Navigating financial toxicity in patients with cancer: A multidisciplinary management approach

Abstract

Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients' risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors' recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care.

The Emerging Boon of Information and Communication Technology in Multidisciplinary Cancer Care: A Force Multiplier With a Human Touch

“…Furthermore, over 60-80% of the cost of cancer care (CC) happens in the last months and weeks of the patients’ demise from uncontrolled cancer. The loss of income to the patients and their families during the CC, the cost of CC to the family, and if the patient ends up with disabilities and unable to work or dies due to cancer, the subsequent loss of income for the family can all add to the economic sufferings for the family [ 2 ] and the necessity to address the financial toxicity in CC [ 3 ]. So, every effort should be made to improve the control of cancer with a goal to cure as high a percentage of patients as possible, because the reduction in human suffering is immeasurable; in addition, rehabilitation following cancer treatment can have many economic benefits to the families, communities, societies, and nations [ 4 ].…”

Ensuring Employment After Cancer Diagnosis: Are Workable Solutions Obvious?

“…Such an evaluation is ongoing and led by the Center for Total Worker Health at the University of Colorado. 9 Another ongoing study is evaluating an intervention to improve patients' ability to negotiate work accommodations 10 that help employed patients remain employed. 7 Despite best efforts, patients' ability to communicate effectively with their employers' may be impeded by the stress they and their informal caregivers feel at the time of diagnosis.…”

Financial Hardship in Cancer Care—The Need to Define and Intervene on Actionable Metrics

“…Despite evolving definitions and imperfect measurement tools, we know that financial hardship from cancer treatment is a common adverse event for patients; the prevalence of financial hardship varies across sociodemographic groups, but adverse implications can be seen in at least half of patients. 1 Financial burdens associated with cancer are associated with increased financial strain, 2 decreased willingness to pay for care, 3 and increased mortality. 4 We have a growing understanding of populations who are most at risk for financial hardship: those who are underinsured or uninsured; those who are minoritized and/or made vulnerable by structural racism, geographic barriers to care, language differences, ageism, sexism, undocumented immigration status, and health literacy, among other means; and those who lack financial reserves.…”

“…Elements of financial hardship include (1) material consequences of treatment, such as out-of-pocket expenses, debt, and decreased income; (2) psychological distress because of costs; and (3) deleterious coping mechanisms, such as delaying or skipping medications or care. Despite evolving definitions and imperfect measurement tools, we know that financial hardship from cancer treatment is a common adverse event for patients; the prevalence of financial hardship varies across sociodemographic groups, but adverse implications can be seen in at least half of patients . Financial burdens associated with cancer are associated with increased financial strain, decreased willingness to pay for care, and increased mortality .…”

“…Embedding cost tools in the electronic medical record may empower both patients and clinicians to discuss costs at the point of care when making treatment decisions. Furthermore, financial navigators have helped decrease both patient and health system costs because navigators link patients to support and services that are designed to improve access; making financial navigators available, particularly at institutions that serve economically vulnerable populations, is an important goal. Work is under way (eg, SWOG CREDIT [A Randomized Trial Addressing Cancer-Related Financial Hardship Through Delivery of a Proactive Financial Navigation Intervention] study) to prospectively evaluate how financial navigation programs may reduce material financial hardship for households.…”