Reducing Cancer-related Financial Toxicity through Financial Navigation: Results from a Pilot Intervention

Abstract

Our purpose was to pilot a novel patient-centered financial navigation (FN) intervention to decrease the burden of financial toxicity (FT) among uninsured and underinsured patients with cancer treated at the North Carolina Cancer Hospital (NCCH). Methods: Participants were recruited by cancer clinic nurses and social workers at the NCCH. Eligible patients scored less than 22 points (indicating significant FT) on the COmprehensive Score for financial Toxicity (COST) instrument. Fifty patients were enrolled in the intervention, which included an intake assessment of financial needs and vulnerability, initial one-on-one consultation with a trained financial navigator (i.e., financial counselor or social worker), triage to financial support services matching patients' needs, and multiple follow-up appointments. Navigator recommendations were based upon a detailed review of patients' financial status, billing information, insurance, and other indicators used to refer patients to appropriate financial and social services resources offered by the hospital, government, nonprofits and private corporations. Following the initial appointment, patients were given a checklist of resources they were eligible for and the required paperwork to complete applications. During follow-up appointments, application status was reviewed, and practical assistance was provided. Patients were re-contacted at 2-week intervals to assess progress toward financial assistance goals. Outcome data collection included pre/post-intervention COST scores, patient satisfaction with the intervention, and intervention fidelity and retention. Results: The first fifty patients approached all screened positive for FT (COST < 22). Baseline COST scores ranged from 0–19. Results indicated a significant improvement in COST scores following the FN intervention (average increase = 6.86, 95% CI = 4.30–9.42), P < 0.0001). Post-intervention questionnaires indicated excellent patient satisfaction and retention with the FN intervention, and navigator logs indicated high fidelity to the intervention protocol. Conclusions: A novel FN intervention was feasible, acceptable, and effective in reducing FT among uninsured and underinsured oncology patients.

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

“…The availability of financial navigators designated for cancer patients is encouraging both for cancer care delivery and for intervention design and testing. Existing data suggest providing a cancer-specific navigator may be a promising intervention to help standardize and coordinate interventions to address financial hardship early into cancer care (23)(24)(25). The use of cancer-specific financial navigators in NCORP practice groups suggests NCORP practice groups have capacity to test financial hardship interventions currently being piloted or tested in randomized trials (24)(25)(26)(27)(28).…”

Financial burdens during the COVID-19 pandemic are related to disrupted healthcare utilization among survivors of adolescent and young adult cancers

“…Financial toxicity in the past 4 weeks was measured using 11 items coded on a 5-point Likert scale from the “COmprehensive Score for financial Toxicity” (COST) [ 12 ]. As low scores indicated higher toxicity, we divided participants into “high” or “low” by COST ≤ 21 (median = 21) as done previously [ 21 ].…”

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

“…These results provide initial evidence that structured financial navigation demonstrates acceptability, enables high‐fidelity provision of interventions, increases patient knowledge about resources, and improves patient‐reported depressive and anxiety symptoms, cancer distress, and social support. The intervention by Wheeler et al also led to participants’ postintervention improvement of subjective FT measured using the COST measure 61 …”

“…Table 1 summarizes recent prospective studies evaluating the effectiveness of patient‐level financial navigation interventions 56‐62 . Studies were from single institutions with limited sample sizes, and almost all used a single‐arm, preintervention‐postintervention design.…”