Notably, cost-of-care conversations should also include an aspect of patient empowerment. In addition to being conducted by a knowledgeable navigator such conversations should also provide tools that patients can assess and understand on their own time. Providing such resources in the form of fliers or online tools has been shown to be effective in reducing patient distress and facilitating further cost-of-care discussions with providers.1,4, 6,22 One such resource termed, “A Helping Hand,” offered by CancerCare, provides an online tool where patients can access information about financial assistance based on their specific diagnosis and zip code.1

Receiving the best course of treatment regardless of its cost is the top priority for both physicians and patients, but discussions of strategies to mitigate financial toxicity are equally vital. Rising or unexpected healthcare costs cause patients profound distress, which in turn can decrease treatment effectiveness. Truly effective cost-of-care conversations not only inform patients of the financial burden before them but allows them to be active participants in mitigating the direct and indirect costs of cancer treatment leading to better patient outcomes.

References

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2. Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL. Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol. 2014;32(4):306-311.

3. Tipirneni R, Politi MC, Kullgren JT, Kieffer EC, Goold SD, Scherer AM. Association between health insurance literacy and avoidance of health care services owing to cost. JAMA Netw Open. 2018;1(7):e184796.

4. Sloan CE, Ubel PA. The 7 habits of highly effective cost-of-care conversations. Ann Intern Med. 2019;170(9_Supplement):S33-S35.

5. Fewer adults report not getting needed care because of costs, but gains have stalled in recent years. The Commonwealth Fund; February 7, 2019.  https://www.commonwealthfund.org/chart/2019/fewer-adults-report-not-getting-needed-care-because-costs-gains-have-stalled-recent. Accessed July 31, 2019.

6. Dine CJ, Masi D, Smith CD. Tools to help overcome barriers to cost-of-care conversations. Ann Intern Med. 2019 May 7. DOI: 10.7326/M19-0778

7. Jagsi R, Ward KC, Abrahamse PH, et al. Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer. 2018;124(18):3668-3676.

8. Simon S. Cancer patients want more information from doctors about cost. American Cancer Society website; August 13, 2018. https://www.cancer.org/latest-news/cancer-patients-want-more-information-from-doctors-about-cost.html. Accessed July 31, 2019.

9. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. Am J Med. 2018;131(10):1187-1199.e5.

10. Beres D. 42% of new cancer patients lose their life savings. Big Think website; October 17, 2018. https://bigthink.com/politics-current-affairs/how-much-does-cancer-cost. Accessed July 31, 2019.

11. Alexander GC, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA. 2003;290(7):953-958.

12. Shih YT, Chien CR. A review of cost communication in oncology: patient attitude, provider acceptance, and outcome assessment. Cancer. 2017;123(6):928-939.

13. Bradham DD, Garcia D, Galván A, Erb C. Cost-of-care conversations during clinical visits in federally qualified health centers: an observational study. Ann Intern Med. 2019;170(9_Supplement):S87-S92.

14. Simmons-Duffin S. Will displaying drug list prices in ads help lower costs? NPR; May 8, 2019. https://www.npr.org/sections/health-shots/2019/05/08/721574626/will-displaying-drug-list-prices-in-ads-help-lower-costs. Accessed July 31, 2019.

15. Miller J. Experts divided regarding impact from Trump’s plan to put drug prices in TV ads. Healio Primary Care; May 29, 2019. https://www.healio.com/family-medicine/practice-management/news/online/{d9681cbb-da4a-4743-ac31-9b180ca9e0a6}/experts-divided-regarding-impact-from-trumps-plan-to-put-drug-prices-in-tv-ads. Accessed July 31,2019.

16. Thomas K. Drug makers sue to block requirement for listing prices in TV ads. New York Times; June 14, 2019. https://www.nytimes.com/2019/06/14/health/drug-prices-tv-ads.html. Accessed July 31, 2019.

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18. Howard J. Trump’s effort to put drug prices in ads now in limbo. CNN. https://www.cnn.com/2019/07/09/health/trump-drug-pricing-ads/index.html. Updated July 9, 2019. Accessed July 31, 2019.

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20. Lei YY, Quain KM, Dizon DS, et al. Desire to address costs at time of treatment decisions among patients with metastatic breast cancer. J Clin Oncol. 2019;37(suppl):abstr 6640

21. Pisu M, Schoenberger YM, Herbey I, et al. Perspectives on conversations about costs of cancer care of breast cancer survivors and cancer center staff: a qualitative study. Ann Intern Med. 2019;170(9_Supplement):S54-S61.

22. Mader K, Sammen JM, Klene C, et al. Community-designed messaging interventions to improve cost-of-care conversations in settings serving low-income, Latino populations. Ann Intern Med. 2019;170(9_Supplement):S79-S86.