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

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). METHODS: All patients who presented to the Division of Hematology and Bone and Marrow Transplant (BMT) at an National Cancer Institute–designated cancer center between April 2021 and January 2022 were screened for 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| = 2.42, P = .019) and caregivers (| t| = 2.43, P = .021) and total FT (| t| = 2.13, P = .041) and material conditions scores (| t| = 2.25, P = .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.

The interplay of financial toxicity, health care team communication, and psychosocial well‐being among rural cancer patients and survivors

“…Ideally, rural practices would include financial navigators to support patients and providers in addressing out‐of‐pocket costs, optimize health insurance, and maximize financial assistance 53 . Recent research has supported the feasibility, acceptability, and preliminary effectiveness oncology financial navigation, including demonstrable out‐of‐pocket savings to participants 54 . At the same time, expanded staffing may be challenging in rural settings.…”

“…53 Recent research has supported the feasibility, acceptability, and preliminary effectiveness oncology financial navigation, including demonstrable out-of-pocket savings to participants. 54 At the same time, expanded staffing may be challenging in rural settings. Leveraging partnerships with non-profit and community-based organizations may offer solutions to improving patient awareness of care costs and access to financial assistance programs.…”

A dyadic analysis of financial toxicity and health‐related quality of life among bone marrow transplant patients and their caregivers

“…Methods for this study have been described 16 . Briefly, we screened patients 18+ years old with a hematology and/or BMT appointment for FT between April 2021 and January 2022.…”

“…debt, borrowing money) using 8 items from the Medical Expenditure Panel Survey‐Experiences with Cancer Survivorship Supplement (MEPS‐ECSS) and two from the demographic survey, 19 and, (3) coping behaviors which measures foregoing care because of financial circumstances (i.e. skipping medications or foregoing treatment) was measured using a series of 16 yes/no MEPS‐ECSS 20 (see main outcomes paper for scoring details) 16 . The COST was adapted for caregivers phrasing questions related to their loved one's cancer treatment 21 .…”

“…In this paper, we evaluated the association of demographics and FT with health‐related QOL among patient‐caregiver dyads who received BMTs (allogeneic and autologous) while participating in an oncology financial navigation (OFN) intervention consisting of one‐on‐one assistance with navigating costs of care from a financial navigator 16 . We hypothesized that there would be an inverse relationship between FT and QOL for both patients and caregivers.…”