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Treatment out-of-pocket cost communication and remote financial navigation in patients with cancer: a feasibility study

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Abstract

Objective

We conducted a pilot study assessing the feasibility of a personalized out-of-pocket cost communication, remote financial navigation, and counseling (CostCOM) intervention in cancer patients.

Methods

Twenty-three adult, newly diagnosed cancer patients at a single community oncology practice were asked to complete a survey and participate in a CostCOM intervention, including patient-specific out-of-pocket cost communication, remote financial navigation, and counseling. Feasibility was defined as patient participation in CostCOM, and its impact on financial worry measured using the Comprehensive Score for Financial Toxicity (COST) (higher score = less worry) was assessed. Eight patients’ and two providers’ experience with CostCOM was evaluated using qualitative interviews.

Results

Mean patient age was 61 (78.3% female; 100% white). Of 23 CostCOM patients, 86.9% completed CostCOM, 60% of them completed a financial assistance application, and 25% of those who applied were enrolled in a co-pay assistance program. Patients’ financial worry significantly improved following CostCOM (COST score of 10.0 ± 9.6 at enrollment vs. 16.9 ± 8.1 at follow-up; p < 0.001). Mean general satisfaction (out of 5) with CostCOM was 4.1 ± 0.7. In qualitative interviews following OOPC communication, 75% felt a positive impact on their mental health, and all patients reported no change in their treatment plan; 83.3% found financial navigation beneficial. In providers’ interviews, buy-in from relevant stakeholders, integration of the CostCOM with existing workflow, and larger studies to assess the effectiveness of CostCOM were identified as factors needed for CostCOM implementation in practice.

Conclusion

CostCOM interventions are feasible and acceptable and decrease financial worry in patients with cancer.

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References

  1. Brown ML, Riley GF, Schussler N, Etzioni R (2002) Estimating health care costs related to cancer treatment from SEER-Medicare data. Med Care 40:104–117. https://doi.org/10.1097/00005650-200208001-00014

    Article  Google Scholar 

  2. Short PF, Moran JR, Punekar R (2011) Medical expenditures of adult cancer survivors aged <65 years in the United States Cancer 117: 2791-2800 https://doi.org/10.1002/cncr.25835

  3. Finkelstein EA, Tangka FK, Trogdon JG, Sabatino SA, Richardson LC (2009) The personal financial burden of cancer for the working-aged population. Am J Manag Care 15:801–806

    PubMed  Google Scholar 

  4. Sadigh G, Switchenko J, Weaver KE, Elchoufi D, Meisel J, Bilen MA, Lawson D, Cella D, El-Rayes B, Carlos R (2022) Correlates of financial toxicity in adult cancer patients and their informal caregivers. Support Care Cancer 30:217–225. https://doi.org/10.1007/s00520-021-06424-1

    Article  PubMed  Google Scholar 

  5. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors: a systematic review. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djw205

  6. Zafar SY, McNeil RB, Thomas CM, Lathan CS, Ayanian JZ, Provenzale D (2015) Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract 11:145–150. https://doi.org/10.1200/JOP.2014.001542

    Article  PubMed  Google Scholar 

  7. Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D (2016) Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34:1732–1740. https://doi.org/10.1200/JCO.2015.63.2232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980–986. https://doi.org/10.1200/JCO.2015.64.6620

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Chino F, Peppercorn J, Taylor DH Jr, Lu Y, Samsa G, Abernethy AP, Zafar SY (2014) Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist 19:414–420. https://doi.org/10.1634/theoncologist.2013-0374

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol 30:1608–1614. https://doi.org/10.1200/JCO.2011.37.9511

    Article  PubMed  Google Scholar 

  11. Claxton G, Rae M, Panchal N, Whitmore H, Damico A, Kenward K (2014) Health benefits in 2014: stability in premiums and coverage for employer-sponsored plans Health Aff (Millwood) 33:1851–1860 https://doi.org/10.1377/hlthaff.2014.0792

  12. Lopes L, Kearney A, Hamel L, Bordie M. Data note: public worries about and experience with surprise medical bills. Available at: https://www.kff.org/health-costs/poll-finding/data-note-public-worries-about-and-experience-with-surprise-medical-bills/. Accessed on September 27, 2021

  13. Sadigh G, Carlos RC, Krupinski EA, Meltzer CC, Duszak R Jr (2017) Health care price transparency and communication: implications for radiologists and patients in an era of expanding shared decision making. AJR Am J Roentgenol 209:959–964. https://doi.org/10.2214/AJR.17.18360

