"Patient expectation plays a role in their level of financial distress," Zafar said. "If patients expect to pay a lot, they are able to cope better. If we prepare patients for the cost, even if we can't reduce the cost, preparation can go a long way."
Further, by considering costs in individual cases of clinical decision-making, doctors could play a crucial part in reducing overall health care costs for society as a whole.
Such conversations would be welcomed by patients, said Kim Bailey, research director for Families USA, a nonprofit health care advocacy group.
"Providers have been really hesitant to talk about cost, and they haven't thought a great deal about cost when talking with their patients about care," Bailey said. "In some ways, it's been seen as the provider's role is to focus solely on medicine, and that discussions of cost is really an insurance role."
It may take some training to help doctors grow comfortable adding a financial dimension to discussion of medical options, paper co-author Zafar said. Medical societies, advocacy groups and medical schools should consider playing a role in such training.
"It's a sensitive topic. It's embarrassing for many patients. And we as physicians don't have the knowledge base to talk about cost," he said. "But we give patients chemotherapy that we know is going to cause a physical toxicity we can't stop. We talk with them about how to best cope and expect it. That's how we should start thinking about the financial toxicity of some of the health care we provide."
For her part, Bailey suggested that physicians daunted by the overwhelming complexity of cost-sharing and different insurance plans might want to start the discussion by asking general questions about patients' financial concerns.
"Maybe the conversation could start there," Bailey said. "'Are you worried about the cost of your treatment? If so, have you looked into what your plan covers?'"