Real-world evidence data (RWED) of financial toxicity (FT) in patients (pts) receiving cancer immunotherapy treatments.

Abstract

90 Background: RWED denotes data accumulated via EHR as well as cutting edge technology paired with consumer mobile devices. We are reporting data on 105 pts, users of Belong.life, a worldwide mobile application, who received immunotherapy for their various cancers and were asked to reply to a short, targeted survey on their FT while on treatment. Methods: 105 pts anonymously and voluntarily replied to a survey which included 14 general information questions and those describing FT, its most common encountered causes and their personal financial coping strategies. Results: 79% of the pts were USA based. 21% of the pts were < 50 years of age (yoa), 32% were 51-60 yoa and 47% were > 61 yoa. Pts’s stages were Stage 3 in 23% and 4 in 62% with unknown in 15%. There were 36% males and 64% females. The most common cancer diagnosis was lung in 46% followed by kidney in 17%, malignant melanoma in 14% and colorectal in 10%. The prevalent immunotherapy drugs were nivolumab and pembrolizumab in 36% respectively, and ipilimumab in 14% and durvalumab in 10%. Frequently reported FTs were high medical copayments in 35% of the pts, loss of income in 33% and high drugs and treatments copayments in 21%. 41% of the pts were insured by Medicare and 25% by Medicaid and other HMOs. Only 48% of the pts were aware of possible financial difficulties as a result of their diagnosis and treatment, and 34% received pre-treatment financial advice from their doctors which reduced the reported FT from 48% to 30%. When asked about coping strategies, 39% used personal savings, 28% trimmed their private expenses, and 24% received financial support from their families and friends. Conclusions: 105 users of the Belong.life application reported on their FTs experienced while receiving cancer immunotherapy. FT was most prevalent in the older group ( > 61 yoa) due to high medical and treatment copayments. Nearly half of the pts was not aware of the possible FT and only 38% received advisory information from their doctors. Reduced FT prevalence (from 48% to 30%) was reported by those informed pts. Physicians should become aware of their pts’s possible risks for FTs, therefore appropriate advice should be given prior to immunotherapy initiation.

Practical Strategies for Advanced Practitioners Streamlining the Integration of Oncology Biosimilar Therapies Into Practice

“…Monetary constraints can lead to “financial toxicity” (i.e., problems related to the cost of medical care) and add to the burden of cancer patients receiving treatment ( Oubre, 2019 ). Common reasons for financial distress are an uninsured status, high medical copayments or high drug and treatment copayments, loss of income, loss of coverage tied to work benefits, the need for medical leave or early retirement, or the uncertainty about how to navigate insurance coverage issues or safety-net resources ( Vorobiof et al, 2020 ; Rotter et al, 2019 ; Warsame et al, 2019 ). Given that financial hardship is associated with reductions in quality of life, adherence to treatment, and adverse psychological consequences, finances can become a source of harm to patients ( Rotter et al, 2019 ).…”

“…Some practices prefer to employ financial counselors or utilize the expertise of coders and payer experts to help patients navigate their benefits ( McGraill, 2019 ; Shah, 2019 ). Financial toxicity was reduced from 48% to 30% among surveyed patients receiving cancer immunotherapy after pretreatment financial counseling from their healthcare provider ( Vorobiof et al, 2020 ). Examples of brief conversations, including switching a patient's drug and other scenarios, demonstrate possible strategies for approaching cost conversations that could be adapted when discussing biosimilars ( Hunter et al, 2017 ).…”

Den Patienten wirklich verstehen lernen: Real-world-Evidenz aus der „patient journey“

“…Emotionale, soziale und finanzielle Auswirkungen (wie z. B. finanzielle Schwierigkeit [ 31 ], Isolation [ 23 ], Demoralisierung [ 14 ]) stellen relevante Bereiche dar, die bisher unzureichend adressiert werden und die ebenfalls bedeutende Aspekte innerhalb der „patient journey“ darstellen.…”

Unequal distribution of financial toxicity among people with cancer and its impact on access to care: a rapid review

“…There is a significant body of recent literature examining the financial and social impact of a cancer diagnosis on patients and their families related to cancer treatment and follow-up care. These studies have shown impacts related to out-of-pocket costs (OOPC) [1–7], lost income for patients [8–14,15 ▪ ,16,17,18 ▪ ,19 ▪ ] or both [20–23,24 ▪ ,25,26,27 ▪ ,28–30]. In some cases, studies are focused on specific cancers including breast [4,18 ▪ ,22,23,31], colorectal [22,23,32,33], lung [22,23], prostate [3,22,23,25], other solid tumours [16,21,34] as well as hematologic malignancies [26].…”

“…These studies have shown impacts related to out-of-pocket costs (OOPC) [1][2][3][4][5][6][7], lost income for patients [8-14,15 ,22,23,31], colorectal [22,23,32,33], lung [22,23], prostate [3,22,23,25], other solid tumours [16,21,34] as well as hematologic malignancies [26]. These data suggest that having metastatic disease [34], receiving immunotherapy treatment [30] and the specific tumour types [28] increases financial toxicity. A recent review by Longo et al [27 & ] illustrates that these costs continue to be of concern in a variety of countries, including: Canada, Australia, Ireland, UK, Germany, France, Denmark, the Netherlands, Finland, Malaysia and South Korea, despite largely public-funded healthcare systems.…”