Time to add screening for financial hardship as a quality measure?

Abstract

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.

Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery

“…In care delivery, implementation of multidimensional FT assessment and screening need to be age-appropriate and cancer phase-appropriate. 11 Establishing guidance on quality practice for FT screening needs to be defined, for example, with systematic FT screening and methods for documenting FT at initial clinical encounters and periodic reassessments throughout care to guide and engage the health care team's response to patient FT. [37][38][39] In addition, collection of FT measures should be embedded in the design phase of clinical trials and prospective clinical studies alongside other patient-reported-outcome measures to proactively define the comprehensive toxicity profile of new therapeutic options, especially in those at high risk for FT such as younger patients, 40 who face distinct stressors such as onco-fertility costs 41 and vocational challenges that impact stability of insurance. 42 Broad scale collection of these data are critical for informing future targeted policy Cancer July 1, 2022 changes, such as continued uptake of state initiatives mandate coverage of onco-fertility in YAs 41 and incorporating FT screening as a quality measure linked to valuebased or performance-based payment.…”

Radiology as a Screening Encounter for Medical Financial Hardship

“…Although there is no standardized national screening tool for financial hardship, several domains were proposed by Bradley et al [7] to meet such need including queries about (1) adequacy of health insurance coverage, (2) whether insurance coverage depends on patient or caregiver employment and whether the patient is at risk for losing coverage, (3) the health insurance and financial literacy of the patient and caregiver, (4) OOPC for medical services, and (5) OOPC for nonmedical services (eg, transportation, child care). Furthermore, few singleitem measures have been proposed as screening tools for financial hardship, such as the summary item from comprehensive score for financial toxicity measure: "My illness has been a financial hardship to my family and me" [8].…”

Tackling the next taboo in cancer: the urgency of talking about and addressing financial toxicity

“…The next step would be to develop new standardized financial burden screening tool, that fits the context and local professional practice. [19] However, the near total lack of continuing education on financial toxicity was decried during our discussions with cancer team members. Professionals feel the need for specific training on the financial toxicity of cancer to improve their ability to discuss the issue.…”