Current Practices for Screening and Addressing Financial Hardship within the NCI Community Oncology Research Program

Abstract

Background: Cancer-related financial hardship is associated with poor care outcomes and reduced quality-of-life for patients and families. Scalable intervention development to address financial hardship requires knowledge of current screening practices and services within community cancer care. Materials and Methods:The National Cancer Institute's Community Oncology Research Program (NCORP) 2017 Landscape Assessment survey assessed financial screening and financial navigation practices within U.S. community oncology practices. Logistic models evaluated associations between financial hardship screening and availability of a cancer-specific financial navigator and practice group characteristics (e.g., safety-net designation, critical access hospital, proportion of racial and ethnic minority patients served).Results: Of 221 participating NCORP practice groups, 72% reported a financial screening process and 50% had a cancer-specific financial navigator. Practice groups with more than 10% of new cancer patients enrolled in Medicaid ( adj OR = 2.81, p = .02) and with less than 30% racial/ ethnic minority cancer patient composition ( adj OR = 3.91, p <.01) were more likely to screen for financial concerns. Practice groups with less than 30% racial/ethnic minority cancer patient composition ( adj OR = 2.37, p <.01) were more likely to have a dedicated financial navigator or counselor for cancer patients. Conclusions:Most NCORP practice groups screen for financial concerns and half have a cancer-specific financial navigator. Practices serving more racial or ethnic minority patients are less likely to screen and have a designated financial navigator.

Financial Assistance Processes and Mechanisms in Rural and Nonrural Oncology Care Settings

“…However, existing processes were limited by insufficient staff resources, challenges in identifying patient needs, and inadequate infrastructure to track external resource availability and referrals. Our findings add to those of previous studies of financial services in US cancer centers 15,17,18 by documenting how oncology practices in diverse rural and nonrural settings screen for financial hardship and route patients to assistance.…”

Financial burden for caregivers of adolescents and young adults with cancer

“…Information was incomplete, unclear, delivered sporadically, and late. Financial navigation interventions have primarily been patient‐targeted, with minimal inclusion of the caregiver 28–30 . Our results suggest a formal process including regular meetings with a financial resource navigator at diagnosis and across the cancer continuum is warranted for caregivers of AYAs.…”

“…A recent study of practice settings within the National Cancer Institute (NCI) Community Oncology Research Program suggests the use of the National Comprehensive Cancer Network (NCCN) distress thermometer problem checklist as part of standard distress screening may be helpful in detecting financial burden across the cancer continuum. Further, community practice settings with a cancer‐specific financial navigator were more likely to assess financial burden and identify areas of intervention for individual practices and patient groups 28 …”

“…Size, resources available, and vulnerability of patient groups vary by cancer care setting. There is no “gold standard” for recommended screening tools and financial resources as pathways are often fragmented and ill defined 28 . Healthcare practices should consider the degree to which current procedures and patient level factors affect financial burden for AYAs and adopt actionable strategies such as supporting patient‐provider financial communication, training existing employees in financial navigation, partnering with community agencies, creating/gathering and disseminating informational resources.…”

Insurance coverage change and survivorship care among young adult survivors of childhood cancer

“…For example, social workers or financial counselors at cancer treatment facilities could counsel patients and their families about the importance of maintaining insurance coverage during survivorship. In fact, at 72% of NCI Community Oncology Research Program (NCORP) practices and 76% of National Comprehensive Cancer Network (NCCN) facilities, patients are routinely screened for financial distress 39,40 . Perhaps, if screening for insurance accessibility becomes standard of care prior to the transition to survivorship, it could lead to improved utilization of survivorship care.…”