Physician attitudes about cost consciousness for breast cancer treatment: differences by cancer sub-specialty
High costs of cancer care place considerable burden on patients and society. Despite increasing recognition that providers should play a role in reducing care costs, how physicians across cancer specialties differ in their cost-consciousness has not been reported. We examined cost-consciousness regarding breast cancer care among medical oncologists, surgeons, and radiation oncologists.
We identified 514 cancer surgeons, 504 medical oncologists, and 251 radiation oncologists by patient report through the iCanCare study. iCanCare identified newly diagnosed women with breast cancer through the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles. We queried providers on three dimensions of cost-consciousness: (1) perceived importance of cost saving for society, patients, practice, and payers; (2) awareness of patient out-of-pocket expenses; and (3) discussion of financial burden.
We received responses from 376 surgeons (73%), 304 medical oncologists (60%), and 169 radiation oncologists (67%). Overall levels of cost-consciousness were moderate, with scores ranging from 2.5 to 3.0 out of 5. After adjusting for covariates, surgeons had the lowest scores on all three cost-consciousness measures; medical oncologists had the highest scores. Pairwise contrasts showed surgeons had significantly lower scores than medical oncologists for all three measures and significantly lower scores than radiation oncologists for two of the three cost-consciousness variables: importance of cost saving and discussion of financial burden.
How cost-consciousness impacts medical decision-making across specialty and how policy, structural, and behavioral interventions might sensitize providers regarding cost-related matters merit further examination.
KeywordsCost-consciousness Financial toxicity Cancer care costs Surgeons Medical oncologists Radiation oncologists
Research reported in this publication was funded by Grant P01CA163233 to the University of Michigan from the National Cancer Institute and supported by the University of Michigan Cancer Center Biostatistics, Analytics and Bioinformatics shared resource (P30CA46592); Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative Agreement 5NU58DP003862-04/DP003862; the NCI’s Surveillance, Epidemiology and End Results Program under Contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California, and Contract HHSN261201000034C awarded to the Public Health Institute. Cancer incidence data collection in Georgia was supported by Contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative Agreement 5NU58DP003875-04-00 from the CDC. We acknowledge with gratitude our survey respondents.
We acknowledge the contributions of our staff members on this project: KR: Conceptualization of the original study including questionnaire design and data collection, data analyses, writing and editing of the manuscript. MCM: Data analysis, writing and editing of the manuscript. SJK: Conceptualization of the original study including questionnaire design and data collection, data analyses, and editing of the manuscript. RJ: Conceptualization of the original study including questionnaire design and data collection, data analyses, writing and editing of the manuscript. MRP: Data analyses, writing and editing of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was received from all individual participants included in the study by way of a signed form of consent provided by the journal.
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