Cancer care affordability: what is our role?

Objectives: With rapidly rising health care costs, affordability is a major concern of cancer treatment and survivorship. We sought to determine the role oncologists believe they should play in decreasing costs and improving cancer care affordability. Methods: A survey was developed to assess oncologists’ attitudes toward affordability and assess whether a range of provider-based solutions to reduce financial toxicity for patients would be practical or acceptable to practicing clinicians. Attending physicians practicing clinical cancer care at an urban, academic, tertiary referral center, were emailed a voluntarily, anonymous survey. Surveys were administered via REDCap between February and March 2020. Four reminder emails were sent to encourage participation. Results: Of 851 eligible physicians, 346 completed the survey (41% response rate); 342 answered all questions (99% completion rate). A total of 118 (34%) were medical oncologists, 52 (15%) were surgical oncologists, 46 (13%) were radiation oncologists, 7 (2%) were neuro-oncologists, and 123 (36%) were other specialty oncologists. One hundred twelve (32%) were within 5 years of their terminal year of training, 165 (48%) were 6-25 years out, and 69 (20%) were more than 25 years out. One hundred eighty-eight (54%) were male. Of all participants, 308 (89%) indicated they believed that at least 20% of patients on active treatment have significant financial issues related to paying for their cancer treatment; 57 participants (16%) indicated they thought that at least 60% of patients may have this concern; 286 (83%) felt there was at least some way of either preventing or mitigating patient financial toxicity; 285 (82%) indicated they thought they should play an active role in minimizing financial toxicity; and 270 (78%) indicated they thought they should be aware of a patient's risk for financial toxicity prior to making treatment recommendations. Two hundred thirty-nine participants (70%) believed they could modify test or treatment plans to reduce costs for patients at high risk for financial burden if they knew, and 232 (67%) said they would modify their plans; this included 55 (24%) who would modify treatment dosing/frequency, 152 (66%) would change testing/imaging frequency, and 154 (67%) who would change follow-up interval. A total of 223 (65%) felt that national guidelines should incorporate patient affordability concerns when being developed. Only 76 (22%) had received any training on costs, affordability, or value-based care, and only 18 (5%) had received any training on cost conversations. Conclusions: Academic oncologists overwhelmingly believe they should play an active role in addressing affordability issues for patients, and the majority believe it is possible to reduce financial toxicity through various means. Provider-facing interventions to improve patient affordability may include proactively identifying patients at high risk for financial burden in order to create tailored plans to reduce their risk of high costs and resultant financial toxicity.