Over the past decade, the financial burden of cancer care on patients and their families has garnered increased attention. Many of the potential solutions have focused on system-level interventions such as adopting value-based payment models and negotiating drug prices; less consideration has been given to actions at the patient level to address cancer care costs. We argue that it is imperative to develop and support patient-level strategies that engage patients and consider their preferences, values and individual circumstances. Opportunities to meet these aims and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.

Lay abstract

The financial burden of cancer care on patients and their families is a growing problem and action is critically needed to alleviate the high costs of such care. So far, potential solutions have focused on system-level interventions, with less consideration given to solutions at the patient level. This review argues that it is imperative to develop and support patient-level strategies that engage patients. Next, the review presents evidence of the interplay between patient preferences and values and the costs of cancer care. Finally, opportunities to enhance engagement and improve the economic experience of patients in oncology are discussed, including: shared decision-making and communication, financial navigation and treatment planning, digital technology and alternative care pathways, and value-based insurance design.

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

References

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J. Clin. 70(1), 7–30 (2020).
MedlineGoogle Scholar
2. American Cancer Society. Cancer Treatment & Survivorship Facts & Figures 2019–2021. GA, USA (2019). https://www.cancer.org/research/cancer-facts-statistics/survivor-facts-figures.html
Google Scholar
3. Park J, Look KA. Health care expenditure burden of cancer care in the United States. Inquiry 56, 46958019880696 (2019).
MedlineGoogle Scholar
4. Mariotto AB, Enewold L, Zhao J, Zeruto CA, Yabroff KR. Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol. Biomarkers Prev. 29(7), 1304–1312 (2020).
MedlineGoogle Scholar
5. Mehlis K, Witte J, Surmann B et al. The patient-level effect of the cost of cancer care – financial burden in German cancer patients. BMC Cancer 20(1), 529 (2020).
MedlineGoogle Scholar
6. Leng A, Jing J, Nicholas S, Wang J. Geographical disparities in treatment and health care costs for end-of-life cancer patients in China: a retrospective study. BMC Cancer 19(1), 39 (2019).
MedlineGoogle Scholar
7. Gordon LG, Walker SM, Mervin MC et al. Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur. J. Cancer Care 26(1), e12392 (2017).
Google Scholar
8. Dinesh AT, Nair P, Abhijath V, Jha V, Aarthy K. Economics of cancer care: a community-based cross-sectional study in Kerala, India. South Asian J. Cancer 09(1), 7–12 (2020).
CASGoogle Scholar
9. Meropol NJ, Schrag D, Smith TJ et al. American Society of Clinical Oncology guidance statement: the cost of cancer care. J. Clin. Oncol. 27(23), 3868–3874 (2009).
MedlineGoogle Scholar
10. Gyawali B. Low-value practices in oncology contributing to financial toxicity. Ecancermedicalscience 11, 727 (2017). • Review article that summarizes the pathway between low-value cancer care and financial toxicity, highlighting specific examples in oncology.
MedlineGoogle Scholar
11. Tran G, Zafar SY. Price of cancer care and its tax on quality of life. J. Oncol. Pract. 14(2), 69–71 (2018).
MedlineGoogle Scholar
12. Lentz R, Benson AB 3rd, Kircher S. Financial toxicity in cancer care: prevalence, causes, consequences, and reduction strategies. J. Surg. Oncol. 120(1), 85–92 (2019).
