Cancer care

New standard requires oncologists to tell patients the full cost of treatment


Oncologists will be expected to disclose to patients all options for cancer treatment and associated costs under a draft standard for informed financial consent drawn up by cancer charities.

Many cancer patients still face “bill shock” because doctors and clinics are not being transparent enough about fees and hidden expenses, says Cancer Council Australia, which led the development of the draft document now out for consultation.

Doctors have an “ethical and moral responsibility” to disclose all the necessary information to support patient informed financial consent prior to treatment, the standard states.

And meeting that responsibility requires doctors to initiate discussions with patients about costs rather than passively wait for them to ask. Practitioner are also obliged to point patients to independent sources for further information on costs of care.

In order to obtain informed financial consent, doctors must give a full and frank disclosure of expected costs which include:

  • Expected additional services such as diagnostics and anaesthesia that attract a fee;
  • Possible indirect costs associated with different treatment options, such as time off work;
  • Telling patients if an equivalent procedure and care can be provided more cheaply or free in the public system;

Doctors should publicly disclose their average fees for common services and billing status, and update patients about service fees if the treatment plan changes, the draft standard states.

And practitioners cannot charge a higher fee for a service based on a claim of better outcomes unless they can defend the claim with published evidence.

The standard recommends practices to commit to:

  • Full financial disclosure
  • Not engaging in shadow billing (including booking fees)
  • Informing patients about Medicare reimbursements and disclosing gap fees
  • Not charging higher fees to wealthier patients

The standard will “reduce the burden of hidden expenses and avoidable high costs for equivalent procedures conducted in the public system or lower-cost setting”, the document states.

It is also designed to reduce variation in the out-of-pocket expenditure of patients for like treatments and financial hardship for cancer patients.

Cancer Council CEO Professor Sanchia Aranda said many people with cancer start treatment without a clear idea of what the costs of treatment are going to be, due to “a lack of consistency in how health professionals disclose their own and related costs”.

One in two Australians with cancer have out of pocket costs in excess of $5000,  and similarly one in two cancer survivors face financial hardship, she noted.

“We know that people with cancer borrow money, access their super, sell investments, re-mortgage their house, increase their credit card limits and increase their partner’s working hours to cover the cost of treatment and everyday expenses,” she said.

Consultant urologist Associate Professor Declan Murphy has already signed on to adopt the standard in his private practice in Melbourne.

“We have a responsibility to those we care for to make sure we are doing everything we can to minimise financial stress and engaging them in decisions about their treatment,” said Professor Murphy who is also Director of Genitourinary Oncology at Peter MacCallum Cancer Centre.

“That includes transparency about out-of-pocket costs, as well as advice about options in the public system. It’s not too much to ask.”

The draft standard was developed by Cancer Council Australia in collaboration with Breast Cancer Network Australia, the Prostate Cancer Foundation Australia and CanTeen and was launched at the Clinical Oncology Society of Australia Annual Scientific Meeting (COSA ASM) in Perth in November.

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