Several professional organizations, such as the American Society for Clinical Oncology, recommend that physicians have discussions with patients about the expected costs of their cancer treatments, as these expenses can become burdensome on patients. Robin Yabroff, PhD, MBA, American Cancer Society, Kennesaw, Georgia, and Michael T. Halpern, MD, PhD, MPH, National Cancer Institute, Bethesda, Maryland, recently examined documentation of these cost discussions between physicians and patients with non–small cell lung cancer (NSCLC) and melanoma.

The researchers reviewed medical records of individuals enrolled in the SEER program who were randomly selected for the National Cancer Institute Patterns of Care study. Particularly, they examined the records of newly diagnosed patients with stage III/IV NSCLC (n = 1767) and melanoma (n = 689) from 2017 to 2018 for documented cost discussions with physicians. They then abstracted terms used and the location of the records. The researchers also completed a multivariable logistic regression analysis to find potential associations with cost discussions and patient and hospital factors such as health insurance coverage, age, sex, race/ethnicity, and comorbidities. 

Dr Yabroff and Dr Halpern found that the most-used terms in the participants’ medical records were “out-of-pocket costs,” “patient assistance plan,” and “inability to pay.” The cost discussions were documented for 24.6% of patients with NSCLC and 25.5% of patients with melanoma and were typically noted in physician or nursing progress notes and assessment plans. Patient and hospital factors had little impact on the record keeping of the discussions. 

The researchers also found that, in adjusted analyses, patients who were privately insured were less likely to have these discussions documented vs patients who were publicly insured (odds ratio [OR]: 0.54; 95% CI, 0.37-0.80). In addition, patients who received systemic therapy were more likely to have cost discussions with their physicians (OR: 0.46; 95% CI, 0.30-0.70) compared to those who did not (OR: 0.39; 95% CI, 0.19-0.81).

The results of the study show that the costs discussions between physicians and patients with NSCLC and melanoma were documented infrequently. The researchers warn that the “variability in documentation may hinder identifying this information and tracking referrals to address patients’ financial needs.” They note that the study highlights the importance of “systematic” documentation of cost of care discussions in order to provide high-quality cancer care for these patients. 

Yabroff R, Halpern MT. Cost-of-care discussions for individuals with newly diagnosed advanced non-small cell lung cancer and melanoma: Findings from a population-based study. Presented at: the 2023 ASCO Quality Care Symposium; October 27-28, 2023; Boston, MA, and virtual; Abstract 3.

Sourced from the Journal of Clinical Pathways