MedlineGoogle Scholar
13. Yabroff KR, Gansler T, Wender RC, Cullen KJ, Brawley OW. Minimizing the burden of cancer in the United States: goals for a high-performing health care system. CA Cancer J. Clin. 69(3), 166–183 (2019).
MedlineGoogle Scholar
14. Desai A, Gyawali B. Financial toxicity of cancer treatment: moving the discussion from acknowledgement of the problem to identifying solutions. EClinicalMedicine 20, 100269 (2020).
MedlineGoogle Scholar
15. Laviana AA, Luckenbaugh AN, Resnick MJ. Trends in the cost of cancer care: beyond drugs. J. Clin. Oncol. 38(4), 316–322 (2020).
MedlineGoogle Scholar
16. Tran G, Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies. Ann. Transl. Med. 6(9), 166 (2018).
MedlineGoogle Scholar
17. Falchook AD, Hendrix LH, Chen RC. Guideline-discordant use of imaging during work-up of newly diagnosed prostate cancer. J. Oncol. Pract. 11(2), e239–246 (2015).
MedlineGoogle Scholar
18. Baltz A, Makhoul I, Siegel ER. The clinical impact of ASCO ‘choosing wisely’ recommendations on staging imaging for early stage breast cancers: an interrupted time-series analysis utilizing SEER-Medicare data. J. Clin. Oncol. 38(Suppl. 15), 2078–2078 (2020).
Google Scholar
19. Offodile AC 2nd, Hwang ES, Greenup RA. Contralateral prophylactic mastectomy in the era of financial toxicity: an additional point for concern? Ann. Surg. 271(5), 817–818 (2020).
MedlineGoogle Scholar
20. Financial Toxicity and Cancer Treatment (PDQ®)–Health Professional Version. National Cancer Institute (2019). https://www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq
Google Scholar
21. Zafar SY, Abernethy AP. Financial toxicity, part I: a new name for a growing problem. Oncology (Williston Park) 27(2), 80–81, 149 (2013).
MedlineGoogle Scholar
22. Ubel PA, Abernethy AP, Zafar SY. Full disclosure – out-of-pocket costs as side effects. N. Engl. J. Med. 369(16), 1484–1486 (2013).
Medline CASGoogle Scholar
23. Greenup RA, Rushing C, Fish L et al. Financial costs and burden related to decisions for breast cancer surgery. J. Oncol. Pract. 15(8), e666–e676 (2019).
MedlineGoogle Scholar
24. Pearce A, Tomalin B, Kaambwa B et al. Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors. J. Cancer Surviv. 13(1), 10–20 (2019).
MedlineGoogle Scholar
25. Arastu A, Patel A, Mohile SG et al. Assessment of financial toxicity among older adults with advanced cancer. JAMA Netw. Open 3(12), e2025810 (2020).
MedlineGoogle Scholar
26. Lee A, Shah K, Chino F. Assessment of parking fees at National Cancer Institute-designated cancer treatment centers. JAMA Oncol. 6, 1295–1297 (2020).
MedlineGoogle Scholar
27. Mols F, Tomalin B, Pearce A, Kaambwa B, Koczwara B. Financial toxicity and employment status in cancer survivors. A systematic literature review. Support. Care Cancer 28, 5693–5708 (2020).
MedlineGoogle Scholar
28. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. Am. J. Med. 131(10), 1187–1199 e1185 (2018).
MedlineGoogle Scholar
29. National Cancer Institute. Howlader N, Am N, Krapcho M et al. SEER Cancer Statistics Review, 1975-2017 (based on November 2019 SEER data submission). Bethesda, MD, USA (2020). https://seer.cancer.gov/csr/1975_2017/
Google Scholar
30. Ramsey SD, Bansal A, Fedorenko CR et al. Financial insolvency as a risk factor for early mortality among patients with cancer. J. Clin. Oncol. 34(9), 980–986 (2016). •• Large study that demonstrated that bankruptcy appears to be a risk factor for mortality among cancer patients.
Medline CASGoogle Scholar
31. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by cancer survivors: a systematic review. J. Natl Cancer Inst. 109(2), djw205 (2017).
