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. 2014 May;10(3):162-7.
doi: 10.1200/JOP.2014.001406.

Patient-oncologist cost communication, financial distress, and medication adherence

Christine M Bestvina  1 , Leah L Zullig  1 , Christel Rushing  1 , Fumiko Chino  1 , Gregory P Samsa  1 , Ivy Altomare  1 , James Tulsky  1 , Peter Ubel  1 , Deborah Schrag  1 , Jon Nicolla  1 , Amy P Abernethy  1 , Jeffrey Peppercorn  1 , S Yousuf Zafar  2
Affiliations

Patient-oncologist cost communication, financial distress, and medication adherence

Christine M Bestvina et al. J Oncol Pract. 2014 May.

Abstract

Background: Little is known about the association between patient-oncologist discussion of cancer treatment out-of-pocket (OOP) cost and medication adherence, a critical component of quality cancer care.

Methods: We surveyed insured adults receiving anticancer therapy. Patients were asked if they had discussed OOP cost with their oncologist. Medication nonadherence was defined as skipping doses or taking less medication than prescribed to make prescriptions last longer, or not filling prescriptions because of cost. Multivariable analysis assessed the association between nonadherence and cost discussions.

Results: Among 300 respondents (86% response), 16% (n = 49) reported high or overwhelming financial distress. Nineteen percent (n = 56) reported talking to their oncologist about cost. Twenty-seven percent (n = 77) reported medication nonadherence. To make a prescription last longer, 14% (n = 42) skipped medication doses, and 11% (n = 33) took less medication than prescribed; 22% (n = 66) did not fill a prescription because of cost. Five percent (n = 14) reported chemotherapy nonadherence. To make a prescription last longer, 1% (n = 3) skipped chemotherapy doses, and 2% (n = 5) took less chemotherapy; 3% (n = 10) did not fill a chemotherapy prescription because of cost. In adjusted analyses, cost discussion (odds ratio [OR] = 2.58; 95% CI, 1.14 to 5.85; P = .02), financial distress (OR = 1.64, 95% CI, 1.38 to 1.96; P < .001) and higher financial burden than expected (OR = 2.89; 95% CI, 1.41 to 5.89; P < .01) were associated with increased odds of nonadherence.

Conclusion: Patient-oncologist cost communication and financial distress were associated with medication nonadherence, suggesting that cost discussions are important for patients forced to make cost-related behavior alterations. Future research should examine the timing, content, and quality of cost-discussions.

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Conflict of interest statement

Although all authors completed the disclosure declaration, the following author(s) and/or an author's immediate family member(s) indicated a financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO's conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors.

Employment or Leadership Position: Amy P. Abernethy, Athena Health (C), Orange Leaf Associates (C), Advoset (C), AAHPM (C); Jeffrey Peppercorn, GlaxoSmithKline (C) Consultant or Advisory Role: Deborah Schrag, New Century Health (C), Ohio State University (C); Amy P. Abernethy, Novartis (C), Pfizer (C), BMS (C) Stock Ownership: Jeffrey Peppercorn, GlaxoSmithKline Honoraria: None Research Funding: Amy P. Abernethy, Dara, Celgene, Helsinn, Dendreon, Pfizer Expert Testimony: None Patents, Royalties, and Licenses: None Other Remuneration: None

Figures

Figure A1.
Figure A1.
Derivation of the study cohort.
See this image and copyright information in PMC

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