Patient-centered financial navigation assistance helps reduce financial toxicity among cancer patients

Among cancer patients, the high financial cost of cancer care is a prevalent problem. This financial burden is also associated with potentially harmful behavioral strategies that patients might use to cope with costs, such as delaying or forgoing treatment and skipping medications. Collectively, researchers refer to this impact as financial toxicity.

On Oct. 16, UNC Lineberger’s Stephanie B. Wheeler, Ph.D., MPH, presented results from a clinical trial of a financial navigation intervention aimed at helping adult cancer patients navigate the costs of cancer care more effectively. The results, presented at the American Society of Clinical Oncology Quality Care Symposium, show that the intervention, called Lessening the Impact of Financial Toxicity (LIFT), significantly reduced financial toxicity experienced by patients in the study.

The results were published simultaneously with the Oct. 16 presentation in the Journal of Clinical Oncology.

The clinical trial was conducted at eight oncology practice sites in North Carolina: four rural sites and four nonrural sites. A total of 179 patients received the intervention and 134 stayed in the study until its completion. Each patient was screened for financial toxicity by completing a Comprehensive Score for Financial Toxicity (FACIT-COST) survey. Only patients who screened positive for financial toxicity on this survey were eligible to receive the intervention.

LIFT financial navigation included an intake appointment lasting 45 minutes to one hour to gather information about each patient’s unique financial and insurance situation to determine their eligibility for specific financial assistance resources. Patients then received between one and seven short check-in appointments depending on their individual needs to answer any questions, assist with application submissions and/or monitor the status of financial assistance application submissions. At the end of their financial navigation appointments, patients again completed the FACIT-COST survey to determine their updated financial toxicity score.

After receiving LIFT, patient FACIT-COST scores significantly improved by an average of 8.1 points on a 44-point scale, demonstrating reduced financial toxicity. In addition, the intervention improved health-related quality of life outcomes such as depression and anxiety.

“To our knowledge, this is the first large-scale clinical trial to show the impact of financial navigation on patients who screened positive for financial toxicity,” said Wheeler, who added, “The positive impacts of financial navigation on these patients held for both rural and nonrural residents and regardless of whether or not patients had health insurance.” Wheeler is a professor in the UNC Gillings School of Global Public Health and associate director of community outreach and engagement in UNC’s Lineberger Comprehensive Cancer Center.

Nearly 50% of survivors experience financial problems associated with cancer, according to a 2022 survey of survivor views on cancer and medical debt conducted by the American Cancer Society Cancer Action Network and published online. Studies have also shown that Black women and those living in rural areas are disproportionately affected, including work conducted by Wheeler and colleagues through the U.S. Centers for Disease Control and Prevention-funded Cancer Prevention and Control Research Network and through an American Cancer Society-funded analysis of the Carolina Breast Cancer Study.

Donald Rosenstein, M.D., a professor in the psychiatry department within UNC’s School of Medicine, stated, “It is important to note, this trial was developed in direct response to North Carolina community oncology practice needs identified by oncology nurses, social workers and other cancer support professionals participating in our NC Cancer Survivorship Professionals Action Network. Dealing with cancer-related financial toxicity was their No. 1 program priority for their patients across the state. This is a great example of research generated by the community and for the community in partnership with UNC cancer researchers.”

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Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021.

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Andrew Zinin

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