Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
Institute of Medicine (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. Institute of Medicine, Washington, DC
Schnipper LE (2009) ASCO Task Force on the Cost of Cancer Care. J Oncol Pract 5(5):218–219
Carrera PM, Kantarjian HM, Blinder VS (2018) The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin
Cohen D (2017) Cancer drugs: high price, uncertain value. BMJ 359:j4543
Zafar SY, Abernethy AP (2013) Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park) 27(2):80–81, 149
Ryskina KL, Halpern SD, Minyanou NS, Goold SD, Tilburt JC (2015) The role of training environment care intensity in US physician cost consciousness. Mayo Clinic Proc 90(3):313–320
Grover M, Abraham N, Chang YH, Tilburt J (2016) Physician cost consciousness and use of low-value clinical services. J Am Board Fam Med 29(6):785–792
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
Workman PDG, Schellens JHM, Bernards R (2017) How Much Longer Will We Put Up With $100,000 Cancer Drugs? Cell 168(4):579–583
Tilburt JC, Wynia MK, Sheeler RD, Thorsteinsdottir B, James KM, Egginton JS, Liebow M, Hurst S, Danis M, Goold SD (2013) Views of US physicians about controlling health care costs. Jama 310(4):380–388
Neumann PJ, Palmer JA, Nadler E, Fang C, Ubel P (2010) Cancer therapy costs influence treatment: A national survey of oncologists. Health Affairs (Project Hope) 29(1):196–202
Schrag D, Hanger M (2007) Medical oncologists’ views on communicating with patients about chemotherapy costs: a pilot survey. J Clin Oncol 25(2):233–237
Berry SR, Bell CM, Ubel PA, Evans WK, Nadler E, Strevel EL, Neumann PJ (2010) Continental Divide? The attitudes of US and Canadian oncologists on the costs, cost-effectiveness, and health policies associated with new cancer drugs. J Clin Oncol 28(27):4149–4153
Nadler E, Eckert B, Neumann PJ (2006) Do oncologists believe new cancer drugs offer good value? Oncologist 11(2):90–95
Morrow M, Abrahamse P, Hofer TP, Ward KC, Hamilton AS, Kurian AW, Katz SJ, Jagsi R (2017) Trends in reoperation after initial lumpectomy for breast cancer: addressing overtreatment in surgical management. JAMA Oncol 3(10):1352–1357
Katz SJ, Hawley ST, Bondarenko I, Jagsi R, Ward KC, Hofer TP, Kurian AW (2017) Oncologists’ influence on receipt of adjuvant chemotherapy: does it matter whom you see for treatment of curable breast cancer? Breast Cancer Res Treat 165(3):751–756
Katz SJ, Hawley ST, Hamilton AS, Ward KC, Morrow M, Jagsi R, Hofer TP (2018) Surgeon influence on variation in receipt of contralateral prophylactic mastectomy for women with breast cancer. JAMA Surg 153(1):29–36
Dillman DSJ, Christian L (2009) Internet, mail, and mixed-mode surveys: the tailored design method, 3rd edn. Wiley, Hoboken
Goold SD, Hofer T, Zimmerman M, Hayward RA (1994) Measuring physician attitudes toward cost, uncertainty, malpractice, and utilization review. J Gen Intern Med 9(10):544–549
Cooke M (2010) Cost consciousness in patient care–what is medical education’s responsibility? N Engl J Med 362(14):1253–1255
Collins SR, Gunja MZ, Doty MM (2017) Following the ACA repeal-and-replace effort, where does the U.S. stand on insurance coverage? Findings from the commonwealth fund affordable care act tracking survey. Issue Brief (Commonw Fund) 2017:1–21
Acknowledgements
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.
Author information
Authors and Affiliations
Contributions
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.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare they have no conflict of interest.
Ethical approval
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
Informed consent was received from all individual participants included in the study by way of a signed form of consent provided by the journal.
Rights and permissions
About this article
Cite this article
Resnicow, K., Patel, M.R., Mcleod, M.C. et al. Physician attitudes about cost consciousness for breast cancer treatment: differences by cancer sub-specialty. Breast Cancer Res Treat 173, 31–36 (2019). https://doi.org/10.1007/s10549-018-4976-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-018-4976-7