Littman Dalia, Lam Anh B, Chino Fumiko
Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY.
Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
JCO Oncol Pract. 2025 Jan;21(1):23-28. doi: 10.1200/OP-24-00454. Epub 2025 Jan 10.
The direct and indirect financial burden of cancer care, from medication costs to lost wages, results in financial toxicity for patients. Despite the growing recognition of financial toxicity as a problem for patients, there are few solutions available at the point of care. Structured cost conversations between oncologists and patients to help identify financial toxicity and intervene early when it is recognized have been posited as a patient facing intervention. Cost conversations fit into a framework of shared decision making within cancer care. Although more than 90% of patients with cancer express a desire to discuss the costs of their care, <15% report that such conversations occurred. This contrasts with oncologists who self-report that they discuss costs with patients up to 60% of the time. Poor utilization of cost conversations may be due to both patient and oncologist reluctance of discussing money; this can be driven by fear that lower cost care is less effective and lack of training/guidance for oncologists on how to effectively conduct cost conversations. Currently, there is an abundance of small, pilot studies showing benefits of cost conversation or other decision aids in meaningfully reducing financial toxicity. However, no large randomized prospective study has assessed the role of structured conversations designed exclusively to address costs in cancer care. This review suggests a framework for cost conversations in oncology and outlines the steps necessary to develop a full cost conversation guide.
癌症治疗的直接和间接经济负担，从药物费用到工资损失，都会给患者带来经济毒性。尽管人们越来越认识到经济毒性是患者面临的一个问题，但在医疗现场几乎没有可用的解决方案。肿瘤学家与患者之间进行结构化的成本对话，以帮助识别经济毒性并在识别后尽早进行干预，这被认为是一种面向患者的干预措施。成本对话适用于癌症治疗中的共同决策框架。尽管超过90%的癌症患者表示希望讨论治疗费用，但只有不到15%的患者报告进行过此类对话。这与肿瘤学家的自我报告形成对比，他们称自己与患者讨论费用的时间高达60%。成本对话利用率低可能是由于患者和肿瘤学家都不愿谈论金钱；这可能是因为担心低成本治疗效果较差，以及肿瘤学家缺乏如何有效进行成本对话的培训/指导。目前，有大量小型试点研究表明成本对话或其他决策辅助工具在有效降低经济毒性方面具有益处。然而，尚无大型随机前瞻性研究评估专门为解决癌症治疗费用而设计的结构化对话的作用。本综述提出了肿瘤学中成本对话的框架，并概述了制定完整成本对话指南所需的步骤。
