Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA

Kazzi, Bahaa; Chino, Fumiko; Timlin, Homa; Jain, Bhav; Tian, Sibo; Paguio, Joseph Alexander; Yao, Jasper Seth; Muralidhar, Vinayak; Mahal, Brandon A.; Nguyen, Paul L.; Sanford, Nina N.; Dee, Edward Christopher

doi:10.1007/s00520-022-07234-9

Cited by 24 publications

(14 citation statements)

References 55 publications

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“…The rising costs of cancer care highlight the urgent need to assess and address financial toxicity and its ripple effect on families and caregivers of patients with cancer. While we highlight this growing problem in Southeast Asia, it is important to recognize that the financial toxicity of cancer is a global concern and also occurs in regions of the world with greater financial resources 7,8 . Further research is needed to elucidate the complexities of financial toxicity in the context of regional cultures, socioeconomic milieu, and cancer care system.…”

Section: Discussionmentioning

confidence: 94%

“…While we highlight this growing problem in Southeast Asia, it is important to recognize that the financial toxicity of cancer is a global concern and also occurs in regions of the world with greater financial resources. 7,8 Further in the context of regional cultures, socioeconomic milieu, and cancer care system. Critically, work is needed to develop, evaluate, and implement policies and interventions that are responsive to the needs of the most vulnerable.…”

Section: Discussionmentioning

confidence: 99%

“…The work of Su and Malhotra builds upon prior studies demonstrating that cancer does not occur in a vacuum and has major deleterious effects on family and other caregivers as well, [8][9][10][11] ranging from psychosocial to financial. 12 Cancer can increase their risk of (1) experiencing isolation, anxiety, and depression, [13][14][15][16] and (2) losing work hours resulting from the provision of care.…”

Section: Introductionmentioning

confidence: 99%

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The ripple effect: Cancer‐related financial toxicity for family members and caregivers

et al. 2022

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The ripple effect: Cancer‐related financial toxicity for family members and caregivers

et al. 2022

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“…This burden results from out-of-pocket direct medical costs (e.g., copayments, coinsurance, over-thecounter and prescription drug costs, medical supplies), as well as out-of-pocket indirect and non-medical costs related to treatment-seeking and downstream followup care (e.g., transportation, lost wages, lost productivity, caregiving expenses). The significant out-of-pocket material cost burden placed on cancer patients also frequently leads to psychological distress for patients and caregivers, as well as negative coping behaviors that affect health and health outcomes [4,5]. Both cancer patients and caregivers report high distress and anxiety associated with cancer care costs [6,7].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Lessening the Impact of Financial Toxicity (LIFT): a protocol for a multi-site, single-arm trial examining the effect of financial navigation on financial toxicity in adult patients with cancer in rural and non-rural settings

Wheeler

Biddell

Manning

et al. 2022

Trials

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Background Almost half of the patients with cancer report cancer-related financial hardship, termed “financial toxicity” (FT), which affects health-related quality of life, care retention, and, in extreme cases, mortality. This increasingly prevalent hardship warrants urgent intervention. Financial navigation (FN) targets FT by systematically identifying patients at high risk, assessing eligibility for existing resources, clarifying treatment cost expectations, and working with patients and caregivers to develop a plan to cope with cancer costs. This trial seeks to (1) identify FN implementation determinants and implementation outcomes, and (2) evaluate the effectiveness of FN in improving patient outcomes. Methods The Lessening the Impact of Financial Toxicity (LIFT) study is a multi-site Phase 2 clinical trial. We use a pre-/post- single-arm intervention to examine the effect of FN on FT in adults with cancer. The LIFT trial is being conducted at nine oncology care settings across North Carolina in the United States. Sites vary in geography (five rural, four non-rural), size (21–974 inpatient beds), and ownership structure (governmental, non-profit). The study will enroll 780 patients total over approximately 2 years. Eligible patients must be 18 years or older, have a confirmed cancer diagnosis (any type) within the past 5 years or be living with advanced disease, and screen positive for cancer-related financial distress. LIFT will be delivered by full- or part-time financial navigators and consists of 3 components: (1) systematic FT screening identification and comprehensive intake assessment; (2) connecting patients experiencing FT to financial support resources via trained oncology financial navigators; and (3) ongoing check-ins and electronic tracking of patients’ progress and outcomes by financial navigators. We will measure intervention effectiveness by evaluating change in FT (via the validated Comprehensive Score of Financial Toxicity, or COST instrument) (primary outcome), as well as health-related quality of life (PROMIS Global Health Questionnaire), and patient-reported delayed or forgone care due to cost. We also assess patient- and stakeholder-reported implementation and service outcomes post-intervention, including uptake, fidelity, acceptability, cost, patient-centeredness, and timeliness. Discussion This study adds to the growing evidence on FN by evaluating its implementation and effectiveness across diverse oncology care settings. Trial registration ClinicalTrials.gov NCT04931251. Registered on June 18, 2021.

