Delivery of Financial Navigation Services within National Cancer Institute-Designated Cancer Centers

Abstract

Background Cancer Centers have a responsibility to help patients manage the costs of their cancer treatment. This article describes the availability of financial navigation services within the National Cancer Institute (NCI)-Designated Cancer Centers. Methods Data were obtained from the NCI Survey of Financial Navigation Services and Research, an online survey administered to NCI-Designated Cancer Centers from July to September 2019. Of the 62 eligible Centers, 57 completed all or most of the survey, for a response rate of 90.5%. Results Nearly all Cancer Centers reported providing help with applications for pharmaceutical assistance programs and medical discounts (96.5%), health insurance coverage (91.2%), assistance with non-medical costs (96.5%), and help understanding medical bills and out-of-pocket costs (85.9%). Although other services were common, in some cases they were only available to certain patients. These services included direct financial assistance with medical and non-medical costs and referrals to outside organizations for financial assistance. The least common services included medical debt management (63.2%), detailed discussions about the cost of treatment (54.4%), and guidance about legal protections (50.1%). Providing treatment cost transparency to patients was reported as a common challenge: 71.9% of Centers agreed or strongly agreed that it is difficult to determine how much a cancer patient’s treatment will cost and 70.2% of oncologists are reluctant to discuss financial issues with patients. Conclusions Cancer Centers provide many financial services and resources. However, there remains a need to build additional capacity to deliver comprehensive financial navigation services and to understand the extent to which patients are referred and helped by these services.

Navigating financial toxicity in patients with cancer: A multidisciplinary management approach

“…The primary strategy to mitigate FT at the patient level is financial navigation 38,39,52 . Patient navigators traditionally guide patients one‐on‐one through aspects of care, such as communicating with providers, setting up appointments, or interacting with insurance companies, through screening, treatment, and follow‐up.…”

“…These studies will also provide better understanding of the resources needed and the potential for return on investment 53 to support adequate training, implementation, and sustainability of financial navigator roles embedded within health systems or linked with third‐party organizations that provide financial navigation. Such insight is needed given the current heterogeneity across settings in the services available, staff involved, and barriers to financial navigation in current oncology practice, 52 as well as the only nascent development of professional and core knowledge standards for financial navigators and other multidisciplinary team members 64 . Furthermore, successful patient intervention strategies will still need to be coupled with concurrent, multilevel solutions to address the causes of FT at system and policy levels to impact the direct out‐of‐pocket expenses of cancer care 36 .…”

Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

“…Such dilemmas in patient-physician discussions about cost were also mentioned in past studies [18][19][20]. Additionally, over a third of the participants indicated that they feel embarrassed and uncomfortable discussing the cost of care with patients-another trend indicated in recent studies [21,22].…”

Financial Navigation in Cancer Care Delivery: State of the Evidence, Opportunities for Research, and Future Directions

“…7 In addition, a National Cancer Institute survey of FN services at US Comprehensive Cancer Centers revealed a lack of cost transparency, an inability to predict patient costs, and a general reluctance by oncologists to engage in cost conversations. 8 The latter is salient as both the National Academy of Medicine and ASCO have strongly advocated for integrating cost conversations into routine practice. 9,10 In the same survey, most centers reported being able to identify patients at high risk for FT but pointed to the need for infrastructural support such as FN, cost transparency tools, and health literacy materials.…”