MedlineGoogle Scholar
32. Cohen AJ, Brody H, Patino G et al. Use of an online crowdfunding platform for unmet financial obligations in cancer care. JAMA Intern. Med. 179, 1717–1720 (2019).
MedlineGoogle Scholar
33. Weaver KE, Rowland JH, Bellizzi KM, Aziz NM. Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer 116(14), 3493–3504 (2010).
MedlineGoogle Scholar
34. Daw JR, Law MR. Compared with other countries, women in the US are more likely than men to forgo medicines because of cost. Health Aff. (Millwood) 39(8), 1334–1342 (2020).
MedlineGoogle Scholar
35. Kale HP, Carroll NV. Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer 122(8), 283–289 (2016).
MedlineGoogle Scholar
36. Robin Yabroff K, Bradley C, Tina Shih YC. Understanding financial hardship among cancer survivors in the United States: strategies for prevention and mitigation. J. Clin. Oncol. 38, 292–301 (2020).
MedlineGoogle Scholar
37. Fleisch Marcus A, Illescas AH, Hohl BC, Llanos AA. Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults. PLoS ONE 12(3), e0173370 (2017).
MedlineGoogle Scholar
38. Narbutas S, York K, Stein BD et al. Overview on patient centricity in cancer care. Front. Pharmacol. 8, 698 (2017).
MedlineGoogle Scholar
39. Barrera FJ, Ponce OJ, Espinoza NR et al. Interventions supporting cost conversations between patients and clinicians: a systematic review. Int. J. Clin. Pract. 75(5), e14037 (2021).
MedlineGoogle Scholar
40. Zafar Y, Abernethy AP, Tulsky JA et al. Financial distress, communication, and cancer treatment decision making: does cost matter? J. Clin. Oncol. 31(Suppl. 15), 6506–6506 (2013).
Google Scholar
41. Bien DR, Danner M, Vennedey V, Civello D, Evers SM, Hiligsmann M. Patients’ preferences for outcome, process and cost attributes in cancer treatment: a systematic review of discrete choice experiments. Patient 10(5), 553–565 (2017).
MedlineGoogle Scholar
42. Jagsi R, Ward KC, Abrahamse PH et al. Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer. Cancer 124(18), 3668–3676 (2018).
MedlineGoogle Scholar
43. Warsame R, Kennedy CC, Kumbamu A et al. Conversations about financial issues in routine oncology practices: a multicenter study. J. Oncol. Pract. 15(8), e690–e703 (2019).
MedlineGoogle Scholar
44. Williams CP, Miller-Sonet E, Nipp RD, Kamal AH, Love S, Rocque GB. Importance of quality-of-life priorities and preferences surrounding treatment decision making in patients with cancer and oncology clinicians. Cancer 126(15), 3534–3541 (2020). • Analysis of breast cancer patients that showed variability among patients’ preferences for affordability and functional independence when making treatment decisions.
MedlineGoogle Scholar
45. Cancercare. Decision making at the point of care: voices of oncology providers. A Patient Values Initiative Issue Brief. Cancercare, NY, USA (2018). https://media.cancercare.org/publications/original/378-pvi_ii.pdf
Google Scholar
46. Hollin IL, Gonzalez JM, Buelt L, Ciarametaro M, Dubois RW. Do patient preferences align with value frameworks? A discrete-choice experiment of patients with breast cancer. MDM Policy Pract. 5(1), 2381468320928012 (2020).
Google Scholar
47. Chebli P, Lemus J, Avila C et al. Multilevel determinants of financial toxicity in breast cancer care: perspectives of healthcare professionals and Latina survivors. Support. Care Cancer 28(7), 3179–3188 (2020).
MedlineGoogle Scholar
48. Williams C, Gallagher KD, Deehr K et al. Quantifying treatment preferences and their association with financial toxicity in women with breast cancer. J. Clin. Oncol. 38(Suppl. 29), 141–141 (2020).
Google Scholar
