It's time to have 'The talk': Cost communication and patient-centered care

摘要

One of us recently saw a young, insured patient with newly diagnosed rectal cancer. He completed 5 1/2 weeks of pre-operative treatment with the oral agent capecitabine and radiation without any physical complications. Unfortunately, after that course of treatment, he was diagnosed with metastatic cancer. As he began his first-line treatment with a standard chemotherapy regimen that included 'oxaliplatin, bevacizumab, and capecitabine, the patient remarked, "Doc, the capecitabine is too much for me." His comment was surprising as he had previously tolerated the treatment without any physical complications. On further questioning, the patient revealed that his health insurance did not cover capecitabine, resulting in bills totaling thousands of dollars.