    Article  PubMed  Google Scholar 

  14. Wu SJ, Sylwestrzak G, Shah C, DeVries A (2014) Price transparency for MRIs increased use of less costly providers and triggered provider competition. Health Aff (Millwood) 33:1391–1398. https://doi.org/10.1377/hlthaff.2014.0168

    Article  Google Scholar 

  15. Sinaiko AD (2019) What is the value of market-wide health care price transparency? JAMA 322:1449–1450. https://doi.org/10.1001/jama.2019.11578

    Article  PubMed  Google Scholar 

  16. Sadigh G, Gallagher K, Obenchain J, Benson A 3rd, Mitchell E, Sengupta S, Carlos RC (2019) Pilot feasibility study of an oncology financial navigation program in brain cancer patients. J Am Coll Radiol 16:1420–1424. https://doi.org/10.1016/j.jacr.2019.07.014

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shankaran V, Leahy T, Steelquist J, Watabayashi K, Linden H, Ramsey S, Schwartz N, Kreizenbeck K, Nelson J, Balch A, Singleton E, Gallagher K, Overstreet K (2018) Pilot feasibility study of an oncology financial navigation program. J Oncol Pract 14:e122–e129. https://doi.org/10.1200/JOP.2017.024927

    Article  PubMed  Google Scholar 

  18. Sherman DE (2017) Transforming practices through the oncology care model: financial toxicity and counseling. J Oncol Pract 13:519–522. https://doi.org/10.1200/JOP.2017.023655

    Article  PubMed  Google Scholar 

  19. Hung A, Blalock DV, Miller J, McDermott J, Wessler H, Oakes MM, Reed SD, Bosworth HB, Zullig LL (2021) Impact of financial medication assistance on medication adherence: a systematic review. J Manag Care Spec Pharm 27:924–935. https://doi.org/10.18553/jmcp.2021.27.7.924

    Article  PubMed  Google Scholar 

  20. TailorMed Medical Inc. Available at: https://tailormed.co/. Accessed on September 27, 2021

  21. Shea CM, Jacobs SR, Esserman DA, Bruce K, Weiner BJ (2014) Organizational readiness for implementing change: a psychometric assessment of a new measure. Implement Sci 9:7. https://doi.org/10.1186/1748-5908-9-7

    Article  PubMed  PubMed Central  Google Scholar 

  22. de Souza JA, Yap BJ, Hlubocky FJ, Wroblewski K, Ratain MJ, Cella D, Daugherty CK (2014) The development of a financial toxicity patient-reported outcome in cancer: the COST measure. Cancer 120:3245–3253. https://doi.org/10.1002/cncr.28814

    Article  PubMed  Google Scholar 

  23. de Souza JA, Yap BJ, Wroblewski K, Blinder V, Araujo FS, Hlubocky FJ, Nicholas LH, O’Connor JM, Brockstein B, Ratain MJ, Daugherty CK, Cella D (2017) Measuring financial toxicity as a clinically relevant patient-reported outcome: the validation of the COmprehensive Score for financial Toxicity (COST). Cancer 123:476–484. https://doi.org/10.1002/cncr.30369

    Article  PubMed  Google Scholar 

  24. Agency for Healthcare Research and Quality. Medical expenditure panel survey. Available at: https://www.meps.ahrq.gov/mepsweb/. Accessed on September 27, 2021

  25. Marshall GN, Hays RD. (1994) The Patient Satisfaction Questionnaire Short-Form (PSQ-18) Santa Monica, CA: RAND

  26. Lown JM (2011) Development and validation of a financial self-efficacy scale. J Financ Couns Plan 22(2):54–63

    Google Scholar 

  27. Paez KA, Mallery CJ, Noel H, Pugliese C, McSorley VE, Lucado JL, Ganachari D (2014) Development of the Health Insurance Literacy Measure (HILM): conceptualizing and measuring consumer ability to choose and use private health insurance. J Health Commun 19(Suppl 2):225–239. https://doi.org/10.1080/10810730.2014.936568

    Article  PubMed  PubMed Central  Google Scholar 

  28. Patton MQ (2014) Qualitative research & evaluation methods: integrating theory and practice. Sage publications Inc. Thousands Oak, California.

  29. Miles MB, Huberman AM, Saldana J (2014) Qualitative data analysis: a methods sourcebook. Sage Publications Inc. Thousands Oak, California.

