June is Cancer Survivors Month. Any cancer diagnosis induces feelings of anxiety, uncertainty and fear in patients. While novel approaches to and treatments for cancer are improving survival rates, social determinants of health continue to exert significant impact on patients’ ability to experience positive outcomes to treatment. Let’s look at one of these determinants, economic stability, in the context of cancer survival.
The term “cancer-related financial toxicity” was introduced in 2013 by Zafar and Abernethy, and described as, “the patient-level impact of the cost of cancer care” (Zafar and Abernethy, 2013). Even those patients who are privately insured are not protected from financial toxicity, as a 2022 study published in the Journal of the National Cancer Institute found. Out-of-pocket expenditures by privately-insured cancer patients in the United States have increased, due to the rise in high-deductible insurance plans and greater expected patient contribution to medical expenses (Shih et al, 2022).
How best, then, to help patients navigate the potential financial burdens of a cancer diagnosis, and thereby improve their potential treatment outcomes? A 2023 scoping review in Critical Reviews in Oncology/Hematology examined interventions for financial toxicity among cancer survivors. The interventions discussed include: financial navigation, which includes identifying patients at high risk for financial toxicity, offering guidance on out-of-pocket costs, and facilitating access to programs to alleviate financial stress. Financial counseling helps patients access advice and guidance on managing financial toxicity caused by cancer treatment. Insurance education entails providing patients a structured way to develop insurance literacy and assistance in choosing a plan. Other types of interventions examined included multidisciplinary psychosocial supports, intensive symptom assessments, and supportive care (Yuan et al, 2023).
The effectiveness of the interventions, researchers found, were closely tied to the causes of the cancer-related financial toxicity, with socioeconomic and employment status, cancer stage, and type of treatment, type of insurance, as well as coping skills all having a direct impact on how effective financial interventions could be. Looking closely at just one of the interventions mentioned above, engaging with financial navigation helped cancer patients save significant dollar amounts annually by facilitating the procurement of free medication, and insurance premium and co-pay assistance.
The financial interventions described in the evidence reviewed differed greatly, but more generally, the recent focus in the literature on finding ways to alleviate financial toxicity frequently faced by cancer patients is one promising step towards improving outcomes for all patients dealing with cancer.
References
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Shih, Y. T., Xu, Y., Bradley, C., Giordano, S. H., Yao, J., & Yabroff, K. R. (2022). Costs Around the First Year of Diagnosis for 4 Common Cancers Among the Privately Insured. Journal of the National Cancer Institute, 114(10), 1392–1399. https://doi.org/10.1093/jnci/djac141
Yuan, X., Zhang, X., He, J., & Xing, W. (2023). Interventions for financial toxicity among cancer survivors: A scoping review. Critical reviews in oncology/hematology, 192, 104140. https://doi.org/10.1016/j.critrevonc.2023.104140
Zafar SY, Abernethy AP. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park, NY). 2013;27(2):80-149.
