Addressing the True Cost of Cancer Care:
Effective Interventions
of Financial Toxicity by Oncology Professionals
By: Elisabeth Brewington
In recent years, the medical community has begun to utilize the term “financial toxicity” to describe the burden of care costs, most often in reference to oncology patients. Recent studies indicate around 40% of American adults will receive a cancer diagnosis in their lifetime, and as many as 47% of those living with cancer in the U.S. will report “catastrophic” financial hardships. These statistics clearly illustrate both the widespread prevalence and the severity of financial toxicity (Chi, 2015). A cancer diagnosis often results in a care plan that is both higher in cost and longer in duration than others, leaving oncology patients particularly susceptible to financial burden and distress. The increased incidence of cancer, rapidly specialized nature of treatments, decline in mortality rates, and skyrocketing costs are all factors which further contribute (Knight et al., 2018). Patients are often left to manage this financial aftermath without support and end up handling these stressors through a variety of responses that result in further harmful effects.
The use of maladaptive coping methods, non-adherence to their established care plan, worsened quality of life, anxiety and discomfort around the care they receive are commonly reported means in which patients react. Each of these factors and subsequent behaviors accumulate and create the all-encompassing effect of financial toxicity. Despite these present challenges, the medical community has come to understand and appreciate the unique opportunities oncology professionals are presented with in ensuring financial well-being for their patients. With effective interventions, oncology providers can proactively and efficiently reduce cost-related harm as they are positioned to interact closely and communicate directly and regularly with the patient. Oncology professionals can learn about barriers patients may have, particularly those related to access to assistance as well as determinants of financial toxicity that may be present. Now that most oncology providers are familiar with the concept of financial toxicity, greater opportunities are present for offering recommendations and outlining methodologies for daily practice to act in the best interest of patients.
Within the patient-provider relationship, oncology professionals are able to create the most significant and direct impact on outcomes. As soon as the treatment plan is established, providers are responsible for rapidly coming to understand and address barriers and determinants that may impact their patient’s course of care and outcomes. Although a paradigm shift related to the traditional role of physicians is required, this shared decision-making to address and reduce costs is supported by the Institute of Medicine as a priority practice for oncologists (Zafar, 2016). Providers are also responsible for focusing on the value of care provided, largely by avoiding clinical interventions with a high cost and little benefit. Although oncology providers are not able to combat the increasing cost of cancer care, they are able to establish practices and identify opportunities that allow for lower levels of financial toxicity in their patients. Rather than resigning this responsibility of addressing costs and blaming larger structures or systems such as the government or healthcare industry, providers should be equipped to empower their patients in addressing their financial well-being in relation to their course of care (Gyawali, 2017).
Oncology providers who effectively address financial toxicity and intervene appropriately are engaging in true patient-centered care practices. They deserve support and resources from their healthcare organization and team members in their efforts. From the organizational standpoint, oncology providers need to have the educational and training opportunities available to develop, maintain, and fine-tune these skills. Addressing and decreasing discomfort around discussion of financial factors allows more natural and open communication to occur between providers and patients. Similarly, patients should have access to cost-related health literacy materials and supports from other staff, such as financial navigators and clinical social workers who can further address financial outcomes (Zafar, 2016). At the administrative and managerial level, efforts related to improving cost transparency, the availability of skilled supporting staff, a culture that cultivates and incentivizes high-value practices, and support and resources for clinicians in addressing these topics are crucial (Desai & Gyawali, 2020).
Lastly, larger considerations at the national level can also be impacted by the actions of providers and their research findings. These findings do not subtract from, nor replace, this expansive need. It goes without saying that significant reform and progress are urgently needed within the realm of health insurers, federal funding, policymakers, pharmaceuticals, and the industry in its entirety. There are a wide variety of methods to be considered of this scope to minimize financial toxicity. Significant research, progress, and improvements are overdue from a larger societal context in exploring the ways in which patients manage the costs of their care and clinical outcomes. American oncology patients can no longer be expected to carry the unsustainable and unethical financial burden associated with their care. Healthcare leaders are called to contribute to long-term, comprehensive efforts to address the weight of financial toxicity, and to effectively intervene today.
References
Chi, M. (2015). Clinical Social Work Journal, 43(1). Retrieved from media.cancercare.org/
publications/original/366hidden_cost.pdf#:~:text=The%20term%20financial%20toxicity%20(FT,chemotherapy%20or%20other%20cancer%20treatments.
Desai, A., & Gyawali, B. (2020). Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions. The Lancet, 20. Retrieved from thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30013-4/fulltext.
Gyawali, B. (2017). Low-value practices in oncology contributing to financial toxicity. ECancer Medical Science, 11(727). Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC5365336.
Knight, T., Deal, A., & Dusetzina, S. (2018). Financial Toxicity in Adults with Cancer: Adverse Outcomes and Noncompliance. Journal of Oncology Practice, 14(11). Retrieved from ascopubs.org/doi/full/10.1200/JOP.18.00120.
Zafar, S. (2016). Financial Toxicity of Cancer Care: It’s Time to Intervene. Journal of the National Cancer Institute, 108(5). Retrieved from academic.oup.com/jnci/article/
108/5/djv370/2412415.
About the Author
With a background in healthcare administration/management, Elisabeth Brewington currently serves as a supervisor at the Maine Center for Disease Control and Prevention on the Infectious Disease/Field Epidemiology team. She has recently obtained her MHA degree from Saint Joseph’s College of Maine. This blog post was adapted from her graduate “Capstone” research.
