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Training, Alerts Up The Odds of Discussions About Genomic Testing Costs

Key clinical point: Training in genomic testing and electronic alerts increased the likelihood of discussing costs of testing and related treatment.

Major finding: Oncologists were more likely to often discuss costs of genomic testing/related treatment with patients if they were formally trained in this testing (odds ratio, 1.74) and more likely to sometimes or often do so if their practices had EMR testing alerts (odds ratios, 2.09 and 2.22).

Study details: Cross-sectional survey of 1,220 oncologists who reported discussing genomic testing with their patients in the 2017 National Survey of Precision Medicine in Cancer Treatment.

Disclosures: Dr. Yabroff did not disclose any relevant conflicts of interest. The study did not receive any specific funding; the survey was funded by the National Institutes of Health.

Citation:

Yabroff KR et al. J Natl Cancer Inst. 2019 Nov 1. doi: 10.1093/jnci/djz173.

Commentary:

Many oncology patients experience financial toxicity, whereby the high cost of care not covered by insurance takes a personal toll that can include bankruptcy, reduced treatment adherence, and ongoing stress, Richard L. Schilsky, MD, notes in an editorial.

Professional associations have developed frameworks to capture an intervention’s magnitude of clinical benefit and impact on the disease and patient – and sometimes the related cost. “However, the extent to which any of these frameworks is useful to guide decision making is hard to determine, perhaps because the perceived value of an intervention often depends on the lens through which it is viewed,” he comments.

Discussions about costs are only the first step in informed decision making, as the investigators point out. “In any context, the value of the test depends on its impact on clinical decision making and patient outcome, that is, its clinical utility,” Dr. Schilsky maintains.

Key challenges oncologists face in discussing these issues with patients, as also outlined by the investigators, include limited time, lack of training materials and discussion guides, and poor price transparency, he notes.

“But the biggest challenge may be explaining to a patient the nuances of context of use and clinical utility that define the true value of a tumor biomarker test,” Dr. Schilsky concludes. “Patients need to know not just what the test will cost but how it will inform their care, impact their options, affect their outcomes and whether, in the long run, it might even guide them to better treatments and/or lower their overall costs of care. Further research on how best to convey these complex issues in the course of a clinical encounter is desperately needed before we can effectively ‘talk the talk’ about tumor genomic testing.”

Richard L. Schilsky, MD, is senior vice president and chief medical officer of the American Society of Clinical Oncology, Alexandria, Va. These comments are taken from the editorial accompanying the study by Yabroff et al (J Natl Cancer Inst. 2019 Nov 1. doi: 10.1093/jnci/djz175).