?Financial toxicity? is a well-documented side effect of cancer diagnosis that encompasses a range of material, psychological, and behavioral hardships such as debt, bankruptcy, financial worry, and treatment non- adherence. Studies suggest that all patients, regardless of insurance type or socioeconomic status, are vulnerable to adverse financial consequences following cancer diagnosis. Financial hardship can impact entire families, most severely affecting spouse caregivers, whose assets, income, and expenses are often inextricably linked with patients?. A number of studies have shown that, collectively, these financial hardships contribute to disparities in patients? quality of life and survival as well as caregivers? well-being and ability to perform caregiving duties. Accordingly, interventions to mitigate financial toxicity should address the shared financial concerns of cancer patients and their spouses. Given the pressing need for such interventions in the context of rising healthcare costs, we developed a financial navigation intervention in collaboration with: 1) Consumer Education and Training Services (CENTS), a Seattle-based financial education and counseling organization; and 2) Patient Advocate Foundation (PAF), a national patient navigation organization. Based on our preliminary work demonstrating feasibility of delivering this intervention in the oncology clinic setting, we propose a prospective, randomized pragmatic trial in which 536 cancer patient - spouse caregiver dyads will receive proactive financial navigation or usual care. The intervention will consist of a one-time financial literacy education video, monthly contact for six months with CENTS counselors and PAF case managers who will help the couple with the financial aspects of cancer care, including budget management, insurance enrollment and optimization, access to copay assistance and other resources to manage medical and non-medical out-of-pocket costs. Usual care will also receive the one-time financial literacy video in order to standardize their experience. Our goals are to: 1) Determine the impact of a remotely-administered financial navigation program on development of material household financial hardship, 2) Investigate whether proactive financial navigation improves patient and caregiver psychosocial and healthcare utilization outcomes, and 3) Describe the use of financial navigation services by financially fragile, lower income, younger, and minority race households and evaluate the intervention?s effect in these subgroups. We will assess outcomes using survey, credit report, and medical record data obtained at baseline, six months, and twelve months post-enrollment. The primary endpoint of this study is incidence of household financial hardship within one year of enrollment. We expect that the results of this study will show that proactive financial navigation improves financial, psychosocial, and clinical outcomes in cancer patients and their spouse caregivers and should therefore be an essential component of high-quality cancer care in the United States.
The proposed study directly addresses recommendations from the National Cancer Institute (NCI) and American Society of Clinical Oncology (ASCO) to urgently design and test interventions to decrease financial toxicity in cancer care. This proposal offers a proactive financial navigation program, one of the first large-scale interventions to address financial toxicity, and goes beyond evaluating financial outcomes to look at health and social outcomes in cancer patients and their spouse caregivers. Findings from this study will address the role of financial navigation in mitigating household financial hardship and its psychosocial and medical consequences and could support the inclusion of financial navigation as an essential component of high-quality cancer care.
