Financial Hardship During Cancer Treatment

Overview

Indirect costs of cancer treatment, is an increasingly common experience for patients and their caregivers. Patients are responsible for an ever-growing share of the cost of their cancer care, paying more for medical appointments, imaging, tests, and procedures. Additionally, the high cost of breakthrough therapies is frequently more expensive than most patients can afford without substantial detriment to their financial well-being. Financial hardship is associated with delaying the start of recommended treatments as well as treatment non-adherence. As the costs of cancer care accumulate, patients are forced to make difficult trade-offs, including delaying or forgoing recommended care due to budget constraints. Further, financial hardship is a major source of stress, leading to poor patient outcomes and diminished quality of life. The impact of financial hardship is cumulative and long-lasting, with consequences extending well beyond the period of active treatment. The patients at greatest risk for financial hardship are often vulnerable sub-groups who already face obstacles to high quality care.

The causes of cancer-related financial hardship are multifaceted, stemming from high out-of-pocket costs, inadequate insurance coverage, missed days from work or job loss, and other related challenges.  Thus, a program of services is needed to address this complex problem. A 2019 survey sponsored by the DCCPS suggested that most NCI-designated Cancer Centers offer a range of financial navigation services including help  applying to pharmaceutic company-sponsored patient assistance programs, financial assistance to manage non-medical costs, help applying for health insurance coverage and help understanding medical bills. However, 40% of Centers reported a lack of staff awareness about available financial navigation services and 46% reported that the pathways or workflows to connect cancer patients with existing financial services were unclear. Additionally, over 50% of Centers reported that patients were reluctant to ask for financial help when they needed it and 37% of Centers could not estimate the percentage of their patients who experience cancer-related financial hardship. Collectively, these findings suggest a need to both enhance the systematic identification of patients experiencing financial hardship and improve the coordination and delivery of financial navigation services. This supplement initiative will help Cancer Centers to develop or expand their capacity and infrastructure to deliver financial navigation services and to collect the preliminary data necessary to more broadly implement and evaluate financial navigation programs.