Financial Toxicity Intervention Improves Outcomes in Patients With Hematologic Malignancy

Abstract

PURPOSE: Patients with hematologic malignancies are extremely vulnerable to financial toxicity (FT) because of the high costs of treatment and health care utilization. This pilot study identified patients at high risk because of FT and attempted to improve clinical outcomes with comprehensive intervention. METHODS: All patients who presented to the Levine Cancer Institute's Leukemia Clinic between May 26, 2019, and March 10, 2020, were screened for inclusion by standardized two question previsit survey. Patients screening positive were enrolled in the comprehensive intervention that used nurse navigators, clinical pharmacists, and community pro bono financial planners. Primary outcomes were defined as improvement in mental and physical quality of life in all patients and improvement in overall survival in the high-risk disease group. RESULTS: One hundred seven patients completed comprehensive intervention. Patients experiencing FT had increased rates of noncompliance including to prescription (16.8%) and over-the-counter medications (15.9%). The intervention resulted in statistically significantly higher quality of life when measured by using Patient-Reported Outcomes Measurement Information System physical (12.5 ± 2.2 v 13.7 ± 1.8) and mental health scores (11.4 ± 2.2 v 12.4 ± 2.2; all P < .001). In patients with high-risk disease (as determined by using disease-specific scoring systems), risk of death in those receiving the intervention was 0.44 times the risk of death in those without the intervention after adjusting for race, and treatment with stem-cell transplant, oral chemotherapy, or immunotherapy (95% CI, 0.21 to 0.94; P = .034). CONCLUSION: Screening and intervention on FT for patients with hematologic malignancies is associated with increased quality of life and survival.

Financial Toxicity Order Set: Implementing a Simple Intervention to Better Connect Patients With Resources

“…As we, and others, have previously highlighted, financial navigation is a promising option for hospital-delivered interventions. 12-14 Other potential hospital-level interventions include financial toxicity screening, tumor board-style interdisciplinary review of specific cases, and support for patient essential needs and nonmedical costs associated with treatment (eg, parking). 9,15-18 All hospital-level interventions must be accessible to historically excluded and limited resource populations to be impactful, and intervention work must be designed to consider scalability in other practice settings.…”

A Narrative Review of Financial Burden, Distress, and Toxicity of Inflammatory Bowel Diseases in the United States

“…Such networks could develop creative mechanisms to assist with the nonmedical costs of care: weekend and evening services for endoscopies, infusions and imaging, on-site childcare provision, medical escorts, improved transportation access, and increased cost transparency. In patients with hematologic malignancies, an intervention to provide patient navigators for patients identified to have higher financial toxicity led to improved quality of life and mental health and was associated with a decreased risk of death from cancer (48). High-risk, high-need patients who could preferentially benefit from hospital-level interventions to decrease financial toxicity could be identified with machine learning models integrated into electronic medical records (49).…”

Financial Toxicity Interventions in Hematologic Malignancies Are Timely and Necessary

“…To quickly identify patients experiencing financial toxicity, Knight et al 13 developed a rapid screen consisting of two questions from the validated COmprehensive Score for financial Toxicity (COST) questionnaire. 18 A score of 5 (of 8) indicated a positive screen.…”

“…Of note, Knight et al 13 examined the effect of the financial navigation program on overall survival, controlling for race and prior treatments received. Although studying the association between financial toxicity and overall survival can be challenging because of the contribution of myriad demographic, pathologic, and therapeutic factors, the authors were able to uncover a statistically significant adjusted hazard ratio of 0.44 in the interventional group.…”

“…In the article that accompanies this editorial, Knight et al 13 designed a comprehensive financial navigation program consisting of nurse navigators, clinical pharmacists, and financial planners for patients with myeloid malignancies experiencing financial toxicity. As financial toxicity research continues to progress into the realm of interventions, financial navigation is a cornerstone of emerging approaches.…”