Discussing expensive anticancer drugs – a survey of the opinions of patients with advanced cancer — ASN Events
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Discussing expensive anticancer drugs – a survey of the opinions of patients with advanced cancer (#708)

Linda Mileshkin 1 2 , Edward Livshin 2 , Mark Voskoboynik 2 , Emilia Agalianos 2 , Penelope Schofield 1 3 , Alan Herschtal 4 , Ian Collins 2 , Aparna Rao 2 , Damien Urban 2 , Damien Kee 2 , George Au-Yeung 2 , Sandra Harvey 2 , John Zalcberg 1 2
  1. Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia
  2. Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
  3. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
  4. Centre for Biostatistics and Clinical Trials , Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

Background:   

Novel cancer treatments are increasingly available but not subsidized, and come at considerable financial cost. We have previously reported that although the general public want to be informed about these expensive anticancer drugs (EACDs), Australian medical oncologists commonly do not discuss them because of concern about causing distress. We aim to evaluate the views of patients with cancer about this issue.

Methods:

Eligible patients with incurable cancer completed a questionnaire regarding their views about four hypothetical scenarios involving an EACD (out-of-pocket cost A$30,000). The four scenarios described EACDs associated with either improved overall survival of 4-6 months (OS), encouraging response rate (RR) in a treatment-refractory situation, improved treatment tolerability/quality of life (QOL), or an improvement in progression-free survival of 4 months (PFS). An interim analysis is presented.

Results:

Fifty-nine patients (response rate: 97%) completed the survey. Median age of 61 (range 37-83) with 35 (59%) female. 55 patients (93%) wanted their oncologist to discuss a relevant EACD with them but only 6 (10%) have had such a discussion. The majority wanted their oncologist to discuss the 4 EACDs: improved OS = 75%, encouraging RR = 88%, better QOL = 92%, improved PFS = 93%. However, a smaller percentage wanted to actually receive the EACDs (49–64%), or consider paying for them (25–37%).  Those not wanting discussion were mostly concerned about themselves or family being distressed about not being able to afford the treatment. Thirty-four (58%) patients reported out-of-pocket expenses associated with their cancer care, with 9/59 (15%) reporting a moderate-significant financial burden.

Conclusion:

Most patients would like the opportunity to discuss relevant EACDs with their oncologists and a significant minority would be prepared to pay for such treatments. Such discussions need to be handled sensitively given that some patients are already facing significant financial burden.