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Patients' insurance status and out-of-pocket (OOP) expenses figured prominently in oncologists' use of genomic testing to guide treatment decisions, according to a national survey.

About half of the 1,049 oncologists surveyed said insurance and OOP expenses were "very important" considerations, and another 30% said the factors were "somewhat important," reported K. Robin Yabroff, PhD, of the American Cancer Society (ACS) in Atlanta, and colleagues.

In adjusted analyses, oncologists who used next-generation sequencing were twice as likely to consider insurance and OOP costs as compared with oncologists who did not use the testing. The economic factors had a similar differential effect on oncologists who treated solid tumors versus those who treated hematologic cancers. Insurance and OOP costs were taken into account more often by oncologists with more years of experience and those with more Medicaid or self-paid/uninsured patients, they noted in .

The findings point to the importance of discussions between oncologists and patients about cost factors, the authors said.

"I think it's important for patients to understand whether or not things might be covered and not just the genomic testing, but also any treatment that might be identified based on a tumor variant identified during genomic testing," Yabroff told MedPage Today. "I think conversations should include insurance coverage and out-of-pocket costs to the extent they are available. Even when [cost information] may not be readily available, I think oncologists do have a sense of what is the general ballpark of expected costs."

The findings also pointed to the importance of financial counseling for patients with cancer and their families, said Stephen Grubbs, MD, vice president of care delivery for the American Society of Clinical Oncology.

"This article did a good job of bringing attention to two things: first of all, the cost of oncology care ... but also the need for patients and their families to have some really high-quality financial counseling to help them figure out how to best get through the system of getting these expenses paid for," said Grubbs.

"The bottom line was that 80% of the folks that finished the survey, at some point in time, had to take into consideration the coverage for the genomic testing," he added.

The findings were based on data available as of 2017, Grubbs noted. Six years later, the circumstances related to coverage of genomic testing have changed but discussions about cost remain important.

"Back in the early days [of genomic testing] it was really a struggle to convince payers that we needed these genomic tests," he said. "Even though preauthorization is a major hassle factor we all have to deal with, the payers, including Medicare, have very clear policies on what they pay for and what they don't pay for with respect to genomic testing. Having said that, you have to take into consideration the cost of these things for patients, even when you go through the preauthorization form."

Most patients with cancer and their families have concerns about the cost of cancer care, Yabroff and co-authors noted in the introduction to the findings. However, limited information existed about the influence of insurance coverage and OOP costs on oncologists' decisions about use of genomic testing. To examine the issues, investigators queried the 2017 , jointly sponsored by the National Cancer Institute, the National Human Genomic Research Institute, and the ACS.

The search of the database identified 1,049 oncologists who reported using multimarker tumor panels. Using multivariable ordinal logistic regressions, the authors examined associations of oncologists' practice characteristics and their rating of the importance of insurance coverage and OOP costs for genomic testing in treatment decisions.

The results showed that 47.3% of respondents considered patient insurance coverage "very important" for genomic testing. An additional 32.7% said insurance was "somewhat" important, and 20% considered insurance "little/not" important. When asked to rate the importance of OOP costs, the corresponding percentages were 56.9%, 28%, and 15.2%.

Oncologists who used genomic testing were significantly more likely to consider insurance and OOP costs as important considerations as compared with oncologists who did not use the testing (OR 2.00, 95% CI 1.16-3.45 and OR 2.12, 95% CI 1.22-3.68, respectively). As compared with oncologists who treated only hematologic malignancies, those who treated only solid tumors or solid and hematologic malignancies were more likely to rate insurance coverage (OR 1.65 and OR 1.40) and OOP costs (OR 1.74 and OR 1.89) as important considerations for using genomic tests.

As oncologists' years of experience and percentages of Medicaid or self-paid/uninsured patients increased, so did the importance of insurance coverage (OR 1.43) and OOP costs (OR 1.51). Oncologists in practices with molecular tumor boards for genomic testing were less likely to consider insurance coverage or OOP costs important as compared with oncologists in practices without such boards (OR 0.63 and OR 0.72).

Yabroff said she hopes the study helps focus more attention on discussions about insurance, cost of cancer care, and affordability issues, not only among oncologists, but professional societies and other organizations.

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