Nurses and Social Workers Can Collaborate to Help Patients With Financial Toxicity

Nurses and Social Workers Can Collaborate to Help Patients With Financial Toxicity

A collaborative care model integrating oncology nurses and social workers can be a powerful tool to help patients with cancer address financial toxicity, but an open dialogue with patients is the first step in addressing these issues, an expert said.

Max McMahon, LICSW, clinical social worker at Dana-Farber Cancer Institute in Boston, recently presented at a summit held by the Partnership to Reduce Cancer in Rhode Island on how the care team can address cancer-related financial toxicity with patients.

“I really work collaboratively with our provider team, so that’s nurse navigators, medical oncologist, PAs, NPs, providing the best care I can as a social worker, which really entails a lot of different aspects of care,” he said in an interview with Oncology Nursing News. “I do what I can to help patients with housing issues, with financial needs, with access to care, with referrals to other resources. I’m sort of a catch-all for social work oncology.”

In his interview, he also spoke more about his presentation and how nurses can play a role in addressing financial toxicity in patients with cancer.

Can you highlight some of the major takeaways from your presentation?

What's crucial to me is that oncology teams be proactive in screening. I think nurses have a role in that, to ask those questions. Whether there's a formal screening instrument or tool at the particular cancer center, it's important to ask, be open, and say, “Are you having any financial pressures or stress at home?” And by and large, I find that patients want to disclose that. They want to talk about that.

We can have a reluctance or hesitancy to bring up difficult questions, because we don't always have answers or solutions, and that's really OK. I think we can normalize it by saying, “It's helpful to know so I can communicate that with our teams, and we can see if we have resources available to you.” I really think that establishing relationships with patients and asking questions that are outside of treatment considerations and side effects, is really important. If we can do that on our teams — whether that's a PA, an oncologist, or a nurse — that makes my job a lot easier if someone says, “This patient, here's a source of stress.” Oftentimes, we can provide some level of support.

How can nurses and social workers collaborate in helping patients?

Nursing and social work, we can exist in our silos. Nursing has a set of responsibilities. Social work or mental health has a set of responsibilities. And being able to break down those walls and have a collaborative care model, whether it's monthly team meetings about patient needs, whether it's weekly check-ins, having institutional supports for being able to communicate regularly, that's really crucial.

With many of us who work hybrid or sometimes in telehealth, we are very siloed. I know that we have nurse navigators that are working from home; sometimes they come into the clinic, sometimes they work from home. It is really important to have spaces where we can go through patients, we can talk about particular needs. That's something we can always do a better job of, is how do we really have a collaborative care model and team meetings to talk about patients?

We all have limitations of what we can do. I like to think of financial toxicity as what can we do as providers and practitioners, and also what can patients do. One of the important things is at all points in a patient's journey, we really should be reducing the amount of work we ask them to do to take care of their financial wellbeing. So, if we can do things, as an institution, to facilitate access to financial resources, we should be doing that. We shouldn't be asking the patient to fill out lengthy applications, we shouldn't be asking them to make multiple phone calls to the same resource. We have to be able to have support in our cancer centers and hospitals to support patients, because oftentimes, they don't have the capacity or bandwidth. They're already stressed by treatment, they're not feeling well, they might have cognitive limitations, they might be older. We have to ask less of the patient and ask our institutions to do more to address these needs.

Could you share some examples from your experience?

There was a 57-year-old patient living in Connecticut with metastatic prostate cancer, and he transferred his care to Dana-Farber to enroll in a clinical trial. He was working full time as a dispatcher, and his wife received Social Security Disability. The challenge for Stan and Mary was, they made more than $60,000, which made them ineligible for our financial assistance policy. There was a lot of debt that he owed to his local hospital, and that made his wife really anxious. So, what I see in a case like this is the burdens of preexisting medical debt and then accrued medical debt. In this case, there was upwards of $7,000, $8,000 in debt.

The concern was, we thought that they were not going to receive care here because they assumed that they would have copays and screening that they couldn't afford. So, we had to reassure them that no, you'll receive care here. We're not going to turn you away just because you can't afford a copay. This was a case where there wasn't an easy resolution. The success was that we got him in the door on the clinical trial, but he still had significant debt.

What I tried to do is provide some resources for debt relief, and there are a couple of ways that I do that. Some of that is writing letters. Some of it is asking for a reduced monthly payment, payment plan, or forgiveness of what the debt may be. So with Stan and Mary, I think retroactively, his local hospital was able to eliminate half of his debt. That just took some follow-up and requests from our end. Sometimes having providers and clinical staff do this work, we can make inroads faster than a patient can. But that can take significant time.

One thing I also did in this case was, I referred Stan and Mary to…his city's—sometimes the city will have a fund or foundation to help with serious illness treatment and care. I believe they were able to get some grants for gift cards for food and other resources through their town. That's something I also try to do is, what are the local resources, the municipal resources that may be able to help a family? That might be connecting with elder services or making a call to a town social worker. Figuring out what department might best help a family. For Stan and Mary, I did call his town in Connecticut and spoke to a social worker who was able to provide some relief for the two of them. Sometimes they have emergency funds for residents who are in need.

That's part of the role of social workers, to make some of those outreach calls, connect, and build bridges with other organizations and towns so we can do more wraparound support.

This transcript has been edited for clarity and conciseness.