Some Oncologists Fail to Talk About Genomic Testing Costs

Based on a new study conducted by American Cancer Society (ACS) investigators, nearly one in four oncologists discussing genomic testing with their patients rarely or never discusses the cost of testing.

The study found oncologists trained in genomic testing or working in practices with electronic medical record (EMR) alerts for genomic tests, were more likely to have cost discussions.

With the use of genomic testing on the rise in the United States, these types of tests could or cannot be covered by health insurance because it can be expensive, according to the study.

Depending on the diagnosis, genomic tests on cancer cells can help determine whether certain types of treatment might be useful while others may not, most of the time.

As cost of cancer care and high-patient, out-of-pocket costs are rising in the United States, the study set out to find how often discussions about expected costs of genomic testing and related treatments were happening.

These discussions are important because they may influence treatment decision making and help cancer patients prepare for high expenses, the study says.

Related: Opinion: When it Comes to Genomic Testing, Private Insurers Need to Step Up

Not much is known about how often oncologists discuss costs of testing and treatment, or about the physician and practice factors associated with those discussions.

To find further information, investigators led by ACS’ Robin Yabroff , PhD, analyzed data from 1,220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment, a survey sponsored by the National Cancer Institute, National Human Genomic Research Institute, and ACS.

Investigators found among oncologists who discussed genomic testing with patients, 50% reported often discussing the likely costs of testing and related treatments; 26.3% reported sometimes discussing costs; and 23.7% reported never or rarely discussing costs.

In adjusted analyses, oncologists with training in genomic testing or working in practices with (EMR) alerts for genomic tests were more about twice as likely to have cost discussions sometimes or often compared to rarely/never. 

Other factors associated with more frequent cost discussions were treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured, according to the study.

“Initiating a discussion about the expected out-of-pocket costs of genomic testing and related treatment is a necessary first step, but is not sufficient to ensure that patients and their families can make fully informed decisions about treatment options,” says co-authors and scientists of the ACS,  National Cancer Institute, and the National Institutes of Health. “In the context of rising costs of cancer care, interventions targeting modifiable physician and practice factors may help increase the frequency of physician-patient cost discussions, contributing to more informed patient decisions and higher-quality cancer care.”