Abstract
Cancer-related financial toxicity impacts head and neck cancer patients and survivors. With increasing use of proton therapy as a curative treatment for head and neck cancer, the multifaceted financial and economic implications of proton therapy—dimensions of “financial toxicity”—need to be addressed. Herein, we identify knowledge gaps and potential solutions related to the problem of financial toxicity. To date, while cost-effectiveness analysis has been used to assess the value of proton therapy for head and neck cancer, it may not fully incorporate empiric comparisons of patients' and survivors' lost productivity and disability after treatment. A cost-of-illness framework for evaluation could address this gap, thereby more comprehensively identifying the value of proton therapy and distinctly incorporating a measurable aspect of financial toxicity in evaluation. Overall, financial toxicity burdens remain understudied in head and neck cancer patients from a patient-centered perspective. Systematic, validated, and accurate measurement of financial toxicity in patients receiving proton therapy is needed, especially relative to conventional photon-based strategies. This will enrich the evidence base for optimal selection and rationale for payer coverage of available treatment options for head and neck cancer patients. In the setting of cancer care delivery, a combination of conducting proactive screening for financial toxicity in patients selected for proton therapy, initiating early financial navigation in vulnerable patients, engaging stakeholders, improving oncology provider team cost communication, expanding policies to promote price transparency, and expanding insurance coverage for proton therapy are critical practices to mitigate financial toxicity in head and neck cancer patients.
Highlights
Though technological and biomedical advances in cancer therapies have propelled the improvement of key oncology patient outcomes—survival, cancer progression, and treatment-related toxicity—cancer treatment, often costly, is a source of financial hardship for many cancer patients and their families [1, 2]
The ‘‘toxicity’’ of cancer-related financial burdens is reflected in subsequent adverse health outcomes, with worse quality of life, decreased psychosocial well-being, and lower treatment adherence reported by patients experiencing cancer-related financial hardship [2, 10, 11]
Given that acute events such as unplanned hospitalizations and emergency visits represent one of the costliest aspects of cancer care [33], these findings suggest that the potential clinical benefits of proton therapy could potentially translate into benefits for cost, health care delivery, and the health care system
Summary
Though technological and biomedical advances in cancer therapies have propelled the improvement of key oncology patient outcomes—survival, cancer progression, and treatment-related toxicity—cancer treatment, often costly, is a source of financial hardship for many cancer patients and their families [1, 2]. Cancer-related financial hardship, or ‘‘financial toxicity,’’ impacts as many as half of cancer patients. Financial toxicity encompasses the burdens on patients resulting from medical costs of cancer treatment, side-effect management, and survivorship care, along with such nonmedical costs as the extra transport and housing costs often needed to access cancer treatment [1,2,3]
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