Cancer drug costs require more dialogue

Despite substantial differences in health care systems, Canadian and American physicians have surprisingly similar views on cancer drug costs and cost-effectiveness, reveals the first comprehensive survey of medical oncologists' attitudes, led by Sunnybrook researchers and published in the Journal of Clinical Oncology.

Medical oncologists are physicians who specialize in the care and treatment of cancer patients using drug therapies such as chemotherapy. Physicians in both countries face the challenges posed by the rising costs of cancer drugs.

The American system is a non-universal, multi-payer system that rarely uses comparative effectiveness in coverage decisions. In contrast in Canada, there is universal access to intravenous cancer medications on provincial formularies which are constructed using comparative and cost-effectiveness data.

Survey findings indicate most oncologists in both countries (80 percent of Canadians and 84 percent of Americans) felt their treatment recommendations were influenced by a patient's anticipated out-of-pocket drug costs.

Despite this substantial impact of a patient's drug costs on treatment recommendations, the survey also finds only less than half of medical oncologists frequently discussed the costs of cancer treatments with their patients.

"It is always a difficult discussion when you think that a patient may benefit from a treatment but it is not funded by the government," says Dr. Scott Berry, an assistant professor of medicine and the director of the medical oncology training program at the University of Toronto. "Our survey identifies a gap in this dialogue which may be improved through training on how to better approach these types of discussions with patients."