A Pilot Study of a Comprehensive Financial Navigation Program in Patients With Cancer and Caregivers

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  • 1 Hutchinson Institute for Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington;
  • 2 Consumer Education and Training Services, Seattle, Washington;
  • 3 Patient Advocate Foundation, Hampton, Virginia;
  • 4 Family Reach, Boston, Massachusetts;
  • 5 Seattle Cancer Care Alliance, Seattle, Washington; and
  • 6 Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington.
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Background: Few studies have engaged patients and caregivers in interventions to alleviate financial hardship. We collaborated with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach (FR) to assess the feasibility of enrolling patient–caregiver dyads in a program that provides financial counseling, insurance navigation, and assistance with medical and cost of living expenses. Methods: Patients with solid tumors aged ≥18 years and their primary caregiver received a financial education video, monthly contact with a CENTS counselor and PAF case manager for 6 months, and referral to FR for help with unpaid cost of living bills (eg, transportation or housing). Patient financial hardship and caregiver burden were measured using the Comprehensive Score for Financial Toxicity–Patient-Reported Outcomes (COST-PRO) and Caregiver Strain Index (CSI) measures, respectively, at baseline and follow-up. Results: Thirty patients (median age, 59.5 years; 40% commercially insured) and 18 caregivers (67% spouses) consented (78% dyad participation rate). Many participants faced cancer-related financial hardships prior to enrollment, such as work change or loss (45% of patients; 39% of caregivers) and debt (64% of patients); 39% of caregivers reported high levels of financial burden at enrollment. Subjects received $11,000 in assistance (mean, $772 per household); 66% of subjects with income ≤$50,000 received cost-of-living assistance. COST-PRO and CSI scores did not change significantly. Conclusions: Patient–caregiver dyads were willing to participate in a financial navigation program that addresses various financial issues, particularly cost of living expenses in lower income participants. Future work should address financial concerns at diagnosis and determine whether doing so improves patient and caregiver outcomes.

Submitted November 14, 2019; accepted for publication April 28, 2020.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Funding for this study was provided by the Safeway Early Career Award in Cancer Research/Cancer Center Support Grant at the Fred Hutchinson Cancer Research Center.

Correspondence: Veena Shankaran, MD, MS, Hutchinson Institute for Cancer Outcomes Research, 1100 Fairview Avenue North, Mailstop M3-B232, Seattle, WA 98109. Email: vshank@uw.edu

This article was updated from the print version: the url for the Patient Advocate Foundation was updated.

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