Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments

K. Robin Yabroff; Jingxuan Zhao; Janet S. de Moor; Helmneh M. Sineshaw; Andrew N. Freedman; Zhiyuan Zheng; Xuesong Han; Ashish Rai; Carrie N. Klabunde

Disclosures

J Natl Cancer Inst. 2020;112(5):498-506. 

In This Article

Results

The majority of the 1220 oncologists who reported discussing genomic testing with patients within the past 12 months were male and non-Hispanic white, treated both hematological cancers and solid tumors, and practiced in large MSAs (Table 1). Of the oncologists, 56.2% reported that they had received training in genomic testing, 74.5% of oncologists reported using NGS in the past 12 months, and 16.6% reported that their practice has EMR alerts for genomic test recommendations.

In response to the question about frequency of discussing the likely costs of testing and treatments with patients, 50.0% of oncologists reported having these discussions often; 26.3% reported sometimes; and 23.7% reported never or rarely discussing costs. The frequency of cost discussions varied by the types of tumors that oncologists treated: A total of 60.1% of those who treated only solid tumors reported often discussing costs with patients compared to 50.4% of those who treated hematological cancers and solid tumors and 27.9% of those who treated only hematological cancers (P < .001) (Figure 1A). Oncologists with formal training in genomic testing were more likely than those without this training to report discussing costs often (54.6% vs 44.1%, P = .001) (Figure 1B) as were those who used NGS tests in the past 12 months compared with those who did not (53.9% vs 38.7%, P < .001) (Figure 1C). Oncologists working in practices with EMR alerts for genomic test recommendations were more likely than those in practices without EMR alerts to report often (59.0% vs 48.2%, P < .001) discussing costs with their patients (Figure 1D).

Figure 1.

Oncologist and practice characteristics and frequency of discussions about costs of genomic testing and related treatment. A) By types of tumors treated (P < .001); (B) By training in genomic testing (P = .001); (C) by use of next-generation sequencing (NGS) gene panel tests (P < .001); (D) by whether practice has electronic medical records (EMR) with alerts for genomic tests (P < .001). Pearson χ2 test was used to calculate the P values. All statistical tested were two-sided.

Several physician characteristics were statistically significantly associated with the frequency of cost discussions in the intermediate (Supplementary Table 2, available online) and final (Table 2) multivariable models. Oncologists with more years since medical school graduation were more likely to often discuss the cost of genomic testing and related treatment with patients and their families than those who graduated less than 15 years prior to the survey. Compared with oncologists who treated only hematological cancers, those who treated both hematological cancers and solid tumors or who treated only solid tumors were more likely to often have cost discussions with their patients (odds ratio [OR] = 2.82, 95% confidence interval [CI] = 1.58 to 5.02 and OR = 4.01, 95% CI = 2.21 to 7.29, respectively). Formal training in genomic testing was associated with higher likelihood of having cost discussions often (OR = 1.74, 95% CI = 1.25 to 2.42). Oncologists who use NGS tests were more likely to have cost discussions with their patients often (OR = 1.93, 95% CI = 1.34 to 2.77) or sometimes (OR = 1.59, 95% CI = 1.07 to 2.37) instead of rarely or never.

Several practice-level characteristics were also statistically significantly associated with the frequency of cost discussions in intermediate (Supplementary Table 2, available online) and final (Table 2) models. Oncologists with EMR alerts for genomic testing in their practice were more likely than those without alerts to have cost discussions often (OR = 2.22, 95% CI = 1.30 to 3.79) or sometimes (OR = 2.09, 95% CI = 1.19 to 3.69) instead of rarely or never. Oncologists with higher patient volume were more likely to have more frequent cost discussions than those with lower patient volume. The frequency of cost discussions also varied by the health insurance status of patients in the practice. Oncologists with a higher percentage of patients insured by Medicaid, or who were self-pay or uninsured in their practice, were more likely to discuss cost often (OR = 1.55, 95% CI = 1.09 to 2.20) or sometimes (OR = 1.60, 95% CI = 1.09 to 2.36) instead of rarely or never. Lower area-level income was also associated with greater frequency of cost discussions.

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