Background: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distress. Patients and Methods: In November 2018, representatives from 17 (63%) of the 27 existing NCCN Member Institutions completed an online survey. The survey focused on screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes about such practices. Due to the lack of a validated questionnaire in this area, survey questions were generated after a comprehensive literature search and discussions among the study team, including NCCN Best Practices Committee representatives. Results: Responses showed that 76% of centers routinely screened for financial distress, mostly with social worker assessment (94%), and that 56% screened patients multiple times. All centers offered programs to help with drug costs, meal or gas vouchers, and payment plans. Charity care was provided by 100% of the large centers (≥10,000 unique annual patients) but none of the small centers that responded (<10,000 unique annual patients; P=.008). Metrics to evaluate the impact of financial advocacy services included number of patients assisted, bad debt/charity write-offs, or patient satisfaction surveys. The effectiveness of institutional practices for screening and management of financial distress was reported as poor/very poor by 6% of respondents. Inadequate staffing and resources, limited budget, and lack of reimbursement were potential barriers in the provision of these services. A total of 94% agreed with the need for better integration of financial advocacy into oncology practice. Conclusions: Three-fourths of NCCN Member Institutions reported screening and management programs for financial distress, although the actual practices and range of services vary. Information from this study can help centers benchmark their performance relative to similar programs and identify best practices in this area.
Submitted August 13, 2019; accepted for publication January 15, 2020.
Author contributions:Study and survey design: Khera, Sugalski, Griffin, Zafar, Lee. Literature search and drafting of manuscript: Khera. Survey administration and results compilation: Sugalski, Krause. Statistical analyses: Butterfield, Zhang. Interpretation of findings, critical review, and final approval of manuscript: All authors.
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. Ms. Sugalski, Ms. Krause, and Dr. Carlson are employed by NCCN.
Correspondence: Nandita Khera, MD, MPH, Mayo Clinic Alix School of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Email: firstname.lastname@example.org
ZafarSY, PeppercornJM, SchragD, . The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 2013;18:381–390.10.1634/theoncologist.2012-027923442307)| false
JagsiR, PottowJAE, GriffithKA, . Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol2014;32:1269–1276.
JagsiR, PottowJAE, GriffithKA, . Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 2014;32:1269–1276.10.1200/JCO.2013.53.095624663041)| false
KodamaY, MorozumiR, MatsumuraT, . Increased financial burden among patients with chronic myelogenous leukaemia receiving imatinib in Japan: a retrospective survey. BMC Cancer 2012;12:152.2253099210.1186/1471-2407-12-152)| false
HuntingtonSF, WeissBM, VoglDT, . Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol 2015;2:e408–416.2668604210.1016/S2352-3026(15)00151-9)| false
de SouzaJA, YapBJ, WroblewskiK, . Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer2017;123:476–484.
de SouzaJA, YapBJ, WroblewskiK, . Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 2017;123:476–484.10.1002/cncr.30369)| false
DusetzinaSB, BaschE, KeatingNL. For uninsured cancer patients, outpatient charges can be costly, putting treatments out of reach. Health Aff (Millwood) 2015;34:584–591.10.1377/hlthaff.2014.080125847640)| false
YabroffKR, DowlingEC, GuyGPJr, . Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 2016;34:259–267.10.1200/JCO.2015.62.046826644532)| false
SmithSK, NicollaJ, ZafarSY. Bridging the gap between financial distress and available resources for patients with cancer: a qualitative study. J Oncol Pract 2014;10:e368–372.10.1200/JOP.2013.001342)| false
UbelPA, ZhangCJ, HessonA, . Study of physician and patient communication identifies missed opportunities to help reduce patients’ out-of-pocket spending. Health Aff (Millwood) 2016;35:654–661.10.1377/hlthaff.2015.128027044966)| false
ColuzziPH, GrantM, DoroshowJH, . Survey of the provision of supportive care services at National Cancer Institute-designated cancer centers. J Clin Oncol 1995;13:756–764.753382810.1200/JCO.19188.8.131.526)| false
AakhusE, RosensteinA, JoffeeS, BradburyAR. Implementing cost transparency in oncology: a qualitative study of barriers, facilitators, and patient preferences [abstract]. J Clin Oncol2017;35(Suppl):Abstract 6597.
AakhusE, RosensteinA, JoffeeS, BradburyAR. Implementing cost transparency in oncology: a qualitative study of barriers, facilitators, and patient preferences [abstract]. J Clin Oncol 2017;35(Suppl):Abstract 6597.10.1200/JCO.2017.35.15_suppl.6597)| false