Oncology Nurses Have a Responsibility to Manage the Financial Toxicities of Cancer

September 10, 2020

Cancer is one of the most expensive medical conditions to treat, and patients are expected to pay more and more out of pocket. Costs often lead to financial toxicity, defined as “distress or hardship arising from the financial burden of cancer treatment,” according to Darcy Burbage, DNP, RN, AOCN®, CBCN®, who discussed the topic in a session for the inaugural ONS Bridge™ virtual conference.

 “In much the same way as physical side effects of treatment like fatigue or cognitive changes, financial problems after cancer diagnosis are a major contributor to higher levels of stress, decreased quality of life, treatment nonadherence, and delayed medical care,” she said.

Burbage, an oncology clinical nurse specialist from Delaware, explained that some patients or families are forced to spend their savings, rely on credit, buy less food, and even file for bankruptcy. Often, patients make treatment decisions because of financial limitations, such as spreading out appointments beyond recommended intervals, delaying care, stopping medications, and declining tests.

Oncology Nurses’ Role in Managing Financial Barriers to Care

A Tactical Approach

Dan Sherman, MA, LPC, of Mercy Health, Saint Mary’s, in Grand Rapids, MI, said that many patients want to discuss costs of treatment but few end up having the right conversations to help.

To facilitate such talks, some institutions employ financial counselors, financial advocates, social workers, and financial nurse navigators, but sometimes the responsibility lies with oncology nurses. Sherman offered an acronym—TREAT—to help them remember the essential elements:

“Financial navigation seeks to solve financial distress not just where the financial problem is currently, but to where the patient will end up on their healthcare journey,” he said.

Sherman mentioned software that helps healthcare teams reduce financial hardships for patients, such as AssistPoint, TailorMed, Vivor, and FundFinder. In addition, he suggested several training resources for healthcare professionals:

Charitable Foundations

Ayesha Azam, MSHIA, vice president of medical affairs at the Patient Access Network (PAN) Foundation, said that charitable foundations “provide a safety net for low-income Medicare beneficiaries.” The national nonprofit organizations are funded by donations and offer three types of assistance for patients:

Azam explained that assistance is available on a first-come, first-served basis. Foundations are open or closed based on availability of funds. Nurses can monitor available programs at fundfinder.panfoundation.org (https://fundfinder.panfoundation.org/).

Three R’s of Financial Assessment

Although best practices are not yet developed, Burbage offered guidance:

“Financial toxicity is multifaceted and requires a team approach to identify and assist patients at risk for financial toxicity,” Azam said.

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