A Pilot Study of a Comprehensive Financial Navigation Program in Patients With Cancer and Caregivers

Abstract

Background: Few studies have engaged patients and caregivers in interventions to alleviate financial hardship. We collaborated with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach (FR) to assess the feasibility of enrolling patient–caregiver dyads in a program that provides financial counseling, insurance navigation, and assistance with medical and cost of living expenses. Methods: Patients with solid tumors aged ≥18 years and their primary caregiver received a financial education video, monthly contact with a CENTS counselor and PAF case manager for 6 months, and referral to FR for help with unpaid cost of living bills (eg, transportation or housing). Patient financial hardship and caregiver burden were measured using the Comprehensive Score for Financial Toxicity–Patient-Reported Outcomes (COST-PRO) and Caregiver Strain Index (CSI) measures, respectively, at baseline and follow-up. Results: Thirty patients (median age, 59.5 years; 40% commercially insured) and 18 caregivers (67% spouses) consented (78% dyad participation rate). Many participants faced cancer-related financial hardships prior to enrollment, such as work change or loss (45% of patients; 39% of caregivers) and debt (64% of patients); 39% of caregivers reported high levels of financial burden at enrollment. Subjects received $11,000 in assistance (mean, $772 per household); 66% of subjects with income ≤$50,000 received cost-of-living assistance. COST-PRO and CSI scores did not change significantly. Conclusions: Patient–caregiver dyads were willing to participate in a financial navigation program that addresses various financial issues, particularly cost of living expenses in lower income participants. Future work should address financial concerns at diagnosis and determine whether doing so improves patient and caregiver outcomes.

Financial assistance programs for cancer patients

“…Although self-reported financial burden did not change over time, anxiety about costs decreased in 33% of patients. A follow-up to this pilot study [11] expanded to caregivers included a financial education video, monthly contact with a CENTS counselor and PAF case manager for 6 months, and referral to the non-profit charitable assistance program, Family Reach, for help with unpaid cost-of-living expenses (e.g., transportation, housing). Outcomes were measured as baseline and follow-up reports of patient financial hardship using the Comprehensive Score for Financial Toxicity-Patient-Reported Outcomes [12] and caregiver work and financial strain using the Caregiver Strain Index (CSI) measure [13].…”

Divergent Patterns in Care Utilization and Financial Distress between Patients with Blood Cancers and Solid Tumors: A National Health Interview Survey Study, 2014–2020

“…Nonetheless, these findings call for recognition of the unique treatment and survivorship journey of patients with blood cancers and the need for dedicated research. As financial toxicity research in patients with cancer moves into the realm of interventions [ 6 , 10 , 44 , 45 ], it is important to consider the drivers of that financial toxicity. Given the high levels of care utilization seen in the respondents with blood cancer in our study, we question whether medical care utilization is the most prominent driver of financial barriers and distress.…”

Financial Counseling Is Associated with Reduced Financial Difficulty Scores in Head and Neck Cancer Patients Treated with Radiation Therapy

“…Furthermore, unlike modifications of standard therapeutic regimens, the introduction of non-treatment-based interventions to address FT are unlikely to compromise oncologic outcomes. While some have proposed the utility of FC to ameliorate FT, empiric investigation is typically limited to small pilot studies [ 27 , 28 , 29 , 30 , 31 ].…”

“…Moreover, in a non-cancer population, the implementation of financial navigation strategies improved patient satisfaction care and cost-concerns [ 29 ]. Interestingly, when caregivers were also included in financial navigation, participation rate increased to 78%, suggesting targeting the patient-caregiver dyad is a more effective strategy to implement FC [ 30 ].…”