Mitigating financial toxicity ’better than any drug’ for people with cancer
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Key takeaways:
- Clinicians should assess all patients for financial toxicity.
- Financial navigation also can help address financial toxicity.
SAN DIEGO — Successfully addressing financial toxicity for people with blood cancer will require substantial efforts from a variety of stakeholders, according to a speaker at ASH Annual Meeting and Exposition.
The identification and implementation of solutions will need to happen at the clinic, system and policy levels.
“It’s been my long-held belief that doing this kind of work — helping to alleviate financial toxicity and eliminate financial barriers — will be better than any drug,” Thomas G. Knight, MD, an oncologist affiliated with Atrium Health Levine Cancer Institute, told Healio. “We can create the greatest cancer drug in the world but, if people can’t get it or are stretching their prescriptions so they can afford it, then it doesn’t help.”
Tackling a ‘nebulous’ issue
During an ASH special interest session, Knight discussed how financial toxicity encompasses much more than the obvious factors such as drug costs and insurance co-pays.
“Financial toxicity involves all of the different things that go into getting treatment for cancer, including child care, transportation, taking time off from work and lost income,” Knight said. “As a group of researchers looking at financial toxicity, we have done an amazing job of describing the problem. The bigger issue is actually trying to address the problem.”
Clinicians can begin to attack the “nebulous” issue of financial toxicity at the clinic or individual level by proactively screening for financial toxicity, Knight said.
Clinicians should assess all patients for potential financial toxicity rather than relying on the “on-demand” approach in which they attempt to addresses problems once patients raise the subject in clinic.
“Our hope is that, as we go forward, clinicians will try to be more proactive and identify patients before they reach financial toxicity,” Knight said.
Incorporating financial navigation is the second important action clinicians can take to help patients at the individual level, Knight said. He cited encouraging research in this area conducted by Veena Shankaran, MD, MS, and Scott Ramsey, MD, PhD, of Fred Hutchinson Cancer Center.
“They have done a lot of work in this field in terms of proving that financial navigation is an effective way to attack financial toxicity,” he said. “They actually have a multi-institutional trial looking at that, and they have shown high satisfaction.”
Knight’s institution also has done research evaluating financial navigation, specifically in the leukemia clinic. Patients whose response to a two-question screener indicated financial toxicity were directed to a comprehensive intervention, including nurse navigation, social work and a community financial planner.
“We saw improved physical and mental quality of life in all these patients with blood cancer,” he said.
Knight’s institution also conducted a study looking at a financial navigation intervention in two populations with acute myeloid leukemia and acute lymphoblastic leukemia. Although the study stopped early due to the COVID-19 pandemic, early results showed a 56% lower risk for death with the intervention.
“That has led to us now running a randomized trial looking at financial navigation in this high-risk leukemia group,” he said. “That is funded by a charitable organization and should be opening any day now.”
‘Get everyone in one room’
Knight acknowledged that the ability to mitigate toxicity at the clinic level is limited, adding that as large hospital systems continue to proliferate, the power of these systems should be leveraged to address the problem.
To this end, Levine Cancer Institute created what has been called the “financial toxicity tumor board.” This first-of-its kind group has been operating for 5 years.
“If you think about a traditional tumor board, you get everyone in one room — doctors, nurses, radiologists — and everyone weighs in according to their specialty,” Knight said. “We decided to bring all of these decision-makers together into a room and go after the hardest cases [of financial toxicity] we have.”
Levine Cancer Institute also implemented a patient assistance program, through which a dedicated staff work with patients on issues related to medication costs and copays.
“Anytime a new medication or treatment is ordered, we have a group of copay assistants who make sure the copays are taken care of,” he said.
The financial toxicity tumor board also addresses systemic problems that might pose financial hardships to patients. Knight cited an example of a 30-year-old patient with employer-based insurance who loses their job due to an aggressive cancer.
“We might figure out how to get the patient COBRA insurance, we can discuss getting them transportation, or pay for their drugs, or do all of these,” he said. “However, the other thing that comes up in cases like this is why we didn’t anticipate this as a system. Shouldn’t we have seen this coming?”
This type of discussion can yield large- scale change by prompting the creation of a task force dedicated to changing that, according to Knight.
“When these circumstances happen again, we will immediately have navigators, counselors and other experts to address it proactively,” he said. “We’re able to identify these holes in our system — and fix them for thousands of patients — just by looking at one patient case.”
Addressing financial toxicity at a policy level is another important approach, Knight said. He acknowledged that the future of policymaking in this area is uncertain due to results of the presidential election, but he urged providers to redouble their efforts.
“It might be a little bit of a harder time coming up for our folks at greatest need,” he said. “However, there is a lot we can do, and we need everyone to be doing everything they can.”
Reference:
- Knight TG. Cancer and poverty: Mitigating the impact of financial toxicity in patients with hematologic malignancies. Presented at: ASH Annual Meeting and Exposition; Dec. 7-10, 2024; San Diego.
For more information:
Thomas G. Knight, MD, can be reached at thomas.knight@atriumhealth.org.
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