Cancer patients facing costly treatment can benefit from frank talks with doctors

Neal Meropol, an oncologist at the Fox Chase Cancer Center in Philadelphia who helped produce the online guide, says he'd like to see physicians begin to weave cost into their knowledge of cancer care while in medical school. If that happens, it could be a boon to patients. A survey of just over 160 oncologists, published two years ago in the Journal of Clinical Oncology, found that 31% felt uncomfortable discussing costs with patients. Also, 42% said they always discuss treatment cost, 32% sometimes did and 26% said they rarely or never did.

The growing need for frank conversations about the high cost of cancer care was underscored by the report published in early February by the Kaiser Family Foundation, a nonprofit health research group based in Menlo Park, Calif., and the American Cancer Society. The report found that even cancer patients who have insurance can find themselves bearing costs that are difficult to pay off.

Thomas Olszewski, 62, of Graham, Texas, was treated for prostate cancer in 1999 and needs yearly tests so that any recurrence can be detected early. But his insurance comes with an annual $3,750 deductible, and he still owes $500 from his last checkup. He now has his cancer checkups every other year, instead of annually. "I am afraid to go to the doctor," Olszewski says, "because I never know how much it will cost me."

Schilsky, also an oncologist at the University of Chicago Medical Center, says that, difficult as it is, some patient-doctor conversations should include whether the patient wants to continue care that could be a long shot and leave patients or their families saddled with debt -- particularly when the prognosis is poor and many treatment options have already been exhausted.

"The decision is up to the patient, but the doctor should facilitate that conversation. We treat whole patients, not just an isolated cancer," Schilsky says.

Along those lines, Meropol says a chemotherapy patient recently told him that a prescribed anti-nausea drug was just too expensive. The doctor then prescribed a less expensive but also somewhat less effective drug.

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Arash Naeim, head of the geriatric oncology program at UCLA Medical Center, says he hopes that by having the physician bring up cost, patients will feel more comfortable discussing their needs and concerns, and doctors can then refer patients to financial and social work staff to see if resources might be available or if a payment plan can be worked out. Paying at least something regularly shows good faith that could garner added assistance from the billing office.