HP2 Patient-Provider Cost Discussions and out-of-Pocket Costs Among Cancer Survivors with Varying Levels of Cancer-Related Financial Hardships


      Previous research showed patient-provider cost discussions may reduce cancer survivors’ out-of-pocket spending. Meanwhile, survivors who experienced cancer-related financial hardships may be more likely to have cost discussions. This study examined whether cost discussions and financial hardships were related to out-of-pocket spending.


      Using the 2016–2017 Medical Expenditure Panel Survey Experiences with Cancer Survey, survivors were classified as with or without a detailed discussion about out-of-pocket cancer care costs, based on self-reports. The relationship between detailed discussion and out-of-pocket costs was estimated using generalized linear models with gamma distribution and log link. Model 1 covariates included age, sex, race/ethnicity, marital status, education, employment, income, region, insurance, overall health, comorbidities, ≥1 cancers, time since cancer treatment, ambulatory visits, hospitalization, and survey year. Model 2 additionally adjusted for cancer-related financial hardship intensity (presence of material, behavioral, and psychological hardships, range: 0, 1, 2+). Model 3 additionally included an interaction term for cost discussion and hardship intensity.


      Among 1,428 survivors included, 11.4% (95% CI: 9.1%–13.7%) had a detailed cost discussion. Having a detailed discussion was associated with significantly lower out-of-pocket costs ($1,041) compared to without a detailed discussion ($1,389) (average marginal effect [AME]=$347, 95% CI, –$610 to –$30) in model 1, which remains significant after controlling for financial hardship (model 2: AME=–$365, 95% CI, –$616 to –$57). In model 3, having a detailed discussion was significantly associated with lower costs only among no-hardship or multiple-hardship survivors (no hardship: AME=–$380, 95% CI, –$688 to –$11; multiple hardships: AME=–$659, 95% CI, –$1056 to –$156), but not among single-hardship survivors.


      Detailed cost discussions were associated with reduced out-of-pocket costs independent of financial hardship intensity, yet the reduction extent may vary by hardship intensity and warrants further investigation. Providers should continue to be encouraged to have detailed cost discussions with patients.