Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3141–3151 | Cite as

Perspectives on the Costs of Cancer Care: A Survey of the American Society of Breast Surgeons

  • Rachel A. GreenupEmail author
  • Christel N. Rushing
  • Laura J. Fish
  • Whitney O. Lane
  • Jeffrey M. Peppercorn
  • Emily Bellavance
  • Lisa Tolnitch
  • Terry Hyslop
  • Evan R. Myers
  • S. Yousuf Zafar
  • E. Shelley Hwang
Breast Oncology



Cancer treatment costs are not routinely addressed in shared decisions for breast cancer surgery. Thus, we sought to characterize cost awareness and communication among surgeons treating breast cancer.


We conducted a self-administered, confidential electronic survey among members of the American Society of Breast Surgeons from 1 July to 15 September 2018. Questions were based on previously published or validated survey items, and assessed surgeon demographics, cost sensitivity, and communication. Descriptive summaries and cross-tabulations with Chi-square statistics were used, with exact tests where warranted, to assess findings.


Of those surveyed (N = 2293), 598 (25%) responded. Surgeons reported that ‘risk of recurrence’ (70%), ‘appearance of the breast’ (50%), and ‘risks of surgery’ (47%) were the most influential on patients’ decisions for breast cancer surgery; 6% cited out-of-pocket costs as significant. Over half (53%) of the surgeons agreed that doctors should consider patient costs when choosing cancer treatment, yet the majority of surgeons (58%) reported ‘infrequently’ (43%) or ‘never’ (15%) considering patient costs in medical recommendations. The overwhelming majority (87%) of surgeons believed that patients should have access to the costs of their treatment before making medical decisions. Surgeons treating a higher percentage of Medicaid or uninsured patients were more likely to consistently consider costs (p < 0.001). Participants reported that insufficient knowledge or resources (61%), a perceived inability to help with costs (24%), and inadequate time (22%) impeded cost discussions. Notably, 20% of participants believed that discussing costs might impact the quality of care patients receive.


Cost transparency remains rare, however in shared decisions for breast cancer surgery, improved cost awareness by surgeons has the potential to reduce financial hardship.



This work was supported by the National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Career Development Award (K12HD043446-11). Additional support was provided by the developmental funds of Duke Cancer Institute as part of P30-CA014236 (Office of Cancer Centers, National Cancer Institute).


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Rachel A. Greenup
    • 1
    • 2
    • 3
    • 5
    Email author
  • Christel N. Rushing
    • 3
    • 4
  • Laura J. Fish
    • 3
    • 5
    • 6
  • Whitney O. Lane
    • 1
  • Jeffrey M. Peppercorn
    • 7
  • Emily Bellavance
    • 8
  • Lisa Tolnitch
    • 1
  • Terry Hyslop
    • 3
    • 4
  • Evan R. Myers
    • 9
    • 10
  • S. Yousuf Zafar
    • 2
    • 3
    • 5
    • 9
  • E. Shelley Hwang
    • 1
    • 3
  1. 1.Department of SurgeryDuke UniversityDurhamUSA
  2. 2.Department of Population Health SciencesDuke UniversityDurhamUSA
  3. 3.Duke Cancer InstituteDuke UniversityDurhamUSA
  4. 4.Department of Biostatistics and BioinformaticsDuke UniversityDurhamUSA
  5. 5.Duke Cancer Control and Population SciencesDuke UniversityDurhamUSA
  6. 6.Duke School of MedicineDuke UniversityDurhamUSA
  7. 7.Department of MedicineMassachusetts General HospitalBostonUSA
  8. 8.University of Maryland School of MedicineBaltimoreUSA
  9. 9.Department of MedicineDuke UniversityDurhamUSA
  10. 10.Department of Obstetrics and GynecologyDuke UniversityDurhamUSA

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