Providing Accommodations to Ease Financial Toxicity for Radiation Patients

Background: According to a 2013 Institute of Medicine report, cancer treatment costs are escalating rapidly and resulting in less affordable care options for patients.¹ Increasing costs create disparities for patients trying to access high-quality cancer care. On March 11, 2020, the World Health Organization announced COVID-19 as a pandemic.² As a result, the United States surgeon general recommended hospitals and healthcare systems cancel elective and nonemergent surgical procedures.³ In March 2020, the American Cancer Society (ACS) placed its accommodation programs on hold due to patient safety concerns.⁴ The National Cancer Institute has identified that financial toxicity increased further for cancer patients during the COVID-19 pandemic; it determined that social distancing measures, travel restrictions, and financial toxicity created additional difficulties for patients receiving their cancer treatments.

Patients travel relatively long distances to receive care at the Memorial Hermann-Texas Medical Center (MHTMC). In addition to travel, most patients require lodging to proceed with their treatments. ACS had provided lodging assistance to 52 Memorial Hermann cancer patients in 2018. During that time, ACS covered 173 nights of accommodation for 26 MHTMC cancer patients with 111 nights used.⁵ The organization identified that lack of accommodation could cause barriers to care, cause missed appointments, and create treatment delays.

Objectives: To reduce financial toxicity for radiation patients by providing accommodations for the duration of treatment.

Methods: A quality improvement project was conducted in response to the pandemic and to address the Commission on Cancer Standard 8.1, Addressing Barriers to Care with a focus on financial toxicity.⁶ The organization’s oncology service line collaborated with the radiation team and the Memorial Hermann Foundation to provide accommodation resources, including access to grant funding for patients requiring radiation treatments.

The team created a process to identify patients with accommodation needs, developed criteria, and compiled 3 levels of resources to best suit patients’ needs. The oncology nurse navigator met with all new patients to discuss barriers to care and to identify any need for accommodation resources using the program criteria. Once the level of need was established, the application process was initiated with submission to the review committee for approval, processing, and hotel booking.

Results: Financial toxicity was reduced for radiation patients at MHTMC during the COVID-19 pandemic. Data evaluated from October 2020 through May 2021 reveal that the organization was able to provide 138 nights of hotel accommodation for 6 patients, maintaining 166 radiation oncology appointments. There was a significant financial impact on the healthcare organization from this intervention that resulted in a 1842% increase in the return on investment.

Conclusions: Addressing accommodation as a barrier to care can help to prevent missed radiation appointments. An accommodation subcommittee and navigation team can ensure patients have accommodation needs assessed and met so they will receive the lifesaving treatments required, even during a pandemic. The organization will continue efforts to provide financial assistance for patients to prevent barriers to care.

References

1. Institute of Medicine. Delivering High-Quality Cancer Care: Charting A New Course For A System In Crisis. Washington, DC: National Academies Press; 2013. www.ncbi.nlm.nih.gov/books/NBK202150.
2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. 2020.
3. Ambulatory Surgery Center Association. State Guidance on Elective Surgeries. www.ascassociation.org/asca/resourcecenter/latestnewsresource center/covid-19/covid-19-state. 2020.
4. American Cancer Society. American Cancer Society Patient Lodging Programs. www.cancer.org/treatment/support-programs-and-services/pa tient-lodging.html. 2020.
5. American Cancer Society. American Cancer Society’s Hotel Partners and Transportation Program Report. www.cancer.org/treatment/support-pro grams-and-services/patient-transportation.html. 2021.
6. American College of Surgeons. Commission on Cancer. Optimal Resources for Cancer Care 2020 Standards. Updated February 2021. www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx. 2021.