Along with survival chances, cost and side effects are also major considerations when patients choose therapies. In fact, new study findings reveal that a patient’s socioeconomic status, more than any other characteristic, can predict whether the patient will choose high efficacy, low cost, or low toxicity when selecting a treatment.
Yu-Ning Wong, MD, MSCE, Fox Chase medical oncologist and lead author on the study says, “We found that patients’ socioeconomic statuses can tell us a lot about what’s important to them when considering treatment options.”
For the study, hypothetical scenarios were presented to a diverse group of 400 patients, and the researchers asked the patients to choose between 2 treatments of varying levels of efficacy, toxicity, and cost. Highly effective and moderately effective adjuvant therapies as well as palliative therapies were included in the scenarios.
In all 3 categories, patients with an income over $60,000 were more likely to select the most effective therapy, while patients with an income under $60,000 were more likely to choose the most affordable therapy, regardless of whether the alternative treatment offered improved survival or lower toxicity. Conversely, patients with higher income were more likely to choose treatments that offered higher survival even if the alternatives were less expensive or more toxic. Treatment choice was also affected by education and employment status.
“It is possible that patients of higher socioeconomic status were more likely to have greater resources to focus on survival and tolerate more side effects, such as the ability to miss work. On the other hand, patients of lower socioeconomic status are likely much more cost sensitive,” Wong explained.
The study’s findings give rise to troubling implications regarding differences in cancer care. Moreover, health plans with higher deductibles and co-pays may exacerbate inconsistencies, since patients of lower socioeconomic status and those with greater cost concerns may be more likely to avoid costly treatment.
“Policy makers should be aware of patients’ sensitivity to cost as this may influence their decision to proceed with high-value care,” Wong says. “Clinicians need to become more comfortable with the fact that cost affects patients’ decisions,” Wong adds. “As greater focus is placed on ‘patient-centered’ care and ‘preference-sensitive’ decisions, patient sensitivity to costs should be integrated into decision making.”
Source: Fox Chase Cancer Center.
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