Abstract
Honest communication between oncologists and patients is important in alleviating the financial burden of cancer care. This study explored patient–relative–oncologist communication regarding the affordability of out-of-pocket (OOP) medication and the extent to which this communication addresses itself to the families’ financial burden. A cross-sectional survey was conducted among primary caregivers of deceased cancer patients. About 43% of relatives said that they and/or the patients had paid out of pocket for medications during the last six months of the patient’s life. Most (73%) oncologists suggested an OOP medication without asking about financial ability, 43% hardly explained the advantages of an OOP medication, and 52% hardly explained any treatment alternatives. Older age and female gender were related to less communication about an OOP medication, and better education, greater affluence, and having private health insurance were related to more communication. About 56% of relatives said that OOP payment for medications inflicted a very heavy or heavy financial burden on patients and their households. Physicians’ interest in financial ability and giving explanation lightened the burden. Given the difficulty of explaining the complex interactions of cost and clinical outcomes, oncologists need to be better educated in skills that would enable them to communicate costs more openly and should consider the cost of a treatment when prescribing it.
Highlights
Cancer is one of the most expensive medical conditions in the United States [1,2,3,4]; in Europe, too, its cost is rising considerably and more quickly than in many other areas of healthcare [5]
This study shows that patient–oncologist communication about the affordability of out-of-pocket purchase of medication is scarce
The patients were approaching the end of life, only about one-fourth of the oncologists who suggested an OOP medication asked about financial ability and only about half explained the advantages of the medication in question
Summary
Cancer is one of the most expensive medical conditions in the United States [1,2,3,4]; in Europe, too, its cost is rising considerably and more quickly than in many other areas of healthcare [5]. Health-insurance systems and health insurers are increasingly shifting costs of care to patients by raising deductibles and imposing copayments [15]. This creates significant discrepancies in the cost of cancer medication to the patient [16] because even if the cost of a given drug is fixed, it varies relative to household income and may influence persons with cancer in different ways [17,18]. Many studies have repeatedly shown the adverse financial consequences of the cost of cancer medications for patients and their families [7,19]. This study is novel as it focused on the still relatively unexplored topic of surviving family members and the burden that they bear
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