ASCO CEO Discusses New Studies on Patient Financial Toxicity and Opioid Use Risks

Subscribe through iTunes and Google Play. Welcome to this ASCO In Action podcast. This is ASCO's podcast series where we explore policy and practice issues that may impact oncologists, the entire cancer care delivery team, and the quality of care they provide. But most importantly, of course, the patients we care for. My name is Clifford Hudis. And I'm the CEO of ASCO and the host of this ASCO In Action podcast series. For today's podcast, I'm going to share with you some highlights from the research that was featured at this year's recent Quality Care Symposium. So ASCO is the host and sponsor of the Quality Care Symposium, an annual meeting that brings together oncology leaders, and all of the members of the cancer care team, to share strategies and methods for improving the measurement and the implementation of quality and safety activities in oncology. The recently held 2018 symposium presented a wide range of scientific abstracts, focused on initiatives that aim to improve the quality of care for patients with cancer, and, also, new research in this field. Today, I want to highlight five of these abstracts from the Quality Care Symposium. These are abstracts that deal with issues I know are of particular concern to ASCO members, financial toxicity for the one and opioid use for the other. Now, turning first to financial toxicity. As everybody knows, oncologists see the impact of high treatment costs on our patients, many of whom are not taking all of their prescribed medication because of cost. They are drawing down their savings, when they have savings. And they're often not paying their other household bills or taking other drastic measures because the cancer treatment that they have to receive has become so expensive. This distress is now broadly defined as financial toxicity. Three different studies were presented at the Quality Care Symposium that put a spotlight on this issue. In the first study, by Wheeler, et al, we saw results of a national survey of more than 1,000 patients with metastatic breast cancer drawn from 41 states. What we saw here, was that in these individuals, especially those who are uninsured, there really was significant financial distress. A full third of these patients were uninsured and more often they reported refusing or delaying treatment because of the cost of care. They also reported that they were contacted by collection agencies because of unpaid bills, again, for their cancer care. The study also found that insured respondents were not immune to financial toxicity. Those with health insurance reported having higher cost-related emotional distress, being stressed, themselves, because they weren't sure about the cost of their treatment, as well as spending a lot of time-- as well as having, I'm sorry, a lot of financial stress placed on their families because of cancer. The second research study by Arastu, et al, related to the cost of care. And this showed that nearly one in five older patients-- and these patients were defined as age 70 and above-- who had advanced cancer, were experiencing financial difficulties, again, due to the costs of their treatment. They noted that these difficulties negatively affected their care, their quality of life, and mental health. In this study, patients experiencing financial toxicity had a prior higher prevalence of severe anxiety and depression, poor measured quality of life, than patients who did not report financial hardship. And finally, there was a third study by Greenup, et al, in which 600 women with a history of breast cancer were surveyed. The majority of them said that they would prefer to discuss the cost of care before beginning treatment, but few of them recalled having such conversations about treatment costs with their cancer care teams. In this survey, fully 79% of these women said that they preferred to have a full understanding of the costs of care prior to starting, but 78% of them said they never actually discussed costs