DISCO App for Cancer Costs

(DISCO Trial)

Overseen By Lauren Hamel, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Lauren Hamel

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

260 Participants Needed

Trial Summary

What is the purpose of this trial?

The DISCO App is designed to improve, during the interaction, patient active participation and patient-initiated oncologist treatment cost discussions, and, in the short term, patient's treatment cost knowledge, self-efficacy for managing both cost and physician interactions, referrals, perceived financial toxicity (i.e., distress and material hardship); in turn, these will affect longer-term outcomes of financial toxicity and adherence.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the DISCO App treatment for cancer costs?

The research on the Bridge app, which helps cancer patients find financial assistance, suggests that similar apps like the DISCO App could help reduce out-of-pocket costs for patients. This indicates that using technology to identify financial resources can be effective in managing cancer-related expenses. ^{1 2 3 4 5}

How is the DISCO App treatment different from other cancer treatments?

The DISCO App is unique because it focuses on facilitating discussions between patients and doctors about the costs of cancer care, which is not typically addressed by other treatments. This app aims to enhance shared decision-making by making financial considerations a part of the treatment conversation. ^{6 7 8 9 10}

Research Team

Lauren Hamel, PhD

Principal Investigator

Barbara Ann Karmanos Cancer Insitute

Eligibility Criteria

This trial is for English-reading and writing patients with new diagnoses of breast, prostate, lung, or colorectal cancer at Karmanos Cancer Institute. They should be likely to receive systemic therapy and have an email account. Oncologists treating these cancers can also participate.

Inclusion Criteria

Oncologists are eligible if they treat patients with breast, prostate, lung, or colorectal cancers at Karmanos Cancer Institute. Data from oncologists will include their self-report data and video-recorded treatment discussions with participating patients.

I can read and write in English, have an email, and am newly diagnosed with breast, prostate, lung, or colorectal cancer.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants use the DISCO App to discuss treatment costs with their oncologist during a scheduled appointment

1 day

1 visit (in-person)

Follow-up

Participants are monitored for financial toxicity and self-efficacy in managing treatment costs

12 months

Follow-up assessments at 1, 3, 6, and 12 months

Booster

Participants receive a reminder of the information presented on the app two months after the initial intervention

1 month

Treatment Details

Interventions

• The DISCO App

Trial Overview The DISCO App aims to help patients discuss treatment costs with oncologists and manage financial aspects of care. The study compares usual care (Group 1) against the app alone (Group 2) and the app with additional support (Group 3).

Participant Groups

Group I: Group 3: The DISCO App + Booster Experimental Treatment 1 Intervention

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey. The patient will be shown an iPad with an "app" while waiting to see your oncologist. The app includes a short video and asks questions about your financial concerns. The app will give the patient a list of questions they may want to ask their oncologist during their appointment. The patient will then meet with their oncologist. The meeting with their oncologist will be video recorded. The oncologist has agreed to be video recorded. Immediately after meeting their oncologist, they will complete another brief survey. The questions will ask about how the meeting went and what they thought of the app. The patient's meeting with the oncologist will not be delayed or changed in any way because of this study. Two months after that appointment, the patient will be sent a reminder of the information that was presented on the app.

Group II: Group 2: The DISCO App Experimental Treatment 1 Intervention

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey. The patient will be shown an iPad with an "app" while waiting to see their oncologist. The app includes a short video and asks questions about the patient's financial concerns. The app will give the patient a list of questions the patient may want to ask their oncologist during their appointment. The patient will then meet with their oncologist. The meeting with the patient's oncologist will be video recorded. The oncologist has agreed to be video recorded. Immediately after meeting the oncologist, the patient will complete another brief survey. The questions will ask about how the meeting went and what the patient thought of the app. The meeting with the oncologist will not be delayed or changed in any way because of this study.

Group III: Group 1: Usual Care Experimental Treatment 1 Intervention

The patient will be asked to arrive 30 minutes early to their next scheduled appointment with their oncologist so they can complete a survey. The patient will be video recorded at their appointment. The oncologist has agreed to be video recorded. Immediately after this appointment, the patient will be asked to complete another brief survey that takes about 20 minutes. The questions will ask about how the meeting went. The patient's meeting with the oncologist will not be delayed or changed in any way because of this study.

Who Is Running the Clinical Trial?

Lauren Hamel

Lead Sponsor

Trials

1

Recruited

260+

Findings from Research

In a randomized trial involving 200 cancer patients, the Bridge app did not provide sufficient data to assess its primary outcome of reducing out-of-pocket costs, highlighting challenges in measuring effectiveness in such studies.

However, post hoc analyses indicated that patients using the Bridge app were more likely to apply for and receive financial assistance compared to those using traditional educational websites, suggesting potential benefits of the app in helping patients access financial resources.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial. Tarnasky, AM., Tran, GN., Nicolla, J., et al.[2022]

A survey of 106 US payers revealed that a significant majority (85.3%) are interested in using cost-effectiveness models (CEMs) and 80.4% in budget impact models (BIMs) to inform oncology formulary decisions, indicating a strong demand for economic data in treatment evaluations.

