BACKGROUND Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. METHODS We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. RESULTS Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. CONCLUSIONS Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.

中文翻译：

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与肿瘤学家讨论基因组检测和相关治疗费用相关的因素。

背景技术基因组测试的使用在美国正在增加。检测可能很昂贵，而且并非所有检测和相关治疗都包含在健康保险范围内。人们对肿瘤学家讨论检测和治疗成本的频率以及与这些讨论相关的因素知之甚少。方法 我们从 2017 年全国癌症治疗精准医学调查中确定了 1220 名肿瘤学家，他们报告与癌症患者讨论基因组检测。使用多变量多元逻辑回归分析来评估肿瘤科医生和实践特征以及成本讨论频率之间的关联。所有统计检验都是双面的。结果 在与患者讨论基因组检测的肿瘤学家中，50.0% 的人表示经常讨论检测和相关治疗的可能成本，26.3% 的人表示有时会讨论成本，23.7% 的人表示从不或很少讨论成本。在调整后的分析中，接受过基因组测试培训或在基因组测试电子病历警报实践中工作的肿瘤学家有时更有可能进行成本讨论（比值比 [OR] = 2.09，95% 置信区间 [CI] = 1.19 至 3.69 ）或经常（OR = 2.22，95% CI = 1.30 至 3.79），分别与很少或从不进行比较。统计上与更频繁的成本讨论显着相关的其他因素包括治疗实体瘤（而不仅仅是血液癌症）、使用下一代测序基因组测试、拥有更大的患者数量以及与更高比例的医疗补助患者进行实践，或自费或无保险。结论针对可修改的肿瘤学家和实践因素的干预措施，例如基因组测试培训和电子病历警报的使用，可能有助于改善有关基因组测试和相关治疗的成本讨论。