Cancer Treatment: Costs and Impact on Care

Why Do It?

Why is doing research on cancer treatment and costs so important?

Financial navigation has the potential to reduce the severity of cancerrelated financial hardship.

Findings from Café will be among the first reported evidence on the impact of financial navigation and support on financial hardship from cancer, health care use, and quality of life.    

As one of the first NCI-funded prospective studies evaluating interventions aimed at reducing financial hardship among cancer patients, CAFÉ represents an important contribution to the knowledge base. By design, it will provide high quality prospective evidence on the potential benefits of cost of care communication on patient-relevant cancer outcomes.

There is an urgent need for evidence-based interventions on how to prevent or mitigate financial hardship for people with cancer. While the extent of financial hardship as a toxicity of cancer care is increasingly well-documented, there is limited evidence to date as to what types of interventions can mitigate or prevent financial hardship due to cancer care. Policy-, societal-, and organizational-level interventions, such as those focused on bending the curve of rising health care cost or improving price transparency to ordering providers are all needed, but these may take a long time or show limited effect.

How are we trying to reduce financial burden of cancer treatment?

Community Resource Specialists, nurse navigators, and community patient navigators are used in KP cancer care clinics. Both KPWA and KPNW also provide central member services to all members, including answering coverage questions, requesting cost estimates, and referring to patient financial services. However, none of these roles have a dedicated focus on specific cancer-related financial concerns.

During our preliminary study (Project Orca) one of the main findings from our interviews with care team and operations team members was that cancer-specific financial navigation services should be provided by a person in a distinct role.

Café will study the impact of interventions aimed at reducing financial hardship among people with cancer.

Financial Navigation

As costs of cancer care in U.S. have risen over time, so has the burden of out-of-pocket (OOP) costs and indirect costs such as travel, employment changes, and caregiver costs. These cumulative costs pose increased financial risk for people diagnosed with cancer. Despite a patient’s health insurance status, financial hardship from cancer care is prevalent: 47%-49% of cancer survivors report financial hardship and 12%-62% of cancer survivors report debt due to treatment costs(Altice et. al., 2017). Financial hardship is associated with decreased treatment initiation and adherence, poor symptoms and quality of life, and increased mortality risk, so preventing or mitigating its effects is a clinical imperative.

Integration of cost of cancer care information into conversations between patients and clinicians can optimize medical decision-making and reduce the risk of financial hardship, and is consistent with high-quality cancer care and patient preferences. Patient understanding of OOP costs can assist with planning and budgeting, and can facilitate early connection with financial support services that may help to mitigate the financial burden of cancer care. Yet, less than one in five patients report having cost discussions (Bestvina et. al., 2014; Zafar et. al., 2015). Consequently, many patients are uninformed about the costs of their cancer care and face unexpected OOP costs, with important consequences for material (e.g. debt), psychological (e.g. cost-related distress), and behavioral (e.g. treatment adherence) financial hardship.

There is an urgent need for evidence-based interventions on how to prevent or mitigate financial hardship for people with cancer. While the extent of financial hardship as a toxicity of cancer care is increasingly well-documented, there is limited evidence to date as to what types of interventions can mitigate or prevent financial hardship due to cancer care. Policy-, societal-, and organizational-level interventions, such as those focused on bending the curve of rising health care cost or improving price transparency to ordering providers are all needed, but these may take a long time or show limited effect.