NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.
BMC Cancer. 2021 Sep 16;21(1):1036. doi: 10.1186/s12885-021-08697-5.
Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists' discussions with patients about these costs.
We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument.
Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden.
Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients' ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.
在不增加与癌症治疗相关的显著经济负担的情况下，优化癌症患者的护理变得越来越困难。美国临床肿瘤学会（ASCO）建议临床医生与患者讨论癌症护理的成本，以增强共同决策。我们寻求信息来指导肿瘤医生与患者讨论这些成本。
我们从 2009 年 1 月至 2019 年 6 月 1 日，在 Medline、EMBASE 和临床实践指南数据库中搜索了关于讨论护理成本和经济负担的建议。使用 AGREE-II 工具评估指南质量。
有 27 项指南符合我们的入选标准，其中包括来自 ASCO 的 16 项（59%）。27 项指南中有 21 项（78%）在开处方时包含关于讨论或考虑治疗成本的建议，其中有 4 项（15%）提供了实际成本信息。81%（22/27）的指南描述了对经济负担或经济毒性风险的认识。然而，只有 9 项指南（33%）包含有关管理经济负担的信息。
当前的临床实践指南几乎没有关于讨论癌症治疗成本和管理经济负担的信息。这限制了患者控制治疗成本的能力，也限制了医疗团队降低经济负担的发生率和严重程度。当前的指南建议临床医生了解价格变化和治疗费用高昂的问题。建议临床医生探讨成本问题并解决财务问题，特别是在高风险群体中。未来的指南应包括有关促进成本透明度讨论的建议，提供成本信息和资源。
