Financial toxicity is associated with increased morbidity and mortality in patients with cancer. A pilot study found that using a financial toxicity screening method in a busy clinical environment is feasible and identifies high-risk patients. The results of the study were presented at the 2020 ASH Annual Meeting.
Patients who visited the Malignant Hematology Clinic at the Levine Cancer Institute, a tertiary hospital-based specialty practice, were surveyed during visits over a six-month period. The study included 107 adults (median age, 58 years; range, 20-84 years; 56.1% were male) with hematologic malignancies or bone marrow failure syndrome. The most common (n=35; 32.71%) cancer type was acute myeloid leukemia.
The survey consisted of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 measure and two questions from the COST measure. Financial toxicity was defined as a score of five or less in agreement with the COST questions: “I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment” and “I am satisfied with my current financial situation.”
As part of the intervention, patients with financial toxicity were scheduled for a visit with a nurse navigator where they completed a standardized worksheet to identify gaps in care and opportunities for grant funding or other assistance. Patients were also seen by a clinical pharmacist for copay review and discussion of assistance programs. Patients could also visit with a community pro-bono financial planner for help with budgeting, asset management, and general financial advice.
Financial toxicity screening scores were correlated with the full COST measure (P<0.001). Patients in the intervention cohort had high rates of non-compliance due to inability to afford prescription medications (16.8%), over-the-counter medications (15.9%), and doctor visits (6.5%). To pay for care, patients reported reducing spending on food and clothing (48.6%), using savings to cover out-of-pocket expenses (51.4%), and partially filling prescriptions (11.2%).
Among those who underwent intervention, 37.4% qualified for and obtained grants from external foundations, the median value of which was $850 (range, $100-$17,850). Through manufacturer’s assistance and other programs, the clinical pharmacy team was able to obtain free or reduced-cost medications for qualified patients, at a median retail value of $197,158 (range, $29,909-$639,801). Gas cards, food pantry assistance, and transportation assistance were also supplied to patients who qualified, at a median value of $300 (range, $100-$300). More than half of patients (54.2%; n=58) expressed interest and scheduled an appointment with a pro-bono financial counselor.
Compared with baseline, the intervention resulted in statistically significantly higher quality of life, per PROMIS physical (mean, 12.5 vs. 13.7; P<0.001) and mental (mean, 11.4 vs. 12.4; P<0.001) health scores.
The intervention did not appear to reduce emergency department visits three months prior to versus post-intervention (10.3% vs. 6.5%; P=0.317). There was also no difference in inpatient visits and days pre- versus post-intervention.
“Intervening on financial toxicity in a comprehensive way including navigators, pharmacists, and financial counselors is effective and leads to increased quality of life,” the researchers concluded.
Knight TG, Aguiar M, Robinson M, et al. Financial Toxicity Intervention Improves Quality of Life in Hematologic Malignancy Patients. Abstract 430. Presented at the 62nd American Society of Hematology Annual Meeting & Exposition, Dec. 2-11, 2020.