49. Katz SJ, Belkora J, Elwyn G. Shared decision making for treatment of cancer: challenges and opportunities. J. Oncol. Pract. 10, 206–208 (2014).
MedlineGoogle Scholar
50. Millenson ML, Berenson RA. Shared decisions in cancer care: is medicare providing a model? Reform-monitoring and impact. Urban Institute (2017). https://www.urban.org/sites/default/files/publication/89901/2001242-shared_decisions_in_cancer_care_is_medicare_providing_a_model_1.pdf
Google Scholar
51. Covvey JR, Kamal KM, Gorse EE et al. Barriers and facilitators to shared decision-making in oncology: a systematic review of the literature. Support. Care Cancer 27, 1613–1637 (2019).
MedlineGoogle Scholar
52. Lawhon VM, England RE, Wallace AS et al. ‘It’s important to me’: a qualitative analysis on shared decision-making and patient preferences in older adults with early-stage breast cancer. Psychooncology 30(2), 167–175 (2021).
MedlineGoogle Scholar
53. Kane HL, Halpern MT, Squiers LB, Treiman KA, Mccormack LA. Implementing and evaluating shared decision making in oncology practice. CA Cancer J. Clin. 64(6), 377–388 (2014).
MedlineGoogle Scholar
54. FAIR Health. Cost information enhances shared decision making: Lessons from FAIR Health's shared decision-making initiative. (2020). https://s3.amazonaws.com/media2.fairhealth.org/brief/asset/Cost%20Information%20Enhances%20Shared%20Decision%20Making-Lessons%20from%20FAIR%20Healths%20Shared%20Decision-Making%20Initiative-A%20FAIR%20Health%20Brief.pdf
Google Scholar
55. Hong YR, Salloum RG, Yadav S, Smith G, Mainous AG 3rd. Patient–provider discussion about cancer treatment costs and out-of-pocket spending: implications for shared decision making in cancer care. Value Health 23(12), 1592–1598 (2020). •• Evidence to support that patient–provider cost discussions are associated with lower total out-of-pocket spending.
MedlineGoogle Scholar
56. Kelly RJ, Forde PM, Elnahal SM, Forastiere AA, Rosner GL, Smith TJ. Patients and physicians can discuss costs of cancer treatment in the clinic. J. Oncol. Pract. 11(4), 308–312 (2015).
MedlineGoogle Scholar
57. Seidman J, Gaur P, Boler C. The patient-perspective value framework: short-and long-term recommendations to influence value assessment methodology. Avalere Health (2019). https://avalere.com/wp-content/uploads/2019/05/20190530_PPVF-Working-Group-Paper_Final.pdf
Google Scholar
58. Veenstra CM, Hawley ST. Incorporating patient preferences into cancer care decisions: challenges and opportunities. Cancer 126(15), 3393–3396 (2020).
MedlineGoogle Scholar
59. Kreizenbeck KL, Wong T, Jagels B et al. A pilot study to increase adherence to ASCO Choosing Wisely recommendations for breast cancer surveillance at community clinics. J. Clin. Oncol. 38(Suppl. 29), 18–18 (2020).
Google Scholar
60. Parker PA, Peterson SK, Bedrosian I et al. Prospective study of surgical decision-making processes for contralateral prophylactic mastectomy in women with breast cancer. Ann. Surg. 263(1), 178–183 (2016).
MedlineGoogle Scholar
61. Fiscella K, Fox K, Gill L et al. How to welcome cost-of-care conversations in your practice cost-of-care conversations: Practice Brief #3. Avalere Health (2018). https://essentialhospitals.org/wp-content/uploads/2018/11/CostofCarePracticeBrief3.pdf
Google Scholar
62. Schnipper LE, Davidson NE, Wollins DS et al. Updating the American Society of Clinical Oncology Value Framework: revisions and reflections in response to comments received. J. Clin. Oncol. 34(24), 2925–2934 (2016).
MedlineGoogle Scholar
63. Mitchell AP, Dey P, Ohn JA, Tabatabai SM, Curry MA, Bach PB. The accuracy and usefulness of the national comprehensive cancer network evidence blocks affordability rating. Pharmacoeconomics 38(7), 737–745 (2020).
