Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Division of Medical Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
Department of Psychiatry University of North Carolina at Chapel Hill, Chapel Hill, NC
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Background: Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center. Methods: We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability). Results: All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance. Conclusions: A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.
Submitted July 21, 2023; final revision received January 30, 2024; accepted for publication March 21, 2024.
Author contributions: Conceptualization: Wheeler, Manning, Gellin, Padilla, Samuel-Ryals, Reeder-Hayes, Rosenstein. Data curation: Spees, Biddell, Petermann, Deal. Formal analysis: Spees, Biddell, Petermann, Deal. Funding acquisition: Manning, Gellin, Padilla, Rogers, Rodriguez-O’Donnell, Samuel-Ryals, Reeder-Hayes. Methodology: Spees, Biddell, Petermann, Deal. Project administration: Manning, Gellin, Padilla. Supervision: Wheeler, Manning, Gellin, Padilla, Rosenstein. Visualization: Manning, Gellin, Padilla, Spees, Biddell, Petermann. Writing—original draft: Wheeler, Manning, Spees, Biddell, Rosenstein. Writing—review & editing: All authors.
Disclosures: Dr. Wheeler and Dr. Rosenstein have disclosed receiving institutional grant/research support from Pfizer. The remaining 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.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7030. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
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