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

Gallagher, Kathleen D.; Angove, Rebekah; Tucker-Seeley, Reginald; Balch, Alan; Shankaran, Veena

doi:10.1200/jco.21.02184

Cited by 25 publications

(28 citation statements)

References 21 publications

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“…Financial navigation is the most frequently described system-level intervention that aims to mitigate financial burden. 7,8,12 The financial navigator role is often filled by members of health care staff, including social workers, financial counselors, and case managers, rather than a dedicated, trained financial navigator. These staff members are often already stretched thin in their roles and often not formally trained on how to help patients wade through the complexities of applying for insurance and co-pay assistance.…”

Section: Discussionmentioning

confidence: 99%

“…These staff members are often already stretched thin in their roles and often not formally trained on how to help patients wade through the complexities of applying for insurance and co-pay assistance. 7,12 Even with a comprehensive set of financial resources offered by a third-party organization, the importance of a responsive navigator was frequently mentioned in the comments section, albeit with a small sample size. These findings may present an opportunity for future studies to evaluate the impact of navigators who are based at third-party organizations and to explore how their role may be distinct from an institutional navigator.…”

Section: Discussionmentioning

confidence: 99%

“…3,10,11 Furthermore, they were mostly centered around financial navigation and counseling rather than direct financial assistance. 7,8,12…”

Section: Introductionmentioning

confidence: 99%

“…3,10,11 Furthermore, they were mostly centered around financial navigation and counseling rather than direct financial assistance. 7,8,12 Family Reach (FR) is a 501(c)(3) nonprofit organization based in the United States that is dedicated to removing the financial barriers standing between a patient with cancer and their treatment. Their services include financial education, financial coaching, resource navigation, and financial assistance for patients and caregivers.…”

Section: Corresponding Author Introductionmentioning

confidence: 99%

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Impact of a Comprehensive Financial Resource on Financial Toxicity in a National, Multiethnic Sample of Adult, Adolescent/Young Adult, and Pediatric Patients With Cancer

Ragavan

Mora

Winder³

et al. 2023

JCO Oncology Practice

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PURPOSE: Financial toxicity is a well-recognized problem for patients with cancer. However, a crucial gap remains in describing and implementing mitigation strategies. We conducted a national survey of a multiethnic adolescent/pediatric and adult patient population served by Family Reach, a nonprofit organization focused on removing financial barriers to cancer care, to evaluate the impact of a comprehensive financial resource on patient-reported financial toxicity. METHODS: An electronic survey was administered to characterize patients' current financial health and the impact of Family Reach's resources on financial toxicity. The survey was e-mailed to all patients or caregivers who received resources from Family Reach between January 1, 2020, and June 30, 2020. Factors associated with higher financial stress and higher potential impact of resources on financial burden were evaluated through separate multivariate regression models. Qualitative responses were analyzed using manual coding and thematic analysis. RESULTS: Three hundred thirty socioeconomically and racially diverse respondents (overall response rate 40%; 46% non-Hispanic White; 48% with incomes below the federal poverty line) completed the survey and were included in the analysis. More than half of respondents reported high financial stress in the previous week. Hispanic ethnicity, Black race, and low annual household income were associated with higher financial toxicity. A greater amount of financial assistance was associated with a higher confidence rating that resources provided would decrease financial stress. In open-ended comments, respondents highlighted the impact of the COVID-19 pandemic and resulting job loss on financial toxicity, the importance of financial navigation, the benefits of financial assistance, and anxiety about long-term financial health. CONCLUSION: A comprehensive financial resource, particularly financial assistance, alleviated financial toxicity in a multiethnic national sample of patients with cancer. Ongoing work is critical to address sustainable funding sources and financial navigation to support patients during treatment and survivorship.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…3,10,11 Furthermore, they were mostly centered around financial navigation and counseling rather than direct financial assistance. 7,8,12…”

Section: Introductionmentioning

confidence: 99%

Section: Corresponding Author Introductionmentioning

confidence: 99%

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Impact of a Comprehensive Financial Resource on Financial Toxicity in a National, Multiethnic Sample of Adult, Adolescent/Young Adult, and Pediatric Patients With Cancer

Ragavan

Mora

Winder³

et al. 2023

JCO Oncology Practice

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“…As cancer care delivery moves from aligning on the conceptualization and measurement of financial hardship and financial toxicity to developing and implementing interventions to alleviate this hardship for patients and their families [ 14 ], several processes must be in place to ensure the full integration of this type of social care into health care delivery. For example, electronic health records must be capable of documenting and tracking patients as they navigate the health care (primary and specialty care) and social care delivery settings.…”

Section: Integrating Social Care Equitably Into Cancer Care Deliverymentioning

confidence: 99%

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Tucker-Seeley

2023

Journal of the American College of Radiology

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Association of Household Income at Diagnosis With Financial Toxicity, Health Utility, and Survival in Patients With Head and Neck Cancer

Noel

Hueniken

Forner

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceWhile several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient-level data are lacking.ObjectiveTo determine the association of baseline annual household income with financial toxicity, health utility, and survival.Design, Setting, and ParticipantsThis was a prospective cohort of adult patients with head and neck cancer treated at a tertiary cancer center in Toronto, Ontario, between September 17, 2015, and December 19, 2019. Data analysis was performed from April to December 2021.ExposuresAnnual household income at time of diagnosis.Main Outcome and MeasuresThe primary outcome of interest was disease-free survival. Secondary outcomes included subjective financial toxicity, measured using the Financial Index of Toxicity (FIT) tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the association between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. Generalized estimating equations were used to account for patient-level clustering.ResultsThere were 555 patients (mean [SD] age, 62.7 [10.7] years; 109 [20%] women and 446 [80%] men) included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (&lt;$30 000: 67%; 95% CI, 58%-78%) compared with the top quartile (≥$90 000: 88%; 95% CI, 83%-93%). In risk-adjusted models, patients in the bottom income quartile had inferior disease-free survival (adjusted hazard ratio, 2.13; 95% CI, 1.22-3.71) and overall survival (adjusted hazard ratio, 2.01; 95% CI, 0.94-4.29), when compared with patients in the highest quartile. The average FIT score was 22.6 in the lowest income quartile vs 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) (95% CI, 16%-253%) than high-income patients. Similarly, health utility scores were, on average, 0.104 points lower (95% CI, 0.026-0.182) for low-income patients in adjusted analysis.Conclusions and RelevanceIn this cohort study, patients with head and neck cancer with a household income less than CAD$30 000 experienced worse financial toxicity, health status, and disease-free survival. Significant disparities exist for Ontario’s patients with head and neck cancer.

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

Cited by 25 publications

References 21 publications

Impact of a Comprehensive Financial Resource on Financial Toxicity in a National, Multiethnic Sample of Adult, Adolescent/Young Adult, and Pediatric Patients With Cancer

Impact of a Comprehensive Financial Resource on Financial Toxicity in a National, Multiethnic Sample of Adult, Adolescent/Young Adult, and Pediatric Patients With Cancer

Financial Toxicity: A Barrier to Achieving Health Equity in Cancer Care

Association of Household Income at Diagnosis With Financial Toxicity, Health Utility, and Survival in Patients With Head and Neck Cancer

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