MedlineGoogle Scholar
64. Scholl I, Kobrin S, Elwyn G. ‘All about the money?’ A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States. Implement Sci. 15(1), 81 (2020).
MedlineGoogle Scholar
65. Tirodkar MA, Roth L, Fuld Nasso S, Friedberg MW, Scholle SH. Facilitators and barriers to implementing a patient-centered oncology care model. JCO Oncol. Pract. 16(12), e1441–e1450 (2020).
MedlineGoogle Scholar
66. Espinoza Suarez NR, Lavecchia CM, Ponce OJ et al. Using shared decision-making tools and patient-clinician conversations about costs. Mayo Clin. Proc. Innov. Qual. Outcomes 4(4), 416–423 (2020).
MedlineGoogle Scholar
67. Shih YCT, Nasso SF, Zafar SY. Price transparency for whom? In search of out-of-pocket cost estimates to facilitate cost communication in cancer care. Pharmacoeconomics 36, 259–261 (2018).
MedlineGoogle Scholar
68. Stacey D, Bennett CL, Barry MJ et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. (10), CD001431 (2011).
MedlineGoogle Scholar
69. Mccaffery KJ, Holmes-Rovner M, Smith SK et al. Addressing health literacy in patient decision aids. BMC Med. Inform. Decis. Mak. 13(Suppl. 2), S10 (2013).
MedlineGoogle Scholar
70. Perfetto EM, Harris J, Mullins CD, Dosreis S. Emerging good practices for transforming value assessment: patients’ voices, patients’ values. Value Health 21(4), 386–393 (2018).
MedlineGoogle Scholar
71. Khera N, Kumbamu A, Langer SL et al. Developing an educational intervention to address financial hardship in cancer patients. Mayo Clin. Proc. Innov. Qual. Outcomes 4(4), 424–433 (2020).
MedlineGoogle Scholar
72. Watabayashi K, Steelquist J, Overstreet KA et al. A pilot study of a comprehensive financial navigation program in patients with cancer and caregivers. J. Natl Compr. Canc. Netw. 18(10), 1366–1373 (2020).
MedlineGoogle Scholar
73. Khera N, Sugalski J, Krause D et al. Current practices for screening and management of financial distress at NCCN member institutions. J. Natl Compr. Canc. Netw. 18(7), 825–831 (2020).
MedlineGoogle Scholar
74. The Association of Community Cancer Centers. Are we meeting the needs of our cancer patients? (2014). https://www.accc-cancer.org/docs/projects/financial-advocacy/fan-trends-survey-summary-2014.pdf?sfvrsn=64d8fd6c_0
Google Scholar
75. The Advisory Board Company. Oncology roundtable lessons for optimizing program performance maximizing the value of patient navigation. (2011). https://www.advisory.com/Topics/Oncology/2011/03/Maximizing-the-Value-of-Patient-Navigation
Google Scholar
76. Michigan Cancer Consortium. Financial navigation for people undergoing cancer treatment (2018). www.michigancancer.org/PDFs/Publications_Products/MCCExclusiveProd/FinancialNavigationReport_FinalAccessible2018.pdf.
Google Scholar
77. Zafar SY, Polite BN, McClellan M. Engaging patients in value-based cancer care: a missed opportunity. JAMA Oncol. 4, 1479–1480 (2018).
MedlineGoogle Scholar
78. Higgins A, Brainard N, Veselovskiy G. Characterizing health plan price estimator tools: findings from a national survey. Am. J. Manag. Care 22(2), 126–131 (2016).
MedlineGoogle Scholar
79. Gourevitch RA, Desai S, Hicks AL, Hatfield LA, Chernew ME, Mehrotra A. Who uses a price transparency tool? Implications for increasing consumer engagement. Inquiry 54, 46958017709104 (2017).
MedlineGoogle Scholar
80. Benavidez G, Frakt A. Price transparency in health care has been disappointing, but it doesn’t have to be. JAMA 322, 1243–1244 (2019).
MedlineGoogle Scholar
81. Henrikson NB, Shankaran V. Improving price transparency in cancer care. J. Oncol. Pract. 12, 44–47 (2016).
MedlineGoogle Scholar
