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. 2019 Oct;26(10):3141-3151.
doi: 10.1245/s10434-019-07594-3. Epub 2019 Jul 24.

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

Rachel A Greenup  1   2   3   4 , Christel N Rushing  5   6 , Laura J Fish  5   7   8 , Whitney O Lane  9 , Jeffrey M Peppercorn  10 , Emily Bellavance  11 , Lisa Tolnitch  9 , Terry Hyslop  5   6 , Evan R Myers  12   13 , S Yousuf Zafar  14   5   7   12 , E Shelley Hwang  9   5
Affiliations

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

Rachel A Greenup et al. Ann Surg Oncol. 2019 Oct.

Abstract

Background: Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer.

Methods: We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings.

Results: Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that 'risk of recurrence' (70%), 'appearance of the breast' (50%), and 'risks of surgery' (47%) were the most influential on patients' decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported 'infrequently' (43%) or 'never' (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive.

Conclusions: Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.

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Figures

Figure 1.
Figure 1.
Surgeon perceptions of the factors that are most important to women facing decisions for breast cancer surgery (N= 598)
Figure 2.
Figure 2.
Participants’ cost consideration compared to their estimates of how frequently patients consider costs.
See this image and copyright information in PMC

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