Coverage and Cost-of-Care Links: Addressing Financial Toxicity Among Patients With Hematologic Cancer and Their Caregivers

Abstract

QUESTION ASKED: Can an oncology financial navigation (OFN) intervention decrease financial toxicity (FT) experienced by patients with hematologic cancer and their caregivers? SUMMARY ANSWER: OFN interventions can be effective in decreasing FT among patients with hematologic cancer and their caregivers while also demonstrating high acceptability , appropriateness, and return on investment. WHAT WE DID: We conducted a single-arm feasibility and acceptability trial in the Division of Hematology and bone and marrow transplant at an National Cancer Institute-designated Cancer Center and collected pre-and post-intervention surveys to assess changes in FT (measured under the domains of psychological response, material conditions, and coping behavioral) distress and health-related quality of life among 54 patients and 32 care-givers. The pre-/postcomparisons were performed as a preliminary assessment of intervention effectiveness. WHAT WE FOUND: The intervention resulted in statistically significant decreases in the Comprehensive Score for Financial Toxicity (psychological response) for both patients (|t| 5 2.42, P 5 .019) and caregivers (|t| 5 2.43, P 5 .021) and total FT (|t| 5 2.13, P 5 .041) and material conditions scores (|t| 5 2.25, P 5 .031) for caregivers only. Only 27% of eligible patients participated in the study, whereas 100% of eligible caregivers participated. The majority of participants rated the intervention highly for acceptability (89%) and appropriateness (88%). An average financial benefit of $2,500 in US dollars (USD) per participant was secured via the intervention. BIAS, CONFOUNDING FACTOR(S), REAL-LIFE IMPLICATIONS: OFN can be effective in addressing FT of cancer by helping patients optimize health insurance, identify assistance for out-of-pocket expenses, or apply for disability or family medical leave. Standardized screening for FT in cancer care settings is essential to support early identification of financial needs that serve as barriers to care. Oncologists and other members of the health care team should engage in cost-of-care conversations that can help identify patient or caregiver financial hardship and make appropriate referrals to financial navigators. abstract PURPOSE This study examined the feasibility, acceptability, and preliminary effectiveness of an oncology financial navigation (OFN) intervention, Coverage and Cost-of-Care Links (CC Links), among patients with hematologic cancer and their caregivers who are at increased risk of experiencing financial toxicity (FT). FT during inpatient and outpatient visits. Patients who screened positive for FT and met the inclusion criteria were recruited to participate in CC Links that provided financial navigation and assistance via a financial navigator. Caregivers of patients undergoing BMTs were also recruited to participate. Primary outcomes were defined as improvements in FT, distress, and physical and mental quality of life. RESULTS Fifty-four patients and 32 caregivers completed the intervention and pre-/postintervention surveys. CC Links resulted in statistically significant decreases in the Comprehensive Score for FT for both patients (|t| 5 2.42, P 5 .019) and caregivers (|t| 5 2.43, P 5 .021) and total FT (|t| 5 2.13, P 5 .041) and material conditions scores (|t| 5 2.25, P 5 .031) for caregivers only. Only 27% of eligible patients participated in the study, whereas 100% of eligible caregivers participated. The majority of participants rated the intervention highly for acceptability (89%) and appropriateness (88%). An average of $2,500 (USD) in financial benefits was secured per participant via CC Links. CONCLUSION CC Links was effective in decreasing FT among patients with hematologic cancer and their caregivers while demonstrating high acceptability and appropriateness ratings.