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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

Rachel A. Greenup MD, MPH, Christel N. Rushing MS, Laura J. Fish PhD, Whitney O. Lane MD, MHS, Jeffrey M. Peppercorn MD, MPH, Emily Bellavance MD, Lisa Tolnitch MD, Terry Hyslop PhD, Evan R. Myers MD, MPH, S. Yousuf Zafar MD, MHS, E. Shelley Hwang MD, MPH
Breast Oncology
Volume 26, Issue 10 / October , 2019

Abstract

Background

Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer.

Methods

We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings.

Results

Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that ‘risk of recurrence’ (70%), ‘appearance of the breast’ (50%), and ‘risks of surgery’ (47%) were the most influential on patients’ decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported ‘infrequently’ (43%) or ‘never’ (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive.

Conclusions

Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.

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