  30. Chino F, Brizel DM, Mowery YM (2021) Patient Reported Outcomes and Financial Toxicity in Head and Neck Cancer (PaRTNer): baseline financial toxicity and attitudes toward costs from a pilot study. J Clin Oncology 39:56–56. https://doi.org/10.1200/JCO.2020.39.28_suppl.56

    Article  Google Scholar 

  31. Sadigh G, Lava N, Switchenko J, Duszak R Jr, Krupinski EA, Meltzer C, Hughes D, Carlos RC (2021) Patient-reported financial toxicity in multiple sclerosis: predictors and association with care non-adherence. Mult Scler 27:453–464. https://doi.org/10.1177/1352458520913977

    Article  PubMed  Google Scholar 

  32. Laws MB, Lee Y, Taubin T, Rogers WH, Wilson IB (2018) Factors associated with patient recall of key information in ambulatory specialty care visits: results of an innovative methodology. PLoS One 13:e0191940. https://doi.org/10.1371/journal.pone.0191940

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Jenkins V, Solis-Trapala I, Langridge C, Catt S, Talbot DC, Fallowfield LJ (2011) What oncologists believe they said and what patients believe they heard: an analysis of phase I trial discussions. J Clin Oncol 29:61–68. https://doi.org/10.1200/JCO.2010.30.0814

    Article  PubMed  Google Scholar 

  34. Hong YR, Salloum RG, Yadav S, Smith G, Mainous AG 3rd (2020) Patient-provider discussion about cancer treatment costs and out-of-pocket spending: implications for shared decision making in cancer care. Value Health 23:1592–1598. https://doi.org/10.1016/j.jval.2020.08.002

    Article  PubMed  Google Scholar 

  35. Yezefski T, Steelquist J, Watabayashi K, Sherman D, Shankaran V (2018) Impact of trained oncology financial navigators on patient out-of-pocket spending. Am J Manag Care 24:S74–S79

    PubMed  Google Scholar 

  36. Rocque GB, Pisu M, Jackson BE, Kvale EA, Demark-Wahnefried W, Martin MY, Meneses K, Li Y, Taylor RA, Acemgil A, Williams CP, Lisovicz N, Fouad M, Kenzik KM, Partridge EE, Patient Care Connect G (2017) Resource use and Medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol 3:817–825. https://doi.org/10.1001/jamaoncol.2016.6307

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lambert C, Legleitner S, Laraia K. Results of a pilot study at one community cancer center. 2019. Available at: https://www.accc-cancer.org/docs/documents/oncology-issues/articles/jf19/jf19-technology-unlocks-untapped-potential-in-a-financial-navigation-program.pdf Accessed on September 27, 2021

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Acknowledgements

Assistance with data acquisition was provided by Justin Reynolds, BS CCRP at Ballad Health Cancer Center. Assistance with IRB approval and data use agreement at Ballad Health Cancer Center was provided by Asheesh Shipstone, MD. Research reported in this publication was supported in part by the Intervention Development, Dissemination and Implementation Developing Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This work was supported by ECOG-ACRIN Cancer Care Delivery Research Pilot Grant. TailorMed Medical Inc. provided in-kind support including access to their price transparency and financial navigation platforms as well as an hour of remote financial counseling for the enrolled participants for free. TailorMed and ECOG-ACRIN had no role in the design of the study; in the collection of surveys, analyses, or interpretation of data; in the writing of the manuscript; and in the decision to publish the results.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG20, Atlanta, GA, 30322, USA

    Gelareh Sadigh & Debrua Coleman

  2. Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, USA

    Jeffrey M. Switchenko

  3. SCOR NCORP/Novant Health Cancer Institute, Winston-Salem, NC, USA

    Judith O. Hopkins

  4. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Ruth C. Carlos

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  1. Gelareh Sadigh
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  5. Ruth C. Carlos
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Contributions

All authors contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Gelareh Sadigh, Debrua Coleman, and Jeffrey Switchenko. The first draft of the manuscript was written by Gelareh Sadigh, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gelareh Sadigh.

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Conflict of interest

Drs. Sadigh, Coleman, and Switchenko received related research support from ECOG-ACRIN CCDR Pilot. Dr. Sadigh receives research support from the Harvey L. Neiman Health Policy Institute and an honorarium from the Journal of the American College of Radiology in her role as Associate Editor. Dr. Carlos reports a conflict of interest as GERRAF Board of Review Chair and as ECOG-ACRIN CCDR Committee Chair. Dr. Carlos reports salary support from the Journal of the American College of Radiology as Editor in Chief and funding from the National Cancer Institute during the conduct of this study.

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Sadigh, G., Coleman, D., Switchenko, J. et al. Treatment out-of-pocket cost communication and remote financial navigation in patients with cancer: a feasibility study. Support Care Cancer 30, 8173–8182 (2022). https://doi.org/10.1007/s00520-022-07270-5

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  • DOI: https://doi.org/10.1007/s00520-022-07270-5

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