Up For Discussion: Cost Of Cancer Care Avoided Too Often

By Scott Hensley

Published May 17, 2013 at 2:42 PM EDT

A cancer pill can cost patients more than the same treatment given as an infusion.

When the diagnosis is cancer, the expenses can pile up in a hurry.

Even people with insurance can face steep copayments for drugs, a sizable share of hospital bills and significant incidentals. These side effects of cancer care are sometimes even called "financial toxicity."

So wouldn't it make sense for doctors and patients to talk over the financial strain that cancer treatment might bring and what might be done to manage it?

Well, it's not always easy for patients to bring it up, says S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute. He and his colleagues recently asked hundreds of insured cancer patients at Duke and three affiliated rural cancer clinics about their financial concerns.

Median household income for the people in study was about $60,000 a year, and the median out-of-pocket costs for their care were nearly $600 a month .

"The bottom line was that patients want to talk about the cost but only a minority actually do," Zafar tells Shots.

The people who did talk about financial issues told the researchers it was helpful to do so. "They said it helped decrease their expenses," Zafar says. Unfortunately, in this study the researchers didn't get into the details of how that happened.

But he drew one possible way from his own practice. "I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill," he says. "If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version."

The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. "For the most part, it doesn't matter to me," he says. "It comes down to patient preference and cost."

Why don't most patients ask about costs?

"Many said they didn't think their financial problems were bad enough to bring it up," he says. "Many said they wanted the best care regardless of costs." And they may have been worried that doctors might cut corners on care after a cost discussion.

Some patients said it's not their doctor's job to think about the costs, Zafar says, and others figured the doctor wouldn't know what to do about them anyway.

Patients might have a point there. "I don't think the majority of oncologists are prepared to have a discussion about cost," he says. "Quite honestly, we haven't received the training to do so."

In the meantime, doctors can direct patients to social workers and financial counselors to lend a hand. "Any help is likely better than none," Zafar says.

Doctor need to get with it, though. "We can't necessarily give the best care to patients unless we address cost," Zafar says.

The research hasn't been published yet. Zafar will present the findings to cancer specialists at the American Society of Clinical Oncology annual meeting in Chicago in a few weeks.