Financial toxicity: Many oncologists still don’t talk to patients about money


By Geir O'Rourke

30 May 2022

Oncologists still don’t feel fully confident discussing the financial impacts of cancer with their patients and are less likely to initiate conversations on the topic than either social workers or nurses, a survey has found.

The research on behalf of the Clinical Oncology Society of Australia’s financial toxicity working group comes amid growing concern about the costs of treatment and the effects of illness leading to unemployment and financial hardship.

Run last year, the COSA poll found just a fifth of oncologists felt very comfortable discussing patients’ financial or employment difficulties, while 44% said they lacked appropriate information or resources on the topic.

Some 70% of specialists admitted to only occasionally speaking to patients about their money concerns, saying they typically delayed conversations until the time of treatment.

This was connected to a widespread “myth” that little could be done to assist patients in financial distress, the researchers wrote in the Asia-Pacific Journal of Clinical Oncology.

That was despite broad awareness that many patients were experiencing financial challenges, with 42% of the 277 health professionals who completed the poll believing it was in issue for the majority of their patients.

They noted that non-doctors in the survey were generally more confident in having financial conversations with patients, saying 74% of social workers and 39% of nurses had reported feeling very comfortable when the topic came up.

Doctors were also far less likely to have ongoing financial discussions with patients throughout their cancer journey compared to the other two professions, the authors said.

“Unsurprisingly, social workers were the most engaged as their role requires the skills and confidence to initiate conversations as well as the knowledge about resources and information that would help patients,” they wrote.

“In contrast, medical specialists and other professional groups were the least likely to raise the topic with patients and felt less comfortable doing so, while nurses fell somewhere between oncologist and social worker responses.”

The authors stressed it wasn’t simply a matter of discomfort preventing oncologists from initiating conversations about money, given the limited time and resources available for patient care.

“Time is currently not allocated for specialists and nurses to address all the necessary topics in a patient consultation, namely the cancer, prognosis, side effects of treatment, mental health, sexual health, and financial toxicity among others,” they wrote.

Most survey respondents also reported lacking material like conversation starter guides and handouts outlining the specific support options available for patients in each state or setting, the authors added.

They said education was also needed to build understanding among health workers of their role in addressing financial toxicity.

“The awareness among cancer healthcare workers that resolving financial issues of patients can go a long way to improving health outcomes and avoid deterioration in patient wellbeing must be increased,” they wrote.

“This study has highlighted that some health professionals may not have the appropriate skills or may prioritize other issues lessening their engagement and willingness to tackle financial toxicity.”

“In addition, health professionals who incorporate financial discussions into patient care are more likely to take a narrower view focusing exclusively on direct costs.”

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