Optimising the care of individuals with cancer without imposing significant financial burden related to their anticancer treatment is becoming increasingly difficult. The American Society of Clinical Oncology (ASCO) has recommended clinicians discuss costs of cancer care with patients to enhance shared decision-making. We sought information to guide oncologists’ discussions with patients about these costs. We searched Medline, EMBASE and clinical practice guideline databases from January 2009 to 1 June 2019 for recommendations about discussing the costs of care and financial burden. Guideline quality was assessed with the AGREE-II instrument. Twenty-seven guidelines met our eligibility criteria, including 16 from ASCO (59%). 21 of 27 (78%) guidelines included recommendations about discussion or consideration of treatment costs when prescribing, with information about actual costs in four (15%). Recognition of the risk of financial burden or financial toxicity was described in 81% (22/27) of guidelines. However, only nine guidelines (33%) included information about managing the financial burden. Current clinical practice guidelines have little information to guide physician-patient discussions about costs of anticancer treatment and management of financial burden. This limits patients’ ability to control costs of treatment, and for the healthcare team to reduce the incidence and severity of financial burden. Current guidelines recommend clinician awareness of price variability and high costs of treatment. Clinicians are recommended to explore cost concerns and address financial worries, especially in high risk groups. Future guidelines should include advice on facilitating cost transparency discussions, with provision of cost information and resources.

中文翻译：

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癌症及其治疗的费用和经济负担的医患沟通：临床指南的系统回顾

在不造成与抗癌治疗相关的重大经济负担的情况下优化癌症患者的护理变得越来越困难。美国临床肿瘤学会 (ASCO) 建议临床医生与患者讨论癌症护理费用，以加强共同决策。我们寻求信息来指导肿瘤学家与患者讨论这些费用。我们检索了 2009 年 1 月至 2019 年 6 月 1 日期间的 Medline、EMBASE 和临床实践指南数据库，以获取有关讨论护理成本和经济负担的建议。使用 AGREE-II 仪器评估指南质量。27 条指南符合我们的资格标准，其中 16 条来自 ASCO（59%）。27 份指南中的 21 份 (78%) 包含关于处方时讨论或考虑治疗费用的建议，其中 4 份 (15%) 包含有关实际费用的信息。81% (22/27) 的指南描述了对经济负担或经济毒性风险的认识。然而，只有九个指南 (33%) 包含有关管理财务负担的信息。目前的临床实践指南几乎没有信息来指导医患关于抗癌治疗费用和经济负担管理的讨论。这限制了患者控制治疗成本的能力，也限制了医疗团队降低经济负担的发生率和严重程度的能力。目前的指南建议临床医生了解价格波动和高治疗成本。建议临床医生探讨成本问题并解决财务问题，特别是在高风险人群中。未来的指导方针应包括促进成本透明度讨论的建议，并提供成本信息和资源。