Skip to main content

How communication between cancer patients and their specialists affect the quality and cost of cancer care



Communication in cancer care is multidimensional and may affect patient treatment decision-making and quality of life. This study examined cancer patients’ perceptions of the communication with their cancer specialists and explored its impact on the care they received and the financial burden they experienced.


Semi-structured telephone interviews were conducted with 20 rural and 20 outer metropolitan Western Australians diagnosed with breast, lung, prostate or colorectal cancer. Thematic analysis using a phenomenological approach was undertaken to derive key themes regarding the communication experiences of the participants.


Four main themes emerged: information context, communication about treatment options and treatment providers, communication about costs of treatment and impact of communication on continuity of care. The quality of the communication experienced by participants was variable and in many cases sub-optimal. This affected their ability to undertake well-informed decisions regarding treatment and providers and led to substantial out-of-pocket expenses for several participants. Whilst participants differed in their information needs and expectations, most participants trusted clinicians’ treatment recommendations.


Our results raise concerns about the quality of communication cancer patients receive during treatment and the repercussions for their treatment decisions and out-of-pocket expenses. Clear treatment and cost communication could empower patients in choosing treatment and providers. However, these findings suggest patients must remain vigilant during consultations and discuss available treatment pathways and their financial dimension to avoid costly treatments or missing out on available financial aid.

This is a preview of subscription content, access via your institution.


  1. Street RL Jr, Makoul G, Arora NK, Epstein RM (2009) How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 74(3):295–301.

    Article  PubMed  Google Scholar 

  2. Epstein RM, Street RL, Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering Accessed 4 May 2016

  3. Johansen NJ, Saunders CM (2017) Value-based care in the worldwide battle against cancer. Cureus 9(2):e1039.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Thorne SE, Bultz BD, Baile WF (2005) Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology 14(10):875–884; discussion 885-876.

    Article  PubMed  Google Scholar 

  5. Prouty CD, Mazor KM, Greene SM, Roblin DW, Firneno CL, Lemay CA, Robinson BE, Gallagher TH (2014) Providers’ perceptions of communication breakdowns in cancer care. J Gen Intern Med 29(8):1122–1130.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ubel PA, Abernethy AP, Zafar SY (2013) Full disclosure—out-of-pocket costs as side effects. N Engl J Med 369(16):1484–1486.

    Article  CAS  PubMed  Google Scholar 

  7. Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34(9):980–986.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. PDQ Adult Treatment Editorial Board (2017) Financial toxicity (financial distress) and cancer treatment (PDQ®): patient version. National Cancer Institute (US) Accessed 24 Aug 2018

  9. Australian Institute of Health and Welfare (2017) Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. AIHW. Accessed 18 May 2017

  10. Australian Institute of Health and Welfare (2017) Health expenditure Australia 2015–16. Health and welfare expenditure series no. 58. Cat. no. HWE 68. AIHW. Accessed 20 Nov 2017

  11. Consumers Health Forum of Australia (2018) Out of pocket pain research report. Accessed 12 April 2018

  12. Economics DA (2017) Financial impacts of breast cancer in Australia. Deliotte. Accessed 27 Sept 2017

  13. Gordon LG, Beesley VL, Mihala G, Koczwara B, Lynch BM (2017) Reduced employment and financial hardship among middle-aged individuals with colorectal cancer. Eur J Cancer Care 26(5).

  14. Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA, Chambers SK (2017) Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. European Journal of Cancer Care.

  15. Shih YT, Chien CR (2017) A review of cost communication in oncology: patient attitude, provider acceptance, and outcome assessment. Cancer 123(6):928–939.

    Article  PubMed  Google Scholar 

  16. Hamel LM, Penner LA, Eggly S, Chapman R, Klamerus JF, Simon MS, Stanton SC, Albrecht TL (2017) Do patients and oncologists discuss the cost of cancer treatment? An observational study of clinical interactions between African American patients and their oncologists. J Oncol Pract 13(3):e249–e258.

    Article  PubMed  Google Scholar 

  17. Kim P (2007) Cost of cancer care: the patient perspective. J Clin Oncol 25(2):228–232.

    Article  PubMed  Google Scholar 

  18. Kelly RJ, Forde PM, Elnahal SM, Forastiere AA, Rosner GL, Smith TJ (2015) Patients and physicians can discuss costs of cancer treatment in the clinic. J Oncol Pract 11(4):308–312.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bullock AJ, Hofstatter EW, Yushak ML, Buss MK (2012) Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract 8(4):e50–e58.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Breast Cancer Network Australia (2018) State of the nation report. Accessed 15 Jun 2018

  21. Australian Bureau of Statistics (2017) 3101.0—Australian Demographic Statistics, Sep 2017. Australian Bureau of Statistics. Accessed 1 May 2018

  22. Australian Bureau of Statistics (2013) 4364.0.55.002—Australian Health Survey: health service usage and health related actions, 2011–12. Accessed 1 May 2018

  23. Newton JC, Johnson CE, Hohnen H, Bulsara M, Ives A, McKiernan S, Platt V, McConigley R, Slavova-Azmanova NS, Saunders C (2018) Out-of-pocket expenses experienced by rural Western Australians diagnosed with cancer. Support Care Cancer 26:3543–3552.

