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J Natl Cancer Inst. 2019 Nov 1. pii: djz173. doi: 10.1093/jnci/djz173. [Epub ahead of print]

Factors associated with oncologist discussions of the costs of genomic testing and related treatments.

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Surveillance and Health Services Research, American Cancer Society.
Division of Cancer Control and Population Sciences, National Cancer Institute.
Office of Disease Prevention, Office of the Director, National Institutes of Health.



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.


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.


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 (EMR) alerts for genomic tests were more likely to have cost discussions sometimes or often [(OR = 2.09; 95% Confidence Interval (CI): 1.19, 3.69) and (OR = 2.22; 95%CI: 1.30, 3.79), respectively] compared to rarely/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.


Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of EMR alerts, may help improve cost discussions about genomic testing and related treatments.


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