Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA.
Information Management Services, Calverton, Maryland, USA.
Cancer. 2024 Oct 1;130(19):3364-3374. doi: 10.1002/cncr.35380. Epub 2024 Jun 13.
Costs of cancer care can result in patient financial hardship; many professional organizations recommend provider discussions about treatment costs as part of high-quality care. In this pilot study, the authors examined patient-provider cost discussions documented in the medical records of individuals who were diagnosed with advanced non-small cell lung cancer (NSCLC) and melanoma-cancers with recently approved, high-cost treatment options.
Individuals who were newly diagnosed in 2017-2018 with stage III/IV NSCLC (n = 1767) and in 2018 with stage III/IV melanoma (n = 689) from 12 Surveillance, Epidemiology, and End Results regions were randomly selected for the National Cancer Institute Patterns of Care Study. Documentation of cost discussions was abstracted from the medical record. The authors examined patient, treatment, and hospital factors associated with cost discussions in multivariable logistic regression analyses.
Cost discussions were documented in the medical records of 20.3% of patients with NSCLC and in 24.0% of those with melanoma. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.37-0.80). Patients who did not receive systemic therapy or did not receive any cancer-directed treatment were less likely to have documented cost discussions than those who did receive systemic therapy (OR, 0.39 [95% CI, 0.19-0.81] and 0.46 [95% CI, 0.30-0.70], respectively), as were patients who were treated at hospitals without residency programs (OR, 0.64; 95% CI, 0.42-0.98).
Cost discussions were infrequently documented in the medical records of patients who were diagnosed with advanced NSCLC and melanoma, which may hinder identifying patient needs and tracking outcomes of associated referrals. Efforts to increase cost-of-care discussions and relevant referrals, as well as their documentation, are warranted.
癌症治疗的费用可能导致患者经济困难；许多专业组织建议医生在提供高质量护理的过程中讨论治疗费用。在这项试点研究中，作者检查了在医疗记录中记录的患有晚期非小细胞肺癌（NSCLC）和黑色素瘤的患者-这些癌症有最近批准的、高成本的治疗选择。
2017-2018 年间，从 12 个监测、流行病学和最终结果区域中随机选择了新诊断为 III/IV 期 NSCLC（n=1767）和 III/IV 期黑色素瘤（n=689）的个体，参加国家癌症研究所的治疗模式研究。从病历中提取成本讨论的记录。作者在多变量逻辑回归分析中检查了与成本讨论相关的患者、治疗和医院因素。
在 NSCLC 患者的病历中记录了 20.3%的成本讨论，在黑色素瘤患者的病历中记录了 24.0%的成本讨论。在调整后的分析中，与有公共保险的患者相比，私人保险的患者记录成本讨论的可能性较低（比值比[OR]，0.54；95%置信区间[CI]，0.37-0.80）。未接受系统治疗或未接受任何癌症定向治疗的患者记录成本讨论的可能性低于接受系统治疗的患者（OR，0.39[95%CI，0.19-0.81]和 0.46[95%CI，0.30-0.70]），未在有住院医师培训计划的医院接受治疗的患者也是如此（OR，0.64；95%CI，0.42-0.98）。
在诊断患有晚期 NSCLC 和黑色素瘤的患者的病历中，记录成本讨论的情况很少见，这可能会阻碍识别患者的需求和跟踪相关转介的结果。有必要努力增加关于治疗费用的讨论和相关转介，并记录这些讨论和转介。