82. Hendren S, Chin N, Fisher S et al. Patients’ barriers to receipt of cancer care, and factors associated with needing more assistance from a patient navigator. J. Natl Med. Assoc. 103(8), 701–710 (2011).
MedlineGoogle Scholar
83. Sinaiko AD, Rosenthal MB. Examining a health care price transparency tool: who uses it, and how they shop for care. Health Aff. (Millwood) 35(4), 662–670 (2016).
MedlineGoogle Scholar
84. Shankaran V, Leahy T, Steelquist J et al. Pilot feasibility study of an oncology financial navigation program. J. Oncol. Pract. 14(2), e122–e129 (2018).
MedlineGoogle Scholar
85. Yezefski T, Steelquist J, Watabayashi K, Sherman D, Shankaran V. Impact of trained oncology financial navigators on patient out-of-pocket spending. Am. J. Manag. Care 24(Suppl. 5), S74–S79 (2018).
MedlineGoogle Scholar
86. Rocque GB, Pisu M, Jackson BE et al. Resource use and medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol. 3(6), 817–825 (2017).
MedlineGoogle Scholar
87. Zhang B, Wright AA, Huskamp HA et al. Health care costs in the last week of life: associations with end-of-life conversations. Arch. Intern. Med. 169(5), 480–488 (2009).
MedlineGoogle Scholar
88. Vorobiof DA, Malki E, Deutsch I, Hasid L. Real-world data (RWD) and patients reported outcomes (PRO) in breast cancer (BC): physical, emotional side effects (S/E), financial toxicity (FT), and complementary usage (CM) relations. J. Clin. Oncol. 37(Suppl. 15), e18060–e18060 (2019).
Google Scholar
89. Vorobiof DA, Hasid L, Litvin A, Deutsch I, Malki E. Financial toxicity (FT) real-world data evidence (RWDE) in American patients (pts) receiving cancer immunotherapy drugs (IOT). J. Clin. Oncol. 38(Suppl. 15), e19331–e19331 (2020).
Google Scholar
90. Gentile D, Markham MJ, Eaton T. Patients with cancer and social media: harness benefits, avoid drawbacks. J. Oncol. Pract. 14, 731–736 (2018).
Google Scholar
91. Walsh-Buhi ER. Social media and cancer misinformation: additional platforms to explore. Am. J. Public Health 110, S292–S293 (2020).
MedlineGoogle Scholar
92. Zon RT, Frame JN, Neuss MN et al. American Society of Clinical Oncology policy statement on clinical pathways in oncology. J. Oncol. Pract. 12(3), 261–266 (2016).
MedlineGoogle Scholar
93. Source: Navigating Cancer Navigating Cancer’s triage software with symptom management pathways facilitates $3.4 million in annual savings. Press release: www.prweb.com/releases/2017/08/prweb14609775.htm.
Google Scholar
94. Howard SC, Yeatman TJ, Watson ML, Lam C. Increasing the duration and efficacy of intravenous chemotherapy using a patient-centered digital education program: Navigating Cancer’s program for patients receiving pemetrexed for lung cancer. J. Clin. Oncol. 35(Suppl. 15), e18025–e18025 (2017).
Google Scholar
95. Advisory Board The Cancer Care Transformation Playbook opportunities to reduce unwarranted care variation in oncology. 2017). https://www.navigatingcancer.com/wp-content/uploads/2018/03/Oncology-Roundtable_Cancer-Care-Transformation-Playbook.pdf
Google Scholar
96. Basch E, Deal AM, Dueck AC et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA 318, 197–198 (2017).
MedlineGoogle Scholar
97. Dixon S, Nancarrow SA, Enderby PM, Moran AM, Parker SG. Assessing patient preferences for the delivery of different community-based models of care using a discrete choice experiment. Health Expect. 18(5), 1204–1214 (2015).
MedlineGoogle Scholar
98. Orlando JF, Beard M, Kumar S. Systematic review of patient and caregivers' satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients' health. PLoS ONE 14(8), e0221848 (2019).
Medline CASGoogle Scholar
