Financial toxicity can have a negative effect on outcomes for patients with cancer. However, findings from a recent pilot study revealed that a comprehensive intervention focused on the financial aspects of care signficantly improved quality of life for patients with hematologic malignancies. These results were presented during the virtual 2020 ASH Annual Meeting.
“Based on these results, we concluded that utilizing a quick screening method for financial toxicity in a busy clinical environment is feasible and allows identification of an extremely high-risk population,” said lead investigator T. Greg Knight, MD, Assistant Professor, Division of Leukemia, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC. “We also found that intervening on financial toxicity in a comprehensive way is effective and led to increased quality of life,” he added.
According to Dr Knight, previous research has shown that financial toxicity is associated with treatment noncompliance that extends to all aspects of medical care, not just medications, and noncompliance is associated with poor clinical outcomes. In addition, patients with hematologic malignancies are thought to be extremely vulnerable to financial toxicity, due to the high costs associated with treatments and healthcare utilization.
“Given the acuity of most of these illnesses, noncompliance and gaps in care for patients with hematologic malignancies can be especially devastating,” he said.
Dr Knight and his colleagues designed an efficient screening method to identify patients with hematologic malignancies who were at high risk for financial toxicity. All patients seen at the Malignant Hematology Clinic at the Levine Cancer Institute were screened by iPad survey before their visit over a 6-month period. They were asked to agree or disagree with the following 2 statements: “I know I have enough money in savings, retirement or assets to cover my treatment” and “I am satisfied with my current financial situation.” The survey also included the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 measure, which ranks symptoms, functioning, and health-related quality of life on a scale of 1 to 10. In this study, financial toxicity was defined as a score of 5 or lower.
Patients who were identified as experiencing financial toxicity were entered into a 3-step intervention. First, they received a visit with a nurse navigator who helped identify opportunities for grant funding and other financial assistance. Second, they were seen by a clinical pharmacist for copay review and a discussion of assistance programs. Finally, they were provided with the services of a community pro-bono financial planner who was able to offer help with budgeting, asset management, and general financial advice.
The Impact of Financial Toxicity
Dr Knight reported that 107 patients met the study’s criteria for experiencing financial toxicity and were placed in the interventional cohort. Although most of the patients had Medicare or private insurance, a significant percentage had Medicaid or Veterans Affairs insurance or had to pay for therapy on their own.
Approximately 80% of the patients made less than $64,000 annually, and the majority were diagnosed with acute leukemias or myeloproliferative neoplasms.
“Unfortunately, patients who are experiencing financial toxicity had high rates of noncompliance due to these financial issues,” said Dr Knight, who noted that approximately 17% of patients reported missing prescription medications because they could not afford them, and 7% reported missing doctor visits. “Patients experiencing financial toxicity also reported a 50% reduction in spending on food and clothing and using savings to cover out-of-pocket expenses.”
“Perhaps more distressingly, 11% reported stretching their prescriptions by taking less than the prescribed amount due to the cost associated with their cancer therapy,” he added.
Intervention Led to Better Outcomes
Nurse navigators and social workers were able to find grants for more than one-third of patients, with a median value of $850 (range, $100-$17,850). Qualifying patients also received food pantry assistance, gas cards, and help with transportation, with a median value of $300 (range, $100-$300).
The clinical pharmacy team was able to locate medications that were free or offered at a greatly reduced cost for patients in the intervention cohort, at a median retail value of $197,158 (range, $29,909-$639,801) annually.
Finally, 58% of patients met with a pro-bono financial planner who offered one-on-one counseling.
The investigators reported that the intervention led to significantly higher quality of life when measured by PROMIS physical and mental health scores, compared with baseline scores. Dr Knight noted that the screening process used in the study could be utilized in a variety of healthcare settings.