Discussions about treatment options for breast cancer rarely include treatment costs. In a study presented at the 2018 American Society of Clinical Oncology (ASCO) Quality Care Symposium, researchers evaluated the experiences of breast cancer patients with treatment costs and their preferences for cost discussions at diagnosis.
A total of 607 women, median age 49.6 years, with a history of stage 0-III breast cancer completed an 88-question electronic survey regarding their experiences. The majority of participants (78%) never discussed treatment costs with their cancer care team. Women who did have discussions about treatment cost were more likely to have stage 2 or 3 breast cancer, less likely to be depressed, and had had less financial coverage.
The median out-of-pocket costs for treatment was $3500. However, 25% of women reported total out-of-pocket costs of $8000 or more, 10% reported $18,000 or more, and 5% reported $30,000 or more. Several factors were associated with a lower rick of financial harm including, increased age, higher household income, better insurance coverage, and longer time since diagnosis. Bilateral mastectomy with or without reconstruction vs lumpectomy, greater stage at diagnosis, and discussion of costs during the clinical encounter were associated with a higher risk of financial harm.
Seventy-nine percent of women preferred cost transparency prior to treatment and 40% reported they wanted their doctors to consider treatment costs when making recommendations. “Cost transparency may improve the quality of preference-sensitive treatment decisions and reduce the risk of financial harm,” conclude the authors.
Greenup RA, Rushing C, Fish L, Hyslop T, Peppercorn JM, Wheeler SB. The costs of breast cancer care: patient-reported experiences and preferences for transparency. Oral presentation at: 2018 ASCO Quality care Symposium; September 28-29, 2018; Phoenix, AZ. Abstract 32.