2017 ASCO Annual Meeting!
Session: How Can Value Frameworks Be Used to Help Patients? Practical Challenges for the Oncologist
Type: Clinical Science Symposium
Time: Saturday June 3, 1:15 PM to 2:45 PM
How costs get discussed (or not) in routine oncology practice.
Value/Cost of Care
Health Services Research, Clinical Informatics, and Quality of Care
2017 ASCO Annual Meeting
J Clin Oncol 35, 2017 (suppl; abstr 6512)
Author(s): Rahma M. Warsame, Aminah Jatoi, Brittany Kimball, Cara Fernandez, Aaron L Leppin, Ashok Kumbamu, Jon Charles Tilburt; Mayo Clinic, Rochester, MN
Background: Cancer patients are nearly 3x more likely to declare bankruptcy than people without cancer. However, little is known about the dynamics of the healthcare provider/patient (pt) conversations around cost issues, the range of topics explored, and the factors that may influence them. We reviewed audio recordings of a cross-section of medical oncology conversations to determine frequency, patterns and attitudes of pts and providers on cost. Methods: We audio recorded conversations between 5/3/2012 & 11/20/2013 for adult patients with any solid tumor malignancy seen in an outpatient medical oncology clinic at one of three sites in the Upper Midwest and Southern California. Basic demographic variables were abstracted from chart review. Recordings were de-identified, reviewed and flagged for any mention of cost. We used descriptive statistics and inductive qualitative content coding methods to further characterize conversation themes. Results: Among 525 recordings, 151 (28%) contained any mention of cost. Median age (range) of pts was 58 years (22-93), and 75% Caucasian, 18% Hispanic, 5% Asian, and 1% Black. Average length of cost discussions was < 2 minutes, and pts usually initiated the discussion (106 /151). Among the 151 conversations, social service referrals were mentioned only 6 times (4%). Through qualitative analysis we identified several key topics: insurance coverage, disability, drug copays, and transportation. The recording dynamics most frequently displayed acknowledging but not taking action on the part of clinicians. Only 25% of clinicians behave confidently in how to address a patients cost concerns. Conclusions: In a diverse cross-section of oncology visits, cost comes up only 1/4 to 1/3 of the time and focuses on insurance coverage, disability and out of pocket drug costs. However clinicians often leave these issues unaddressed. Discussing financial burdens and identifying way to improve existing conversations will be important to mitigate additional financial distress.
|Institution||Avg. Conversation |
|Avg. Cost |
initiated N (%)
initiated N (%)
initiated N (%)
|Mayo Clinic||28.6||1.8||28 (33)||54 (64)||3 (3)|
|USC Norris||15.2||1.2||1 (5)||18 (90)||1 (5)|
|LA County||14.9||1.5||10 (22)||34 (76)||1 (2)|
2. Do the American Society of Clinical Oncology (ASCO) Value Framework and the European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale measure the same construct of clinical benefit?