Improving Outcomes for Patients Experiencing Financial Toxicity

Financial toxicity (FT) has been linked to increased mortality rates, but can be improved with financial intervention for patients, according to a pilot study presented by Thomas G. Knight, MD, from the Levine Cancer Institute at the 2020 ASH Meeting and Exposition.

Knight and other researchers hypothesized that, “Comprehensive intervention on the financial aspects of care for these patients would lead to decreased mortality.”

In an interview with Oncology Nursing News' sister publication, CURE, Dr. Knight commented on how this study affects knowledge we already have, “showing that with comprehensive intervention, you can really make an impact on the problem in a meaningful way.”

The pilot study consisted of 105 patients with high-risk hematologic malignancies or bone marrow failure syndrome because, as mentioned in the peresentation, they “are thought to be extremely vulnerable to financial toxicity,” because of the high treatment costs and health care utilization.

Patients were surveyed to agree or disagree with the following two statements, which came from the COST measure, at their visits during a six-month period: “I know I have enough money in savings, retirement or assets to cover my treatment” and “I am satisfied with my current financial situation.” The survey also included the PROMIS Global-10 measure which ranks symptoms, functioning and health related quality of life on a scale of 1 to 10. FT was defined as scoring five or less, with a maximum of 10.

There was a total of 59 patients who qualified as experiencing FT and were entered into a three-step intervention. The first was with a nurse looking for gaps in care and trying to find grants and coverage for the patient. The second was a medication review with a pharmacist to hopefully reduce cost of medication or discuss with the doctor for an alternative therapy or medications. The final intervention was with a community pro-bono financial planner; here they talked about budgeting, financial planning, asset management and other general financial advice based on the patient’s income, and treatment expenses.

Patients who were in the FT group reported they could not afford prescription (16.8%), Over-the-counter medications (15.9%), and doctors visits (6.5%). A total of 48.6% of patients reported that in order to pay for their health expenses, they reduced spending on food and clothing; 51.4% used savings; and 11.2% would only partially fill their prescriptions.

After intervention 34.7% of patients were made eligible for grants from foundations. The pharmacy team was able to obtain free or reduced medication costs for those qualified, through manufacturer’s assistance and other programs. Some patients were also able to receive gas cards, food pantry items and transportation assistance.

During the study, those in the intervention group had a 27% mortality rate, while the group receiving standard care was at 43%.

In regard to overall survival (OS), after six months it was 81.4% for the intervention group, compared to 73.9% in the standard of care group. At the 12-month mark 73% were alive in the intervention group, and 46.4% of people were alive in the standard care group.

“High risk hematologic malignancy patients are at high risk for increased complications due to financial concerns,” Knight said. “Intervening on financial toxicity in a comprehensive way including navigators, pharmacists, and financial counselors is effective and leads to decreased mortality.”

Not only did the intervention improve survival rates for patients but it also improved on a better quality of life. When measured by PROMIS, physical and mental health scores increased significantly from the baseline of the study.

“It’s so easy sometimes to go in and identify that this is an issue, but the harder work is trying to see if we can make an impact, I’m an individualist at heart so that has been my focus, trying to devise systems to fix it” says Knight. He says it is important to continue focus on this because we can really impact patients lives with this research.