Oncologists Must Begin to Address Financial Toxicity with Their Patients

Meg Barbor, MPH

August 2017, Vol 7, No 8 - Quality Care


Orlando, FL—The number one stressor for patients with cancer is no longer the fear of dying from their disease; rather, it is fear of their financial obligations because of treatment, said Dan Sherman, MA, LPC, Founder and President, the NaVectis Group, at the 2017 Quality Care Symposium.

Mr Sherman highlighted what providers could do to improve the quality of care when it comes to financial toxicity in their patients, a topic that has been written about in growing frequency in the past few years.

“To understand financial toxicity, I think Maslow’s Hierarchy of Needs is a good starting point,” Mr Sherman said. “If the basic needs of the patient are not addressed, the patient will not be able to experience well-being.”

For many individuals, financial well-being falls under the second tier in the hierarchy—safety and security—and when a person is diagnosed with cancer, feelings of safety and security, along with many other core needs, are threatened.

“Our current status demonstrates that we are not doing a good job when it comes to addressing financial toxicity and distress in the oncology population,” he said.

The now-famous 2013 study by S. Yousuf Zafar, MD, MHS, and colleagues showed that 42% of patients with cancer who have health insurance face a significant or a catastrophic financial burden (Zafar SY, et al. Oncologist. 2013;18:381-390).

And a 2014 study showed that patients with copays exceeding $54 were 70% more likely to discontinue treatment within 6 months; yet another study showed that the probability of having an out-of-pocket burden of at least 20% of income is 75% higher for Medicare beneficiaries with cancer compared with those without cancer.

Lack of Training of Financial Counselors

Research conducted by the Oncology Roundtable revealed that the majority of people who provide financial navigation in the hospital or oncology setting have only a high school diploma, reported Mr Sherman.

“It’s easy to see there’s a lack of competency in the role. We’re providing undereducated individuals to perform highly complicated work,” said Mr Sherman. “From my perspective, that’s extremely unfair to both the financial counselor and the patient.”

The location of financial services also poses a significant problem. Patients are often referred to a counselor with limited training who knows nothing about them from a clinical standpoint, in an office outside of the medical system where they receive treatment.

“These individuals who have no idea what’s going on with this patient are asked to deal with their number one side effect from treatment,” said Mr Sherman. “We really need to start acknowledging the fact that we’re missing the boat in regards to providing an effective service for these individuals.”

The frequently practiced reactive approach to financial counseling poses yet another problem for patients.

“If patients are going through a chemotherapy regimen and you know they’re going to experience nausea or fatigue, you’ll proactively deal with it so they don’t experience the toxicity,” he pointed out. “But every day, we treat patients without regard to the financial outcomes in store for them, and then we scratch our heads and say, ‘Why is this patient in financial distress?’”

Be Proactive

A proactive approach toward financial toxicity and counseling should involve training financial navigators and combining the clinical needs of the patient with his or her financial circumstances.

“Any person who touches a patient in the healthcare system has to have certain certifications to do that, but for the number one stressor of patients with cancer, we don’t have a certification process or specific training, and it’s time we address this differently,” Mr Sherman said.

For example, a patient with glioblastoma should be navigated differently from someone with prostate cancer, because his or her needs will be completely distinct with regard to financial distress, but financial counselors will often provide patients with the same solution, regardless of their cancer type.

Communication between providers and patients needs to be improved, and oncologists should provide their patients with an estimated cost of treatment and effective solutions to deal with that cost, because factors such as prognosis, treatment duration, and expected response have significant financial implications.

Optimizing health insurance coverage is the ideal approach to mitigating financial toxicity, but when that is not an option, external assistance programs can help, Mr Sherman advised.

Financial toxicity is on the rise, and the Oncology Care Model will force further conversations with patients on the matter, because 12 of the 13 components that are outlined in the Institute of Medicine Care Management Plan will affect patients with cancer from a financial standpoint, said Mr Sherman.

“Providers are going to be asked to start discussing these issues with patients and coming up with a plan to address their financial concerns,” he said. Tackling the issue head-on could provide the opportunity for an improved patient experience, as well as revenue capture for providers.