A recent study conducted by researchers at the Mayo Clinic suggests that the high cost of cancer care is one of the last things discussed by health care providers and patients. This important issue was included in less than a third of conversations about cancer treatment. It is an alarming statistic, especially when one considers that the cost of care is a prime stressor in the lives of cancer patients and their families.
Cancer-related medical costs can mount up quickly, especially since many cancers such as mesothelioma involve a long course of treatment. This regimen can include multiple tests and scans, visits to various specialists, hospital stays, and chemotherapy. Expenses are further compounded by lost wages, and variable insurance coverage. Given the weight of this matter, we must ask why more doctors do not have financial discussions with patients.
The Sound of Silence
The overall cost for cancer in the United States was $87.8 Billion in 2014, including hospital stays, doctor visits, and outpatient treatment. Since almost 1 of every 4 deaths in the United States is due to cancer, this is an issue that affects a majority of American families.
Dr. Rhama Warsame, an assistant professor at the Mayo Clinic, led the study of conversations between cancer patients and their doctors regarding costs. Only 28 percent of the 529 discussions involved a mention of finances, and in these cases, 70 percent of the time patients brought up the issue. In 40 percent of the conversations, doctors were unwilling to discuss costs. Even if patients had brought up the subject, that part of the consult usually lasted under 2 minutes.
This statistic is a pressing matter, especially because high costs could ultimately lead to patients missing or stopping treatments.
People who have been diagnosed with cancer are also 3 times as likely to go bankrupt. While Dr. Warsame suggested that patients may have talked about finances with their doctors during other conversations, she emphasized that doctors need to be better educated about costs. If physicians can advocate for their patients financially as well as medically, there is a better chance the patient will stay with their course of treatment.
Knowledge Will Set You Free... Or Not
Research has also been conducted on whether cost knowledge affects the kinds of tests ordered by doctors. Two studies, one published in Pediatrics and the other in the Journal of the American Medical Association, suggest that even when doctors know the cost of a test, it does not change the number or kinds of tests they perform.
When doctors order a test, they have medical as well as financial considerations, and need to base their decisions on treatments they deem necessary. At the same time, we cannot rule out possible economic incentives.
More procedures can often mean more revenue for the practice, and some tests will bring in more money than others. Doctors may also worry about missing medical problems, and the costs of litigation if they do not perform certain tests in follow-up screenings. Further, doctors are rarely taught to be cost-conscious as part of their training in medical school.
Tongue-Tied Over Treatment
Doctors and hospitals must also consider that some doctors don’t know how to discuss finances with their patients.
One study of oncologists suggested that they feel uncomfortable talking about costs, they don’t know what the costs will be, and they are uncertain about how a patient will respond to such conversations. Even if a patient worries over the cost of care, doctors may not have any solutions to the problem. Others doctors may feel that since this is a matter of giving the patient the best care to extend their life, costs should stay out of the discussion altogether.
Studies regarding patient attitudes about the cost of care suggest that some people don’t want to bring up financial matters with their doctors. They may worry that the care they receive will not be as good as it would be otherwise. Patients may also assume that their doctor won’t know what to do about the high costs, and/or they would rather talk about the issue with someone else.
Can We Talk?
Clearly this is an important matter that must have a multi-faceted solution. Neither doctors nor patients should be afraid to bring up financial matters, so they can work together to find treatment options that provide high-quality and cost-effective cancer care.
Doctors have a responsibility to become educated about the costs of treatment methods they advise. Patients must know how to self-advocate, and not remain silent when their physical, emotional, and economic health is at stake.
A patient who is less stressed is also likely to be much more receptive to treatment; therefore, we must accept that dealing with the nitty-gritty economic details may indeed lead to more effective health care and better patient outcomes.
