most of the time, 32% sometimes did, and 26% rarely or never did. Most oncologists (80%) felt that it was important to be explicit about the impact of treatment choices on patients' finances. However, 20% maintained that costs play no role in clinical encounters, and 31% reported a high degree of discomfort in discussing costs with patients. Referral to support staff for these discussions was common. Only a few oncologists (16%) acknowledged omitting treatment options on the basis of their perceptions of patients' ability to afford treatment.

There is important heterogeneity in medical oncologists' attitudes toward discussing chemotherapy treatment costs with patients. Mismatch between physician and patient viewpoints has the potential to result in miscommunication and suboptimally informed treatment decisions.