99. Heyer A, Granberg RE, Rising KL, Binder AF, Gentsch AT, Handley NR. Medical oncology professionals’ perceptions of telehealth video visits. JAMA Netw. Open 4(1), e2033967 (2021). • Survey of medical oncologists that found conflicting opinions on the benefits of telehealth in cancer care.
MedlineGoogle Scholar
100. Zimmerman BS, Seidman D, Berger N et al. Patient perception of telehealth services for breast and gynecologic oncology care during the COVID-19 pandemic: a single center survey-based study. J. Breast Cancer 23(5), 542–552 (2020).
MedlineGoogle Scholar
101. Pham Q, Hearn J, Gao B et al. Virtual care models for cancer survivorship. NPJ Digit. Med. 3, 1–7 (2020).
MedlineGoogle Scholar
102. Shaffer ER. The affordable care act: the value of systemic disruption. Am. J. Public Health 103, 969–972 (2013).
MedlineGoogle Scholar
103. Keith K. New COVID-19 Rule Addresses Coverage, Medicaid Waivers | Health Affairs. Health Affairs Blog (2020). https://www.healthaffairs.org/do/10.1377/hblog20201030.291472/full/
Google Scholar
104. Agarwal R, Gupta A, Fendrick AM. Value-based insurance design improves medication adherence without an increase in total health care spending. Health Aff. (Millwood) 37(7), 1057–1064 (2018).
MedlineGoogle Scholar
105. Gruber J, Maclean JC, Wright B, Wilkinson E, Volpp KG. The effect of increased cost-sharing on low-value service use. Health Econ. 29(10), 1180–1201 (2020).
MedlineGoogle Scholar
106. Choudhry NK, Bykov K, Shrank WH et al. Eliminating medication copayments reduces disparities in cardiovascular care. Health Aff. (Millwood) 33(5), 863–870 (2014). • Proposes a framework for implementation of value-based insurance design in oncology.
MedlineGoogle Scholar
107. De Souza JA, Ratain MJ, Fendrick AM. Value-based insurance design: aligning incentives, benefits, and evidence in oncology. J. Natl Compr. Cancer Netw. 10(1), 18–23 (2012).
Google Scholar
108. Blue Cross NC launches ‘SmartShopper’ program, drives cost awareness by paying members to shop for health care. BlueCross BlueShield, NC, USA (2018). https://mediacenter.bcbsnc.com/news/blue-cross-nc-launches-smartshopper-program-drives-cost-awareness-by-paying-members-to-shop-for-health-care
Google Scholar
109. Schmidt H, Emanuel EJ. Lowering medical costs through the sharing of savings by physicians and patients: inclusive shared savings. JAMA Intern Med 174(12), 2009–2013 (2014).
MedlineGoogle Scholar
110. Caffrey M. Bringing value-based insurance design to oncology: the new ‘skin in the game’. Am. J. Manag. Care 26(10), SP351 (2020).
Google Scholar
111. Richardson H, Budros M, Chernew ME, Fendrick AM. V-BID X: Creating A Value-Based Insurance Design Plan For The Exchange Market | Health Affairs. Health Affairs Blog (2019). https://www.healthaffairs.org/do/10.1377/hblog20190714.437267/full/
Google Scholar

Vol. 17, No. 28

Metrics

Downloaded 4,005 times

History

Received 17 March 2021

Accepted 7 June 2021

Published online 23 July 2021

Published in print October 2021

Information

Keywords

Author contributions

Substantial contributions to: the conception and design of the work (A Gunn, C Sorenson, R Greenup), the acquisition, analysis, or interpretation of data for the work (A Gunn, C Sorenson), drafting the work (A Gunn, C Sorenson); revising it critically for important intellectual content (A Gunn, C Sorenson, R Greenup) and final approval of the version to be published (A Gunn, C Sorenson, R Greenup); and agreement to be accountable for all aspects of the work (A Gunn, C Sorenson, R Greenup).

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

PDF download

Navigating the high costs of cancer care: opportunities for patient engagement

Abstract

Lay abstract

References