    Article  PubMed  Google Scholar 

  24. Creswell JW (2007) Qualitative inquiry & research design: choosing among five approaches / John W. Creswell. Qualitative inquiry and research design. Sage Publications, Thousand Oaks

    Google Scholar 

  25. Morse JM (1994) Designing funded qualitative research

  26. Given LM (2008) The Sage encyclopedia of qualitative research methods. Sage publications, Thousand Oaks

    Book  Google Scholar 

  27. Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101

    Article  Google Scholar 

  28. Cancer Council Australia (2014) Ideal oncology curriculum—communication skills—communication and counselling. Cancer Council Australia. Accessed 17 April 2018

  29. National Cancer Institute (2018) Communication in Cancer Care (PDQ®)–health professional version. Accessed 17 April 2018

  30. Cancer Council Victoria Victorian Cancer Clinicians Communication Program. Accessed 19 November 2018 2018

  31. Cancer Australia Communication skills training Accessed 19 Nov 2018 2018

  32. van Dongen JJJ, de Wit M, Smeets HWH, Stoffers E, van Bokhoven MA, Daniels R (2017) “They are talking about me, but not with me”: a focus group study to explore the patient perspective on Interprofessional team meetings in primary care. Patient 10(4):429–438.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rocque R, Leanza Y (2015) A systematic review of patients’ experiences in communicating with primary care physicians: intercultural encounters and a balance between vulnerability and integrity. PLoS One 10(10):e0139577.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Nekhlyudov L, Levit L, Hurria A, Ganz PA (2014) Patient-centered, evidence-based, and cost-conscious cancer care across the continuum: translating the Institute of Medicine report into clinical practice. CA Cancer J Clin 64(6):408–421.

    Article  PubMed  Google Scholar 

  35. Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, Khayat D, Boyle P, Autier P, Tannock IF, Fojo T, Siderov J, Williamson S, Camporesi S, McVie JG, Purushotham AD, Naredi P, Eggermont A, Brennan MF, Steinberg ML, De Ridder M, McCloskey SA, Verellen D, Roberts T, Storme G, Hicks RJ, Ell PJ, Hirsch BR, Carbone DP, Schulman KA, Catchpole P, Taylor D, Geissler J, Brinker NG, Meltzer D, Kerr D, Aapro M (2011) Delivering affordable cancer care in high-income countries. Lancet Oncol 12(10):933–980.

    Article  PubMed  Google Scholar 

  36. Salmon P, Young B (2017) A new paradigm for clinical communication: critical review of literature in cancer care. Med Educ 51(3):258–268.

    Article  PubMed  Google Scholar 

  37. Doyle C, Lennox L, Bell D (2013) A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 3(1):e001570.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wollins DS, Zafar SY (2016) A touchy subject: can physicians improve value by discussing costs and clinical benefits with patients? Oncologist 21(10):1157–1160.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Australian Government Department of Health (2018) Optimal cancer care pathways (OCPs). Accessed June 2018 2018

  40. Porter ME, Larsson S, Lee TH (2016) Standardizing patient outcomes measurement. N Engl J Med 374(6):504–506.

    Article  CAS  PubMed  Google Scholar 

  41. Porter ME, Lee TH (2013) The strategy that will fix health care. Harv Bus Rev 91(10):1–9

    Google Scholar 

  42. Abrahams E, Balch A, Goldsmith P, Kean M, Miller AM, Omenn G, Sonet E, Sprandio J, Tyne C, Westrich K (2017) Clinical pathways: recommendations for putting patients at the Center of Value-Based Care. Clin Cancer Res 23(16):4545–4549.

    Article  PubMed  Google Scholar 

  43. Aranda S, Whittaker K (2018) Patient out-of-pocket expenses. Asia Pac J Clin Oncol 14(S7):50–90.

  44. Monterosso L, Platt V, Krishnasamy M, Yates P, Bulsara C (2016) The cancer nurse coordinator service in Western Australia: perspectives of specialist cancer nurse coordinators. Aust J Adv Nurs 34(2):16

Download references


The authors thank Ruth McConigley, Angela Ives, Sandy McKiernan and Violet Platt who were involved in the planning and conceptualisation of the study; Catalina Lizama who assisted with data collection; and Rachel Singer who transcribed the interviews. The authors wish to thank the staff at the Western Australian Cancer Registry for their support with the study.


This research was funded by the Cancer Council of Western Australia and Western Australian Government Department of Health through the WA Cancer and Palliative Care Network.

Author information

Authors and Affiliations



CJ and CS designed the study; JN and HH conducted data collection; JN, HH, and NSA conducted the qualitative analysis; JN, NSA, HH, CJ, and CS contributed to the analysis and interpretation of the data; NSA and JN wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Neli Slavova-Azmanova.

Ethics declarations

The authors declare that they have no competing interests. Study participants provided written informed consent. The study was undertaken in accordance with relevant ethical standards and guidelines and was approved by the WA Country Health Service Ethics Committee (#2014:10) and the Department of Health WA Human Research Ethics Committee (#2014/26). The authors have full control of the primary data and are able to provide access upon request if deemed appropriate by all investigators.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Slavova-Azmanova, N., Newton, J.C., Hohnen, H. et al. How communication between cancer patients and their specialists affect the quality and cost of cancer care. Support Care Cancer 27, 4575–4585 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Cancer
  • Communication
  • Supportive care
  • Qualitative study
  • Western Australia