Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines

Anupriya Agarwal,Rachael L Morton,Ann Livingstone,Deme J Karikios,Philip J Beale,Martin R Stockler

doi:10.1186/s12885-021-08697-5

Abstract

BackgroundOptimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs.MethodsWe searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument.ResultsTwenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden.ConclusionsCurrent clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients’ ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.

Highlights

Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult
We limited our search to guidelines published after January 2009 following publication of the American Society of Clinical Oncology (ASCO) Guidance Statement for Costs of Cancer Care [10], which first proposed discussion of costs in the clinical setting
The guidelines included in the full text analysis were from the following four groups: ASCO, Scottish Intercollegiate Guidelines Network (SIGN), Canadian Association of Psycho-Oncology (CAPO), and National Comprehensive Cancer Network (NCCN)

Summary

Introduction

Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. As healthcare costs for cancer are higher than for other conditions [2], discussions regarding expenses are relevant and necessary to allow timely interventions that reduce the risk of financial burden. ‘Financial toxicity’, or treatment-related financial harm of cancer care has been reported in up to one in four patients with cancer [3]. This can have unintended consequences due to patients’ attempts to reduce costs by non-adherence to medication and missing healthcare appointments [4, 5]. Patients who reported higher self-rated financial burden had poorer cancer outcomes, lower quality-of-life scores, and less satisfaction with care [6]

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Results

Discussion

Conclusion