Financial-Legal navigation reduces financial toxicity of pediatric and AYA cancers.

Abstract

Pediatric and Adolescent and Young Adult (AYA) cancer patients and caregivers are at high risk for financial toxicity and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of FINassist (Financial and Insurance Navigation Assistance), a novel interdisciplinary financial and legal navigation intervention for pediatric oncology patients and caregivers. We used a single-arm feasibility and acceptability trial design in the Division of Pediatric Oncology and Hematology and collected pre- and post- intervention surveys to assess changes in financial toxicity (three domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions and coping behaviors), health related quality of life (PROMIS Physical and Mental Health, Anxiety, Depression and Parent Proxy scales), and perceived feasibility, acceptability, and appropriateness. 45 participants received financial navigation, 6 received legal navigation and 10 received both. Among 15 adult patients, there were significant improvements in COST (p=.041), and physical health (.036). Among 46 caregivers, significant improvements were noted for COST (<.001), the total financial toxicity score (.001), and the parent proxy global health score (.0037). We were able to secure roughly $335,323 (USD) in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Integrating financial and legal navigation via FINassist was feasible, acceptable, and underscores the benefit to a multidisciplinary approach to addressing financial toxicity.