Few doctors discuss cancer costs with patients, study finds
Most doctors did not discuss the cost of cancer treatment with patients, spent less than two minutes on it when they did, and usually did so only after patients brought it up, a study that taped hundreds of visits at several large hospitals finds.
Cancer patients are three times more likely to declare bankruptcy than people without cancer are, but many doctors are not having the conversations that might help prevent this and sometimes don’t know the cost themselves, the results suggest.
“That would not occur in any other industry I can think of” where a service or product is sold, said the study leader, Dr. Rahma Warsame of the Mayo Clinic.
Results were released Wednesday by the American Society of Clinical Oncology and will be discussed next month at its annual meeting in Chicago.
The study has some limitations — it’s not nationwide, and it includes newly diagnosed patients, where cost is most likely to come up, as well as others further along in treatment who may have discussed this earlier.
But the larger point is clear, Warsame said: The “financial toxicity” of treatments that can cost more than $100,000 a year is growing, and talks about that aren’t happening enough.
“I’ve had people say ‘no’ to really life-extending therapies” because of worries about bankrupting their family, she said.
For the study, researchers taped 529 conversations between doctors and patients with various types of cancer at three outpatient clinics — the kind of places chemo often is given — at Mayo, Los Angeles County Hospital and the University of Southern California’s Norris campus in Los Angeles.
Patients and doctors knew they were being taped but didn’t know why. Cost came up in 151 of the visits. Patients brought it up in 106 cases and doctors did in 45.
Appointments lasted about 15 minutes on average at the two California hospitals and half an hour at Mayo, but cost discussions ran only one to two minutes when they occurred at all.
JOSHUA TREE NATIONAL PARK — Wildlife biologists say an alarming number of female desert tortoise carcasses found earlier this year just outside the southern edge of Joshua Tree National Park may be the result of mothers fighting extinction by exhausting their water and energy to lay eggs, even under stress.
U.S. Geological Survey biologist Jeffrey Lovich, who has monitored tortoises in and around the park for two decades, said the potentially lethal response to prolonged drought may become more common throughout the Southern California desert as temperatures rise and forage diminishes.
“This is still a hypothesis,” Lovich said on Monday, “but I believe these tortoises died after continuing to lay clutches of four eggs the size of ping pong balls year after year, using up vital resources they need to survive.”
“It was an evolutionary gamble,” he said. “If it pays off, their genetic information will be passed on to a new generation of hatchlings in conditions more suitable for survival of the species.”
A research team led by Lovich was surveying a study area of several square miles on the northern flanks of the Orocopia Mountains when it discovered the remains of 14 female and three male tortoises, and 15 live animals, most of them males.
Judging from the deterioration of the carcasses and chalkiness of the bones, Lovich concluded the animals perished over the past five to 10 years, a period including five consecutive years of drought regarded as the most severe in recorded history.
The find has stepped up concerns over the fate of tortoises within the nearly 800,000-acre national park, which recent rains made into a showcase of habitat, lush with plants and flowers for the lumbering reptiles to fatten up on.
But vast swaths of terrain carpeted with daisies can only do so much, biologists say, in the face of longer droughts and climate change.
Over the past three decades, the park’s tortoise population has plummeted from roughly 30,000 to an all-time low of about 3,000, Michael Vamstad, a wildlife ecologist at the park, said.