Pilot Feasibility Study of an Oncology Financial Navigation Program in Brain Cancer Patients

Abstract

Patients with brain cancer are at risk for developing financial toxicity, which is defined as a combination of subjective financial concerns (eg, anxiety), objective financial consequences of health issues and treatments (eg, decreased income, medical debt), and patients’ coping behaviors [ 1 Altice C.K. Banegas M.P. Tucker-Seeley R.D. Yabroff K.R. Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. 2016 Oct 20; 109 (pii: djw205. Print 2017 Feb) Crossref Scopus (276) Google Scholar ]. The direct costs of care are considerably high in these patients (monthly direct medical cost of approximately $8,478 [ 2 Chang S. Long S.R. Kutikova L. et al. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol. 2004; 22: 3524-3530 Crossref PubMed Scopus (158) Google Scholar ]), and decreased household income is common and reported by at least one-half of the patients as a result of cancer treatment [ 3 Johannesen T.B. Norum J. Lote K. Scheie D. Hirschberg H. A cost-minimising analysis of standard radiotherapy and two experimental therapies in glioblastoma. Radiother Oncol. 2002; 62: 227-231 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar ]. Financial toxicity has been shown to be linked with several clinically relevant patient outcomes, including health-related quality of life [ 4 Zafar S.Y. McNeil R.B. Thomas C.M. Lathan C.S. Ayanian J.Z. Provenzale D. Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract. 2015; 11: 145-150 Crossref PubMed Scopus (167) Google Scholar ], symptom burden [ 5 Lathan C.S. Cronin A. Tucker-Seeley R. Zafar S.Y. Ayanian J.Z. Schrag D. Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol. 2016; 34: 1732-1740 Crossref PubMed Scopus (162) Google Scholar ], care adherence [ 6 Neugut A.I. Subar M. Wilde E.T. et al. Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol. 2011; 29: 2534-2542 Crossref PubMed Scopus (223) Google Scholar ], and survival [ 7 Ramsey S.D. Bansal A. Fedorenko C.R. et al. Financial Insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. 2016; 34: 980-986 Crossref PubMed Scopus (350) Google Scholar ]. Extreme financial distress after cancer diagnosis (manifested by declaring personal bankruptcy) has been reported to be a risk factor for mortality [ 7 Ramsey S.D. Bansal A. Fedorenko C.R. et al. Financial Insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol. 2016; 34: 980-986 Crossref PubMed Scopus (350) Google Scholar ]. Given delay or nonreceipt of an indicated imaging test is a potential outcome of financial toxicity, it is critical for radiologists to understand the financial impact of treatment, which includes surveillance imaging, among patients with this condition.