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“…Collectively, these risks have been termed financial toxicity (FT). In addition to leading to harmful consequences for patients, FT has also been shown to negatively impact caregivers and other members of the household (9,10). Furthermore, FT may negatively impact healthcare system finances through cost-related missed appointments and uncompensated care (11,12).…”

Section: Introductionmentioning

confidence: 99%

Core functions of a financial navigation intervention: An in-depth assessment of the Lessening the Impact of Financial Toxicity (LIFT) intervention to inform adaptation and scale-up in diverse oncology care settings

Wheeler¹,

Birken²,

Wagi³

et al. 2022

Front.Health Serv.

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BackgroundLessening the Impact of Financial Toxicity (LIFT) is an intervention designed to address financial toxicity (FT) and improve cancer care access and outcomes through financial navigation (FN). FN identifies patients at risk for FT, assesses eligibility for financial support, and develops strategies to cope with those costs. LIFT successfully reduced FT and improved care access in a preliminary study among patients with high levels of FT in a single large academic cancer center. Adapting LIFT requires distinguishing between core functions (components that are key to its implementation and effectiveness) and forms (specific activities that carry out core functions). Our objective was to complete the first stage of adaptation, identifying LIFT core functions.MethodsWe reviewed LIFT's protocol and internal standard-operating procedures. We then conducted 45–90 min in-depth interviews, using Kirk's method of identifying core functions, with key LIFT staff (N = 8), including the principal investigators. Interviews focused on participant roles and intervention implementation. Recorded interviews were transcribed verbatim. Using ATLAS.ti and a codebook based on the Model for Adaptation Design and Impact, we coded interview transcripts. Through thematic analysis, we then identified themes related to LIFT's intervention and implementation core functions. Two report back sessions with interview participants were incorporated to further refine themes.ResultsSix intervention core functions (i.e., what makes LIFT effective) and five implementation core functions (i.e., what facilitated LIFT's implementation) were identified to be sufficient to reduce FT. Intervention core functions included systematically cataloging knowledge and tracking patient-specific information related to eligibility criteria for FT relief. Repeat contacts between the financial navigator and participant created an ongoing relationship, removing common barriers to accessing resources. Implementation core functions included having engaged sites with the resources and willingness necessary to implement FN. Developing navigators' capabilities to implement LIFT—through training, an established case management system, and connections to peer navigators—were also identified as implementation core functions.ConclusionThis study adds to the growing evidence on FN by characterizing intervention and implementation core functions, a critical step toward promoting LIFT's implementation and effectiveness.

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Shared burden: the association between cancer diagnosis, financial toxicity, and healthcare cost-related coping mechanisms by family members of non-elderly patients in the USA

Cited by 24 publications

References 55 publications

The ripple effect: Cancer‐related financial toxicity for family members and caregivers

The ripple effect: Cancer‐related financial toxicity for family members and caregivers

Lessening the Impact of Financial Toxicity (LIFT): a protocol for a multi-site, single-arm trial examining the effect of financial navigation on financial toxicity in adult patients with cancer in rural and non-rural settings

Core functions of a financial navigation intervention: An in-depth assessment of the Lessening the Impact of Financial Toxicity (LIFT) intervention to inform adaptation and scale-up in diverse oncology care settings

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