Less than half of cancer patients ask doctor about treatment costs; Wayne State project aims to change that

Wayne State researchers awarded $744,000 grant to help patients ask the right questions about financial costs of cancer treatmentFewer than half of patients have meaningful discussion of treatment costsResearchers believe clearer understanding of costs can improve outcomes and reduce stress

Can patients be coached to ask the right questions to doctors about treatment costs when they are seeking cancer treatment?

Lauren Hamel, a researcher in population health and assistant professor in oncology at Wayne State University School of Medicine, felt they could ask better questions and also that outcomes could be improved having that discussion before treatment begins.

A pilot study funded by the Michigan Endowment Fund in 2018 already proved to Hamel that less than half of patients ask at least one question with physicians about treatment costs. About 32 patients at Karmanos Cancer Institute participated in the pilot study where they were videotaped having an initial chat with their oncologist.

“Most patients don’t want to bring up costs” when they talk with their doctors, Hamel said. “They want to know if they will lose their hair” and what the treatment will be and success possibilities.

But treatment costs often overwhelm patients. Studies have shown that an estimated 30 percent to 50 percent of patients with cancer have trouble paying for medical costs.

Even patients with health insurance, Hamel said cancer treatment costs can be high and many people are forced to use savings and incur debt to pay bills. 

“Financial toxicity is a health equity issue that disproportionately affects patients less than age 65 who have lower incomes and are racial and ethnic minorities,” Hamel said. “Some have to file bankruptcy. They suffer great psychological harm.”

Hamel said hospitals can often work with patients on alternative payment approaches, a plan that often reduces stress on patients. She doesn’t believe talking about costs discourages treatment.

“What we give them is an educational summary of the costs they incur for cancer treatment,” Hamel said. “We give them information before they have that conversation with their doctors because people tend to put off that financial discussion.”

Earlier this month, Hamel and her team were awarded an $844,000 grant by the American Cancer Society to develop a software application called DISCO (Discussions of Cost).

The five-year grant will fund a randomized controlled trial of the DISCO app’s effectiveness using video-recorded interactions between patients and their oncologists. About 250 people will be recruited, she said.

Using the app, patients respond to questions related to their financial situation. For example, employment status, health insurance, support network, transportation availability and if treatment might affect their ability to pay household bills. 

Based on their responses, DISCO presents them with an individualized list of cost-related questions to ask their oncologist or other providers.

“Patients thought the app was helpful. It helped decrease their stress and gave them instructions on what to ask their doctors,” she said.

“We were trying to help patients identify any direct or indirect costs that may affect them as they enter into cancer treatment and into survivorship so we can prompt patients into a discussion with their oncologist (and other providers) to get information and/or connected to resources in a timely manner,” Hamel said.

Hamel’s team also includes oncology professors Susan Eggly, Elisabeth Heath, M.D., Seongho Kim, and David Dougherty, M.D., of the Dana-Farber Cancer Institute in Boston.

Source: Crain’s Detroit By: Jay Greene

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