They can talk about sex. They can talk about end of life. But when it comes to the cost of cancer care, physicians aren't talking to their patients.Although some oncologists feel "economic advisor" isn't part of their job description, the reality is that financial concerns impact the choice of treatment, said presenters during a session at the American Society of Clinical Oncology's annual meeting. A patient's questions and concerns shouldn't be directed at the billing staff because it can restrict the clinical context a physician can provide for making decisions about treatment, said presenter Anthony Back, MD, of the Seattle Cancer Care Alliance.Research has shown that less than half of oncologists discuss treatment costs with their patients, so the presenters--all oncologists themselves--offered the crowd of physicians practical strategies for communicating with patients. Lesson No. 1: You don't have to be an expert on costs to talk openly to patients and reflect on the choices. Presenters urged their peers to talk to patients about any financial stress that may make it difficult to afford cancer treatment, and to designate an intermediary--for instance, a financial counselor within the practice--to assist patients. And if a treatment is found to be out of reach financially, the physician should discuss alternatives for less expensive treatment when one is available.As for specific guidance for patients, ASCO's patient website, Cancer.net, offers a downloadable booklet called "Managing the Cost of Cancer Care." Patients can find helpful tips on dealing with financial issues in CURE's 2010 Cancer Resource Guide.During a question-and-answer session following the presentations, presenter Deborah Schrag, MD, of Dana-Farber Cancer Institute, expressed thanks but also criticism for patient assistance programs offered by drug companies. Although the programs are meant to help patients get access to cancer drugs they otherwise couldn't afford, Schrag said the programs are extremely hard to navigate, which can be discouraging for both patients and physicians, who often give up or don't even try. She called on pharma to simplify the process.CURE has pulled together a list of assistance programs offered by drug companies, nonprofits, and other organizations. Find it here.Melissa Weber is the former managing editor of CURE and is covering the annual meeting of the American Society of Clinical Oncology.