Discussing Financial Toxicity in Oncology Settings

ascoThe American Society of Clinical Oncology is one of the leading specialty organizations for physicians who take care of patients with cancer. A reporter from ASCO just wrote a nice piece, in which she questioned me to go into more detail about the challenge of discussing cost of care with oncology patients. I thought I would share that with you:

High costs of cancer treatments can be an “undisclosed toxicity” that can harm a patient’s overall health and well-being, according to an article in The New England Journal of Medicine. High medical bills can not only cause stress and anxiety but may also compel patients to cut back on spending for other basic needs—such as food, leading to less healthy diets—or to take medications less frequently than prescribed.
“This is a very frequent cause of nonadherence,” the article’s lead author,Peter A. Ubel, MD, Professor of Business, Public Policy, and Medicine at Duke University, Durham, North Carolina, said in an interview with The ASCO Post. “It is a medical problem. Patients may not be showing up for tests or taking their pills because they can’t afford it. Dr. Ubel also tackled the issue of physicians rarely discussing medical intervention costs in an op-ed article he wrote for The New York Times.
Not Always Easy to Know
“Because treatments can be ‘financially toxic,’ imposing out-of-pocket costs that may impair patients’ well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments’ side effects,” Dr. Ubel and colleagues wrote…(Read more here)

More Discussion about Discussing Out-Of-Pocket Costs

renal and urology newsIn the wake of my recent New York Times op-ed, and other writing about patient out-of-pocket costs, I was interviewed by Tammy Worth, a writer at Renal and Urology News. She did a great job of exploring this controversial topic. Here is a sneak peek at her article, followed by a link to the full essay:
Did you know that a hemodialysis session costs about $130, the average surgeon’s fee for a radical prostatectomy is about $1,500, or that it costs nearly $2.500 less for a patient to have a bladder repair operation at an ambulatory surgery center than in a hospital?
You may not know these numbers, but you should be aware that your patients might. With a few minutes of research, patients are now able to find out the relative cost of care on sites like Health Care Bluebook, Fair Health Consumer or Healthcare Atlas.
But keeping up with your patients shouldn’t be the only reason you know how much services cost. Understanding prices can help you contain costs, improve care, and retain patients… (Read more at Renal and Urology News)

Getting Good Cancer Care by Asking the Right Questions

cancer today fall issue
Not long ago, I spoke with a freelance journalist, Charlotte Huff, who put together a really nice article in Cancer Today, describing how cancer patients can get more engaged in their care. I thought I would share a bit of that piece with you today:
Gloria Full wasn’t surprised that the recommended chemotherapy regimen was aggressive. She and her oncologist were, as Full puts it, ‘running scared.’ She had completed treatment for stage IV diffuse large B-cell lymphoma in 2006. Five years later, in 2011, a PET scan and subsequent biopsy identified a mass in her nasal cavity. “First thing I thought was, ‘Oh, my lord. It’s too close to the            brain, so let’s get going,’ ” she recalls.

Full, a 68-year-old retired social worker who lives in Phoenix, was started on the platinum-based chemotherapy combination dubbed DHAP (dexamethasone, cytarabine and cisplatin). Halfway through the aggressive regimen, she and her doctor worried that it was inflicting too much damage on her already suppressed immune system. He suggested a PET scan to see if the treatment had offered any benefit so far, and to determine what to do next. “On that first one, it showed that the mass had become smaller,” Full says. Armed with that good news, she agreed with her doctor’s recommendation to cease any further cycles of treatment… (Read more here)

Are You Getting Too Much Medical Care?

overtreatmentThis summer I had the pleasure of speaking with a very intelligent journalist, who was working on an article about overtreatment in medical care. That article has just come out, and I thought I would give you a sample of it here:
A few months ago, I went to my gynecologist looking for help with a
menstrual problem. She put me in stirrups, and the next thing I knew, I was getting a Pap smear. That wasn’t what I’d come in for, but it had been a year since my last test for cervical cancer, so I went along. After all, catching cancer early is always the goal, right? To
my surprise, I later learned that, according to the most recent science, it’s actually possible to catch a cancer too early. And being tested frequently—i.e., every year—was not my best game plan.
Most cervical cancers progress very slowly, and high-quality research has shown that some of the precursors to cancer that a Pap test can detect will go away without medical treatment. Right
now, however, there’s no “wait and see” in the system. When the Pap reveals certain abnormalities, the immediate next steps are additional doctor visits, plus invasive and painful testing, says Russell Harris, MD, a professor of medicine at the University of North
Carolina at Chapel Hill. This cascade of events saves some lives, but it also needlessly inconveniences and even harms many who were never in danger.
Experts have learned that we can have the best of both worlds: Because cervical cancer is so slow to spread, the Pap test can be done less frequently while still identifying the women who are at risk well within the window of when they can be successfully treated.
At the same time, doctors can spare those who are not truly at risk from unnecessary callbacks and biopsies… (Read more here)

