Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments

Abstract

Background Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. Methods We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. Results Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. Conclusions Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.

Distribution of Genomic Testing Resources by Oncology Practice and Rurality: A Nationally Representative Study

“…We dichotomized patient volume as , 100 and ≥ 100 patients consistent with the literature. 22 Payer mix was identified from one item asking respondents to indicate what proportions of their patients were insured by Medicaid, or self-pay or uninsured. We dichotomized payer mix into , 10% and ≥ 10% Medicaid, or self-pay or uninsured.…”

Co-morbid risk factors and NSAID use among white and black Americans that predicts overall survival from diagnosed colon cancer

“…We therefore calculated the percent at which HYP and diabetes contributed to the racial disparity in OS between WA and BA CC patients. The results showed that HYP and diabetes explained 19.6% and 12% of disparities, respectively ( Table 3), suggesting that there are additional factor(s) that explain the remaining two-thirds of disparity between WA and BA [1][2][3][4][5][6][7]. Although HYP or diabetes alone is not a main contributor to the racial disparity in OS for our cohort, our results show that HYP is an independent factor for shorter OS in CC (Table 2).…”

“…In the United States, there is disparity for colorectal cancer (CRC) incidence and mortality between races, with Black Americans (BA) exhibiting higher rates as compared to White Americans (WA) [1][2][3][4][5]. Current evidence suggests that the contributions to this disparity is multi-factorial, intertwining socioeconomic issues that affect medical insurance coverage, access to preventive and regular medical care, use of tobacco and alcohol, and ingesting a high fiber, lower red meat diet that can affect the gut microbiome and cancer risk [2,[5][6][7]. Pathological and biological analyses show disparity in tumor stage contributing to earlier mortality, potential modification of the local tumor immunological environment, as well as unique somatic genetic mutations that appear isolated in BA CRC patients [1,3,[5][6][7][8][9].…”

“…Current evidence suggests that the contributions to this disparity is multi-factorial, intertwining socioeconomic issues that affect medical insurance coverage, access to preventive and regular medical care, use of tobacco and alcohol, and ingesting a high fiber, lower red meat diet that can affect the gut microbiome and cancer risk [2,[5][6][7]. Pathological and biological analyses show disparity in tumor stage contributing to earlier mortality, potential modification of the local tumor immunological environment, as well as unique somatic genetic mutations that appear isolated in BA CRC patients [1,3,[5][6][7][8][9]. These contributions to BA CRC disparity are under investigation to understand their contribution towards the initial development of CRC, and to inform strategies to mitigate risk and the disparity [10,11].…”

Disparities in germline testing among racial minorities with prostate cancer

“…And, even when germline testing is covered by insurance, there may be prohibitive out-of-pocket costs, including deductibles and copayments. Additionally, not all insurers cover germline testing for PCa [ 46 ], including some private insurers and public options such as Medicare and Medicaid [ 64 ].…”