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Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer.

Methods

We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings.

Results

Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that ‘risk of recurrence’ (70%), ‘appearance of the breast’ (50%), and ‘risks of surgery’ (47%) were the most influential on patients’ decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported ‘infrequently’ (43%) or ‘never’ (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive.

Conclusions

Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.

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Author information

Authors and Affiliations

  1. Department of Surgery, Duke University, Durham, NC, USA

    Rachel A. Greenup MD, MPH, Whitney O. Lane MD, MHS, Lisa Tolnitch MD & E. Shelley Hwang MD, MPH

  2. Department of Population Health Sciences, Duke University, Durham, NC, USA

    Rachel A. Greenup MD, MPH & S. Yousuf Zafar MD, MHS

  3. Duke Cancer Institute, Duke University, Durham, NC, USA

    Rachel A. Greenup MD, MPH, Christel N. Rushing MS, Laura J. Fish PhD, Terry Hyslop PhD, S. Yousuf Zafar MD, MHS & E. Shelley Hwang MD, MPH

  4. Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA

    Christel N. Rushing MS & Terry Hyslop PhD

  5. Duke Cancer Control and Population Sciences, Duke University, Durham, NC, USA

    Rachel A. Greenup MD, MPH, Laura J. Fish PhD & S. Yousuf Zafar MD, MHS

  6. Duke School of Medicine, Duke University, Durham, NC, USA

    Laura J. Fish PhD

  7. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Jeffrey M. Peppercorn MD, MPH

  8. University of Maryland School of Medicine, Baltimore, MD, USA

    Emily Bellavance MD

  9. Department of Medicine, Duke University, Durham, NC, USA

    Evan R. Myers MD, MPH & S. Yousuf Zafar MD, MHS

  10. Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA

    Evan R. Myers MD, MPH

Authors
  1. Rachel A. Greenup MD, MPH
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Corresponding author

Correspondence to Rachel A. Greenup MD, MPH.

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Acknowledgment

This work was supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Career Development Award (K12HD043446-11). Additional support was provided by the developmental funds of Duke Cancer Institute as part of P30-CA014236 (Office of Cancer Centers, National Cancer Institute).

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Greenup, R.A., Rushing, C.N., Fish, L.J. et al. Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons. Ann Surg Oncol 26, 3141–3151 (2019). https://doi.org/10.1245/s10434-019-07594-3

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