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25.04.2018 | Original Article | Ausgabe 10/2018

Supportive Care in Cancer 10/2018

Cancer cost communication: experiences and preferences of patients, caregivers, and oncologists—a nationwide triad study

Supportive Care in Cancer > Ausgabe 10/2018
So Young Kim, Dong Wook Shin, Boyoung Park, Juhee Cho, Jae Hwan Oh, Sun Seog Kweon, Hye Sook Han, Hyung Kook Yang, Keeho Park, Jong-Hyock Park
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00520-018-4201-6) contains supplementary material, which is available to authorized users.



We assessed cost communication between cancer patients, caregivers, and oncologists and identified factors associated with communication concordance.


A national, multicenter, cross-sectional survey of patient-caregiver-oncologist triads was performed, and 725 patient-caregiver pairs, recruited by 134 oncologists in 13 cancer centers, were studied. Discordance in preferences and experiences regarding cost communication between patients, caregivers, and oncologists were assessed. Hierarchical generalized linear models were used to identify predictors of concordance and to identity the possible association of concordance with patient satisfaction and degree of trust in the physician.


Although the oncologists thought that patients would be affected by the cost of care, only half of them were aware of the subjective burden experienced by their patients, and the degree of concordance for this parameter was very low (weighted kappa coefficient = 0.06). Caregivers consistently showed similar preferences to those of the patients. After controlling for covariates, the education level of patients [adjusted odds ratio (aOR) for > 12 vs. < 9 years, 2.92; 95% confidence interval (CI), 1.87–4.56], actual out-of-pocket costs [aOR for ≥ 8 million vs. < 2 million Korean Won, 0.56; 95% CI, 0.34–0.89], and physician age (aOR for ≥ 55 vs. < 45 years, 1.83; 95% CI, 1.04–3.21) were significant.


The results show underestimation by oncologists regarding the subjective financial burden on a patient, and poor patient-physician concordance in cost communication. Oncologists should be more cognizant of patient OOP costs that are not indexed by objective criteria, but instead involve individual patient perceptions.

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