Why Discussing the Cost of an MRI to Evaluate Knee Pain Can Be a Total Pain

knee painI want to share a wonderful blog post with you, written by one of “my” students, Laura Mortimer – a student in the Masters in Public Policy program at the Sanford School at Duke, who also happens to be a talented writer. In linking to her post, and then calling her my student, I of course am trying to grab credit for her accomplishments. What kind of mentor would I be if I didn’t try to do that? Here is her piece:

My right knee started bothering me on a long run a month ago. After weeks of pain, fruitless physical therapy, and no clear diagnosis, I had an MRI scan of my knee. Thankfully, nothing major showed up – just a persistent case of tendonitis. As a competitive runner hoping to compete in the Olympic Trials, I asked my doctor several questions: When will I be able to run again? What kind of cross-training should I do in the meantime? How many times a day should I ice? What can I do to keep this tendonitis from recurring? Should I hold off on buying plane tickets to that big race in December?
I failed to ask one important question, though: How much money will I have to pay for treatment? This failure is especially frustrating and surprising since my year-long Master’s Project focuses on clinical conversations about healthcare costs. I spend hours each week reading, writing, thinking, and talking about how doctors and patients can more effectively discuss out-of-pocket costs. If anybody should have the knowledge and resources to discuss medical costs, I should… (Read  more at Sanford Journal of Public Policy)

Newsweek Tackles the Challenge of Money Talk

newsweekIn response to the New England Journal article I published with Yousuf Zafar and Amy Abernethy, Newsweek chimed in this week with a report on the topic, including some thoughtful commentary from other medical experts. I thought it was worth pointing you towards this article, in part to remind you that Newsweek still exists, and also because it is a very nicely written article:

How much bad news is your doctor obliged to give you?
Consider this very depressing scenario: You’ve got colon cancer. Your doctor might tell you there’s some good news, that there’s a powerful and effective drug called Avastin, but warn you about its potentially harmful side effects – it can mess up your heart. But should your doctor also mention another devastating side-effect – that an Avastin regimen could cost more than $50,000, and that a patient who has Medicare but no supplemental insurance might have to pony up $9,000 for this treatment?

We like to pretend doctors are purists who only focus on our physical and mental well-being, but isn’t the health of your wallet also important?
In light of the current, charged debate about unsustainable health-care costs and the Affordable Care Act, Peter Ubel, Duke University professor of medicine, feels it’s time for a cultural shift among doctors. In a New England Journal of Medicine article he wrote with colleagues, Ubel argues that physicians needed to start incorporating the cost of care into their diagnoses. Continue reading here.



Doctor, First Tell Me What It Costs

nytimes_logo_180x18013If an antibiotic would cure your infection, your doctor would probably still warn you about the chance of sun sensitivity before prescribing the pill.

But even when the costs of a medical intervention might force patients to choose between paying the bill or keeping up with their mortgages, American physicians rarely discuss that serious side effect with them. One physician recently explained to me that he felt money talk would “violate the doctor-patient relationship.”

Given how much attention we have been focusing on health care costs and the Affordable Care Act, now is the time to change such thinking… (Read more at The New York Times)

Toxic Side Effect: High Out-of-Pocket Health Care Costs

rwjfWhen is the treatment worse than the disease? When the high costs associated with care become a financial burden for patients and in many cases prevent them from protecting their health, contends Peter Ubel, MD, a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research.
“We have reached a point where patients’ out-of-pocket health care costs can have more of a negative impact on their quality of life than some illnesses,” Ubel says, citing the thousands of dollars in deductibles, co-pays, coinsurance, and other charges that even burden people with health insurance. The potential financial devastation of the uninsured is also increasingly a factor, especially for people facing serious diseases.
Bringing Costs Out of the Closet
Ensuring that patients understand the possible side effects of a surgery, medical treatment or prescription drug is considered standard medical practice. Unfortunately, that’s not the case when it comes to warning patients about what they may have to pay for care. Engaging patients in a candid conversation about treatment costs is critical at a time when out-of-pocket costs for breast cancer treatment, for example, may run as high as $55,000, Ubel argues… (Read more at Robert Wood Johnson Foundation)