Navigating Patients Through Financial Toxicity in Cancer Care: We Can Do Better!
Presentation by An’Drea Liddell, West Cancer Center
At the Total Health 2023 Diversity, Equity and Inclusion Dinner in held in Memphis, Tennessee, An’Drea Liddell from West Cancer Center discussed the program at her institution for managing patients through the many financial burdens associated with cancer care. She noted data from a 2017 National Cancer Opinion Survey by the American Society for Clinical Oncology (ASCO), which found that, while two-thirds of cancer patients had expressed an interest in communicating with their provider’s offices about the costs of their care, only 27% reported ever having that discussion.¹ She then asked a simple question of the audience: “When was the last time you made a high dollar purchase and did not know the cost?” While most would agree that would never happen in their life, she emphasized that “Cancer patients do this every day.” She further noted that 74% of cancer patients report that an upfront estimate of treatment costs would positively impact their view of their healthcare provider.
Ms. Liddell then reviewed some additional data from a study of women with breast cancer, which found that the vast majority (79%) expressed a preference for understanding the full scope of costs prior to beginning their treatment, but a similarly high percentage (78%) never had the discussion.² She also cited the Becker Hospital Review, which noted that “engaging patients early, and assessing their propensity to pay, are considered best practices for medical offices and hospitals.”³
She described the “perfect storm” of factors which often combine to contribute to the very real issue of financial toxicity in the new cancer patient. For example, while new and innovative treatments may extend life in cancer patients, such treatments are generally expensive, and with more patients having access to quality cancer care and living longer, patients will often be taking these drugs for an extended period of time. These factors combine to drive a higher patient responsibility for costs over a long period, which can, in turn be impacted by changes in patient employment, insurance coverage, and other factors which can impact their ability to pay, and the overall financial risk associated with a cancer diagnosis. Ms. Liddell related her personal experience of both of her parents having lost their battle with lung cancer, her mother having just retired, and the prospect of now having to use her life savings to extend her life. She noted a similar financial situation with her father also being diagnosed thereafter and her passion and understanding of the unique financial needs of cancer patients.
She described the “Comprehensive Financial Advocacy Program” in place at West Cancer Center, a best practices initiative, which includes an explanation of every patient’s individual insurance coverage and benefits. This includes screening for insurance coverage for the uninsured, through Medicaid and, if Medicare eligible, through Medicare with secondary coverage through Medicaid if needed; marketplace plans are also discussed with the patient if they are uninsured. Available patient assistance is also assessed, including potential for drug replacement (free drugs from manufacturers), co-pay assistance, grants and foundations, and financial relief programs such as the West Cancer Foundation which help with regular cancer screenings like mammography. Notably, an estimate of patient responsibility is provided, upfront, and patients are assessed for propensity to pay. Payment arrangements can either be upfront, or flexible payment plans are also available to the patient if necessary, and support is ongoing if there should be any changes in the plan of care or the patient situation. The program is thus designed to facilitate insurance enrollment if available and patient understanding of financial assistance that can help offset costs, and to maximize the utilization of available patient assistance.
Summarizing, Ms. Liddell cited the high financial burden of care for cancer patients in particular and emphasized that financial advocates can help to alleviate this burden. She described the purpose of the financial advocacy program at West Cancer Center, which is to assist patients with financial issues such as insurance billing, insurance coverage, payment responsibility and overall financial coordination, with the goal of providing consistency, clarity, and overall transparency in the financial process.
Quick Summary
Financial toxicity associated with cancer care is a significant issue for many patients, both insured and uninsured.
The vast majority of cancer patients expressed an interest in communicating with their provider offices regarding cost of care, but a similarly high percentage report never having that conversation.
Navigating patients through the financial burdens of cancer care is considered a requisite for best practice.
The Comprehensive Financial Advocacy Program in place at West Cancer Center provides an example of a proactive approach for advising patients upfront on the costs of cancer care and facilitating use of all insurance and available assistance programs.
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