Supportive Care in Cancer

, Volume 26, Issue 10, pp 3517–3526 | Cite as

Cancer cost communication: experiences and preferences of patients, caregivers, and oncologists—a nationwide triad study

  • So Young Kim
  • Dong Wook Shin
  • Boyoung Park
  • Juhee Cho
  • Jae Hwan Oh
  • Sun Seog Kweon
  • Hye Sook Han
  • Hyung Kook Yang
  • Keeho Park
  • Jong-Hyock ParkEmail author
Original Article



We assessed cost communication between cancer patients, caregivers, and oncologists and identified factors associated with communication concordance.


A national, multicenter, cross-sectional survey of patient-caregiver-oncologist triads was performed, and 725 patient-caregiver pairs, recruited by 134 oncologists in 13 cancer centers, were studied. Discordance in preferences and experiences regarding cost communication between patients, caregivers, and oncologists were assessed. Hierarchical generalized linear models were used to identify predictors of concordance and to identity the possible association of concordance with patient satisfaction and degree of trust in the physician.


Although the oncologists thought that patients would be affected by the cost of care, only half of them were aware of the subjective burden experienced by their patients, and the degree of concordance for this parameter was very low (weighted kappa coefficient = 0.06). Caregivers consistently showed similar preferences to those of the patients. After controlling for covariates, the education level of patients [adjusted odds ratio (aOR) for > 12 vs. < 9 years, 2.92; 95% confidence interval (CI), 1.87–4.56], actual out-of-pocket costs [aOR for ≥ 8 million vs. < 2 million Korean Won, 0.56; 95% CI, 0.34–0.89], and physician age (aOR for ≥ 55 vs. < 45 years, 1.83; 95% CI, 1.04–3.21) were significant.


The results show underestimation by oncologists regarding the subjective financial burden on a patient, and poor patient-physician concordance in cost communication. Oncologists should be more cognizant of patient OOP costs that are not indexed by objective criteria, but instead involve individual patient perceptions.


Out-of-pocket costs Patient-physician communication Concordance 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

520_2018_4201_MOESM1_ESM.docx (22 kb)
Table A1 (DOCX 22 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of Medicine, Graduate School of Health Science Business ConvergenceChungbuk National UniversityCheongjuRepublic of Korea
  2. 2.Chungbuk National University HospitalCheongjuRepublic of Korea
  3. 3.Department of Family Medicine/Supportive Care CenterSamsung Medical CenterSeoulRepublic of Korea
  4. 4.Department of Medicine, College of MedicineHanyang UniversitySeoulRepublic of Korea
  5. 5.National Cancer Control InstituteNational Cancer CenterGoyangRepublic of Korea
  6. 6.Department of Health, Behavior, and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  7. 7.Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and TechnologySungkyunkwan UniversitySeoulRepublic of Korea
  8. 8.Center for Colorectal CancerNational Cancer CenterGoyangRepublic of Korea
  9. 9.Department of Preventive MedicineChonnam National University Medical SchoolGwangjuRepublic of Korea

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