The use of a screening method followed by a financial toxicity intervention that involves navigators, pharmacists, and financial counselors demonstrated significantly improved quality of life for patients with hematologic malignancies, said lead investigator Thomas Greg Knight, MD, Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, NC, at ASH 2020.
In this pilot study, among 107 patients with hematologic malignancies who had financial difficulties, more than 33% qualified for the intervention. The evaluation was done through a survey using the 10-question Patient-Reported Outcomes Measurement Information System (PROMIS) scores and 2 questions from the Comprehensive Score for Financial Toxicity (COST) measure.
Patients who received the financial toxicity intervention had significantly higher scores on the physical and mental health PROMIS measures compared with baseline scores.
“Based on these results, we concluded that utilizing a quick screening method for financial toxicity in a busy clinical environment is feasible and allows identification of an extremely high-risk population,” Dr Knight said. “We also found that intervening on financial toxicity in a comprehensive way is effective and led to increased quality of life.”
For this project, the researchers designed a quick screening method to identify patients with hematologic malignancies who were at high risk for financial toxicity. All patients seen at the Malignant Hematology Clinic at the Levine Cancer Institute in Charlotte, NC, completed a survey consisting of the PROMIS and the COST measures at baseline as well as after the intervention.
Financial toxicity was determined by scoring ≤5 on the following 2 questions from the COST measure:
- “I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment.”
- “I am satisfied with my current financial situation.”
A total of 107 patients were classified as having financial toxicity and were included in the intervention cohort. Although the majority of patients had Medicare or private health insurance, a significant percentage of the patients had Medicaid, no health insurance, or Veterans Affairs insurance.
Approximately 80% of the patients had an annual income of <$64,000, and the majority of the patients were diagnosed with acute leukemias or myeloproliferative neoplasms.
Patients who were determined to have financial toxicity were assigned to the intervention cohort and were scheduled for a visit with a nurse navigator, who helped identify opportunities for grant funding and other assistance.
These patients were also seen by a clinical pharmacist for copay review and discussion of financial assistance programs. In addition, the patients were offered the services of a community pro-bono financial planner for help with budgeting, asset management, and general financial advice.
Compared with baseline PROMIS scores, the intervention resulted in significantly higher quality of life based on the PROMIS physical and mental health scores, said Dr Knight. He advised that this screening process could be used in a variety of healthcare settings.
Financial Toxicity and Nonadherence
Financial toxicity is associated with nonadherence to treatment that extends to all aspects of medical care, not just medications, Dr Knight said, and nonadherence is associated with worse clinical outcomes. Furthermore, patients with hematologic malignancies are thought to be very vulnerable to financial toxicity, with rates of distress that are higher than in patients with other malignancies, because of high cost of treatments and healthcare utilization.
“Given the acuity of most of these illnesses, noncompliance and gaps in care for patients with hematologic malignancies can be especially devastating,” Dr Knight emphasized.
“Patients who are experiencing financial toxicity had high rates of noncompliance due to these financial issues,” he added.
Approximately 17% of the patients reported missing prescription medications because they could not afford it, and 7% reported missing doctor visits.
“Patients experiencing financial toxicity also reported a 50% reduction in spending on food and clothing, and using savings to cover out-of-pocket expenses,” Dr Knight said.
“Perhaps more distressing, 11% reported stretching their prescriptions by taking less than the prescribed amount due to the cost associated with their cancer therapy,” Dr Knight added. Addressing these financial problems is clearly important to improve treatment adherence.
Nurse navigators and social workers were able to find grants for more than 33% of the patients, with a median grant value of $850, ranging from $100 to >$17,000. Gas cards, food pantry assistance, and transportation assistance were provided to qualifying patients, at a median value of $300.
The clinical pharmacy team was also able to obtain free medications or at greatly reduced costs for patients in the intervention arm, totaling a median retail value of almost $200,000 annually.
Finally, more than 50% of the patients expressed interest in, and were scheduled with, a pro-bono financial planner to receive one-on-one counseling.