Despite the interest, many payers (44.1%) reported that economic models were often unavailable during reviews, and concerns about potential bias (38.2%) were common, highlighting the need for improved access and transparency in economic modeling for oncology.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Payer perceptions on the use of economic models in oncology decision making. Biskupiak, J., Oderda, G., Brixner, D., et al.[2023]

In Norway, the average direct medical costs for cancer treatment vary significantly by phase: EUR 21,808 in the initial 12 months, EUR 4,347 during the continuing phase, and EUR 12,085 in the terminal phase, highlighting the financial burden of cancer care over time.

Cancers with a 5-year relative survival rate between 50% and 70%, such as myeloma and non-Hodgkin lymphoma, incur higher lifetime treatment costs, indicating that intermediate prognosis cancers may require more resources compared to those with better or worse prognoses.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study. Bugge, C., Brustugun, OT., Sæther, EM., et al.[2023]

A study using a Markov model and Monte-Carlo simulation analyzed treatment plans for metastatic colorectal cancer (mCRC) and found that the cost-effectiveness of these plans varied significantly, with incremental cost-effectiveness ratios (ICER) ranging from $26,260 to $152,530 in the base case scenario.

The research indicated that the sequence of treatments greatly impacts health outcomes and costs, with all efficient treatment plans expected to result in minimal adverse effects, suggesting that while better health outcomes can be achieved, they often come with high costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Up To Three Lines of Chemotherapy Treatment Plans for Metastatic Colorectal Cancer. Toumazis, I., Kurt, M., Toumazi, A., et al.[2020]

The Radiation Oncology Alternative Payment Model (RO Model) indicates that brachytherapy monotherapy for prostate, uterine, and cervical cancers will receive increased reimbursements, suggesting a financial incentive for its use in treatment.

In contrast, combination therapy episodes involving both brachytherapy and external beam radiation will face reduced reimbursements, which could potentially limit access to comprehensive care for some cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of the Radiation Oncology Alternative Payment Model on Brachytherapy Reimbursement. Thaker, NG., Meghani, R., Wilson, C., et al.[2022]

A review of 27 clinical practice guidelines revealed that while 78% recommend discussing treatment costs with patients, only 15% provided actual cost information, highlighting a gap in financial transparency in cancer care.

Most guidelines (81%) acknowledged the risk of financial burden from cancer treatment, but only one-third offered strategies for managing this burden, indicating a need for improved resources to support oncologists in addressing patients' financial concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines. Agarwal, A., Livingstone, A., Karikios, DJ., et al.[2023]

Pembrolizumab, either alone or in combination, is an approved treatment for advanced non-small cell lung cancer (NSCLC), and a review of 14 cost-effectiveness analyses (CEAs) highlighted significant variability in methodologies used to assess its economic value.

Differences in modeling approaches, survival estimates, and cost considerations across studies can lead to varying conclusions about pembrolizumab's cost-effectiveness, emphasizing the need for payers and policymakers to critically evaluate the methodologies of these analyses for informed decision-making.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Review of Cost-Effectiveness Studies of Pembrolizumab Regimens for the Treatment of Advanced Non-small Cell Lung Cancer. Qiao, N., Insinga, R., de Lima Lopes Junior, G., et al.[2021]

Patients undergoing chemotherapy express a strong interest in discussing treatment costs with their oncologists, but these discussions are infrequent, indicating a gap in communication.

Both patients and providers recognize the importance of cost in treatment decisions, yet providers often prioritize clinical benefits and feel they lack access to necessary cost information, highlighting a need for better resources and training in cost discussions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient and oncologist discussions about cancer care costs. Henrikson, NB., Tuzzio, L., Loggers, ET., et al.[2021]

Patients with cancer are significantly more willing to accept intensive chemotherapy for minimal benefits compared to matched controls, with a median acceptable chance of cure at 1% for patients versus 50% for controls.

Healthcare professionals, including doctors and nurses, are less likely to endorse radical treatments for small benefits, indicating a disparity in treatment acceptance between patients and medical professionals that should be considered in treatment discussions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. Slevin, ML., Stubbs, L., Plant, HJ., et al.[2022]

44% of gynecologic cancer patients used an out-of-pocket cost tracker, with most users finding it easy to use and helpful, although fewer found it useful for budgeting over time.

Patients who were aware of their insurance premiums were more likely to use the cost tracker, suggesting that financial literacy may influence engagement with cost management tools.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Piloting use of an out-of-pocket cost tracker among gynecologic cancer patients. Liang, MI., Summerlin, SS., Boitano, TKL., et al.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Mobile Application to Identify Cancer Treatment-Related Financial Assistance: Results of a Randomized Controlled Trial. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Payer perceptions on the use of economic models in oncology decision making. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Phase- and gender-specific, lifetime, and future costs of cancer: A retrospective population-based registry study. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of Up To Three Lines of Chemotherapy Treatment Plans for Metastatic Colorectal Cancer. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of the Radiation Oncology Alternative Payment Model on Brachytherapy Reimbursement. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Physician-patient communication of costs and financial burden of cancer and its treatment: a systematic review of clinical guidelines. [2023]

7. Switzerland pubmed.ncbi.nlm.nih.gov

A Review of Cost-Effectiveness Studies of Pembrolizumab Regimens for the Treatment of Advanced Non-small Cell Lung Cancer. [2021]

8. Germany pubmed.ncbi.nlm.nih.gov

Patient and oncologist discussions about cancer care costs. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. [2022]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Piloting use of an out-of-pocket cost tracker among gynecologic cancer patients. [2022]