Approximately half of oncologists discuss genomic testing with their patients, and several practice-level factors influence oncologists’ likelihood of discussing the associated costs, a study in the Journal of the National Cancer Institute reports. These factors include caring for a higher proportion of patients insured by Medicaid and working with electronic medical record alerts for genomic tests.

The 2017 National Survey of Precision Medicine in Cancer Treatment was used to identify 1220 medical oncologists who reported discussing genomic testing with their patients. Researchers evaluated associations between measures of physician-, practice-, and area-level characteristics and the frequency of discussions pertaining to genomic testing cost.

Characteristics of oncologists that were measured included age, sex, self-reported race/ethnicity, years since medical school graduation, and types of tumors treated. Practice-level characteristics included geographic region, practice type, use of genomic testing services within the practice, and insurance status.

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Half (50.0%) of oncologists who discussed genomic testing with their patients also often discussed potential testing costs and related therapies. The proportion of oncologists who reported occasionally discussing costs was 26.3%, whereas 23.7% reported never or rarely discussing testing costs.

Oncologists who were more likely to have cost discussions sometimes or often were those with training in genomic testing (odds ratio [OR], 2.09; 95% CI, 1.19-3.69) or those working in practices with electronic medical record alerts for genomic tests (OR, 2.22; 95% CI, 1.30-3.79) compared with oncologists who rarely or never discussed costs.

More frequent cost discussions were also associated with physicians treating patients with solid tumors vs hematological cancers (OR, 4.01; 95% CI, 2.21-7.29), physicians who used next-generation sequencing gene panel tests (OR, 1.93, 95% CI, 1.34-2.77), and those who worked in practices with higher percentages of patients insured by Medicaid, who self-paid, or who were uninsured (OR, 1.55; 95% CI, 1.09-2.20).

Limitations of the study were the inclusion of cross-sectional survey data, as well as the low response rate of the survey.

“In the context of rising costs of cancer care,” the researchers wrote, “interventions targeting modifiable physician and practice factors may help increase the frequency of physician-patient cost discussions, contributing to more informed patient decisions and higher-quality cancer care.”


Yabroff KR, Zhao J, de Moor JS, et al. Factors associated with oncologist discussions of the costs of genomic testing and related treatments [published online November 1, 2019]. J Natl Cancer Inst. doi:10.1093/jnci/djz173.