Financial Navigation Helps Address Financial Toxicity of Patients with Cancer

Financial toxicity impacts treatment outcomes and quality of life for patients with cancer, and the experiences are further exacerbated among rural patients. The American Cancer Society supported a study to explore financial toxicity among rural cancer patients and the gaps in staff- and systems-level cancer care delivery approaches.

Impacts of Financial Toxicity on Patients with Cancer

Financial toxicity describes the harmful financial burden faced by patients with cancer and their families during the cancer journey. The incidence of financial distress for patients with cancer has been reported as high as 49% from large meta-analyses.¹

The overall cost of cancer treatments consists of more than treatment expenses—there are other out-of-pocket costs such as copayments, transportation, childcare, and loss of income. To cope with the expenses, patients and their families may need to cut back leisure activities, spend less on food and clothing, or work longer hours. Some people may deplete their retirement savings or even file for personal bankruptcy.

Other than negatively impacting the quality of life for patients and their families, the financial burdens and distresses may also harm the quality of cancer treatment due to medication nonadherence and delaying medical care.

For instance, patients with pharmacy benefit plans that require high cost-sharing are more likely to discontinue oral chemotherapy. Among patients with breast cancer, higher copayments for hormonal therapy are associated with a higher likelihood of nonadherence with those drugs.²

There is even a consistent, positive association between financial burdens and earlier mortality among patients with cancer; in other words, people who reach the point of financial insolvency after a cancer diagnosis have significantly poorer outcomes than those who do not.³

Financial Toxicity and Rural Cancer Patients

Experiences of financial toxicity are further exacerbated among rural patients with cancer, and the reasons could be in part due to the lack of local care options and financial assistance resources, among other contributing factors.

To explore the characteristics and delivery of financial navigation and counseling practices specifically tailored for rural cancer survivors, the American Cancer Society supported a study to interview financial counselors and navigators, social workers, and patient lay navigators for a range of inquiries:

• staff perceptions of cancer patient and survivor experiences of financial toxicity
• financial needs of the communities served, with a focus on rural communities
• availability of staff and roles in providing financial counseling related to cancer care costs
• needed resources to support staff development or ability to effectively deliver financial assistance services.

Among other findings, the availability of trained financial navigators/counselors dedicated solely to assisting the cancer patient population was found to be limited. While in-house and external financial assistance programs were frequently tapped into, there were limitations in the navigators’ ability to provide cost estimates based on insurance coverage and in assisting patients with applying for health insurance.

Researchers in this study suggested that with the short- and long-term effects of the pandemic, cancer centers should enhance their financial navigation and assistance services to help address patient financial toxicity. Establishing sustainable and oncology-designated financial navigation roles is imperative to maintaining continued patient support.

References:

1. Schroeder SR, Agusala V, Sher DJ. Financial Toxicity and Cancer Therapy: A Primer for Radiation Oncologists. Hematology/Oncology Clinics of North America. 2019(33);1117–1128.
2. Zafar SY, McNeil RB, Thomas CM, et al. Population-Based Assessment of Cancer Survivors’ Financial Burden and Quality of Life: A Prospective Cohort Study. Journal of Oncology Practice. 2015 Mar;11(2):145-150.
3. Ramsey SD, Bansal A, Fedorenko CR, et al. Financial Insolvency as a Risk Factor for Early Mortality Among Patients with Cancer. Journal of Clinical Oncology. 2016;34(9): 980-986.