ASCO Expert Corner: Talking About the Cost of Cancer Care

ASCO Expert Corner: Talking About the Cost of Cancer Care


The cost of cancer care can be high, and it’s important that doctors and patients talk openly about how to cope with these costs if they could affect the patient’s medical decisions. To help, the American Society of Clinical Oncology (ASCO) created the Managing the Cost of Cancer Care booklet (also available en Español) to help patients start and guide conversations with their health care team about financial planning before, during, and after treatment. To learn more about this resource and what people with cancer should know, Cancer.Net talked with Lidia Schapira, MD.

Q: Why did ASCO create this information booklet for patients?

A: Being diagnosed with cancer often has a significant financial impact on patients and their families, especially in these difficult economic times. And, financial costs can affect the medical decisions that patients make. Therefore, ASCO created this free booklet as a service to patients and health care professionals to help guide discussions about this important topic in an organized and respectful way. It’s a starting point to help launch conversations between doctors and patients, since we know that it can be difficult to do so. We encourage patients to learn and anticipate what costs may be associated with specific treatments. Then, working with their health care team, they can plan how to manage financial issues through budgeting, supplemental sources of income, and sometimes financial assistance. Whether a person has private insurance, government insurance such as Medicare, or no insurance, this booklet helps them prepare to face possible financial concerns associated with cancer care.

Q: What are some other costs besides medical treatment that might not be obvious at first to a person newly diagnosed with cancer?

A: The costs associated with daily living may add up quickly over the course of treatment and recovery. Examples of these “hidden costs” may include transportation costs to and from the medical center or clinic (especially if the facility is not local), child or elder care needed when receiving medical treatment or during recovery, as well as loss of income when the patient or caregiver may need to miss days at work, and many others. Thinking about these different types of day-to-day expenses helps patients recognize beforehand what types of support they may need, including financial assistance and practical help, such as accepting offers of child care or rides to and from treatment from family and friends. The booklet offers more examples of cost categories to help patients understand the costs related to care.

Q: When should patients talk with their health care team about the costs of their care?

A: We recommend that patients begin to talk about these issues as soon as possible and that they continue to do so as often as needed. After a diagnosis of cancer, a patient and his or her doctor will make important treatment decisions together. If the costs could become a barrier to care, this topic should be a part of the conversation. By addressing these concerns directly, patients and doctors can consider possible solutions and resources for support. This will reduce stress, confusion, and tension.

Q: Talking about financial concerns with others can be difficult. How do you suggest patients bring up their concerns with their doctor?

A: My recommendation is to be as clear and straightforward as possible. Every patient should feel it’s okay to tell the doctor from the very first visit: “I am worried about how much this is going to cost and how I will pay for treatment. Can we talk about my concerns?” This is a legitimate topic for discussion. Specifically related to drug costs, if there is a choice of medication and the difference in cost is substantial, it is preferable to ask the doctor clearly about this choice, rather than risk a misunderstanding. A patient can ask important questions to help understand the recommendation for treatment and also to consider other alternatives. For instance, a patient can and should ask about other options, such as receiving less expensive treatments. Only then can a patient make an informed and reasonable choice about the plan of care.

Doctors don’t have all the answers to every question, but can help patients find them, given some time and advance notice. In fact, it is likely that several people will be involved in answering financial questions. These include health care professionals such as nurses, social workers, and representatives of insurance companies, or patient advocacy organizations. The Managing the Cost of Cancer Care booklet offers more examples of who and what to ask about cost.

Q: What are some steps patients can take to gain a better sense of control over their financial situation?

A: I would recommend making a detailed list of anticipated expenses, talking to a case manager at the hospital or clinic if possible, and then to a representative of the health insurance company. Also, keeping a folder of all bills and financial information may be useful. In some cases, talking with the employer’s human resources department may also help clarify health insurance benefits and options for preserving some form of income during cancer treatment. The booklet offers more tips on getting organized, in addition to a list of financial resources and organizations that offer help for people with cancer facing financial challenges.

Dr. Schapira is a medical oncologist at Massachusetts General Hospital and serves as the Cancer.Net Associate Editor for psychosocial oncology. She is a member of the Patient Resources Subcommittee of ASCO’s Cost of Cancer Care Task Force.

More Information:
Caring for the Whole Patient
Managing Your Care
Patient Information Resources
Last Updated: June 08, 2009