The Financial Toxicity Tumor Board: 5-Year Update on Practice and a Guide to Implementation
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Veterans Administration Medical Center, Salisbury, NC
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Background: Financial toxicity has been increasingly recognized as a major driver of negative outcomes for patients with cancer, with prior interventions focused primarily on patient-level support. The Financial Toxicity Tumor Board (FTTB), established in 2019, is the first institutional-level intervention addressing these challenges. We report on its function and outcomes over 5 years of operation. Methods: Drawing on expertise from across the cancer center, the FTTB was designed to operate similarly to traditional, disease-focused multidisciplinary tumor boards but with a focus on issues related to financial distress. Over time, this system-level intervention has evolved, with major changes including a shift to disease-focused meetings and the developing refinement of process to an Archetype system—categorizing cases as Immediate Assistance Required, System-Level Issue Identified, or Policy/Legislative Issue Identified—which has enhanced its function and effectiveness. In tandem, the pharmacy-based patient assistance program (PAP) arm of the FTTB, formerly focused only on drug approvals, has expanded to address routine financial challenges associated with broader cancer care. Results: Over the past 5 years, >70 cases have been presented to the tumor board, with most resulting in immediate solutions for the individual patient as well as numerous systemic changes. The PAP arm of the FTTB has provided 9,321 patients with copay assistance, totalling >$10,316,695. Furthermore, 16,495 patients have received free medications, amounting to $392,895,101 in patient benefits. Conclusions: The success of the FTTB—both through the tumor board and PAP arms—demonstrates that focused systemic intervention can lead to sustained, substantial improvements in financial toxicity. This model should be further developed as a new standard of care.
Submitted July 8, 2024; final revision received December 11, 2024; accepted for publication January 24, 2025. Published online April 16, 2025.
Author contributions: Design & implementation: All authors. Analysis of results: All authors. Manuscript writing: All authors.
Disclosures: Dr. Mesa has disclosed serving as a consultant for Novartis, Sierra Oncology, Genentech, Blueprint Medicines, Geron, Telios Pharma, CTI BioPharma, Incyte, Bristol Myers Squibb, AbbVie, GSK, and MorphoSys. The remaining authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by philanthropic funds from the Leon Levine Foundation, Charlotte, NC.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2025.7010. 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.
Supplementary Materials
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