What factors are associated with oncologist discussions of the costs of genomic testing and related treatment?

Abstract

95 Background: Use of genomic testing to inform cancer treatment is an increasingly common practice in the US. Genomic testing and related treatment can be expensive and not all tests and treatments are covered by health insurance plans. Little is known about how often physicians discuss costs of genomic testing and related treatment with their patients, nor about the physician and/or practice factors associated with those discussions. Methods: We identified 1220 oncologists who participated in the National Survey of Precision Medicine in Cancer Treatment in 2017 and reported discussing genomic testing with their patients within 12 months. Weighted percentages were used to describe the frequency of cost discussions and multivariable polytomous logistic regression analyses were used to assess associations between physician and practice characteristics and the frequency of cost discussions. Results: Among oncologists who discussed genomic testing, 50.0% reported often discussing the likely costs of testing and related treatment; 26.3% reported sometimes discussing costs; and the remaining 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists who used next-generation sequencing gene panel tests were more likely to have cost discussions with their patients often (OR = 2.3; 95% CI: 1.6,3.2) or sometimes (OR = 1.8; 95% CI: 1.2, 2.7) compared to rarely or never. Other physician and practice factors associated with more frequent cost discussions were treating solid tumors only (rather than hematologic only or both hematologic and solid tumors), training in genomic testing, and working in practices with electronic medical record (EMR) alerts for genomic tests (all p < 0.05). Conclusions: Physician and practice factors are associated with discussions of the costs of genomic testing and related treatments. As professional organizations increasingly recommend discussions of costs with cancer patients, consideration of modifiable physician and practice factors, such as training in genomic testing and use of EMR alerts, may help achieve these aims.