Oncology Providers Can Transform the Trajectory of Financial Toxicity

February 09, 2023 by Jan Tipton DNP, APRN-CNS, AOCN®

The complexity of cancer care may affect patients’ financial toxicity more than we’ve realized. Many patients struggle with the economic burden (https://doi.org/10.21037%2Fjhmhp-20-68) of out-of-pocket spending for cancer care, including insurance copayments, transportation, and reduced income, as well as their psychological burden (https://doi.org/10.3322/caac.21730) of worry and coping with less funds for food and medications. Multimodality treatments, maintenance and ongoing therapies for metastatic disease, and geographic factors such as travel for clinical trials and specialized services or paying for out-of-network care can put patients’ finances in a deeper hole (https://doi.org/10.3322/caac.21730). The adverse implications (https://doi.org/10.1200/OP.22.00056) are significant: decreased quality of life, increased anxiety and depression, lower adherence to prescribed medications and oncology care, and reduced survival.

Financial Toxicity Directly Influences Cancer Treatment Adherence

Access and adherence to oral therapies are particularly concerning because of their significant role in cancer therapy (https://doi.org/10.1200/OP.22.00056). Patients experiencing financial toxicity may not only struggle with access to their oral targeted drugs (https://doi.org/10.1200/OP.22.00056), but they may also delay their refills or discontinue treatment (https://doi.org/10.1200/OP.22.00056) altogether because of an inability to afford the out-of-pocket costs. Patients who are female, are of a younger age (with less savings, insurance issues, or child expenses), are from a minority population, or have low incomes, Medicaid or no insurance, or work disability are at higher risk (https://doi.org/10.21037%2Fjhmhp-20-68) for nonadherence (https://doi.org/10.3322/caac.21730).

Providers Need to Do More for Their Patients

Despite national recommendations for oncology advanced practice providers (APPs) to actively address financial toxicity, many do not. Barriers include (https://doi.org/10.1007/s00520-021-05984-6) lack of knowledge of out-of-pocket costs, time, and awareness of resources. Patients say they want their providers to be actively involved (https://doi.org/10.1007/s00520-021-05984-6) in their financial concerns, and APPs have several opportunities (https://doi.org/10.21037%2Fjhmhp-20-68) to better understand our patients’ needs.

The solutions involve all levels—APPs, clinics, hospitals, insurance, and government agencies. It takes a village to address financial toxicity; therefore, oncology APPs must use an interdisciplinary approach throughout the continuum of care. Those with defined financial navigation roles are increasingly called on to address patients’ financial needs, but we can all contribute to our hospital’s or practice’s financial viability. See the sidebar for suggested approaches.

Bring Change to a Broader Level

Beyond our commitment to peer-to-peer consultations and assessing patients’ financial concerns during all follow-up visits, oncology APPs also have significant influence on health policy and must advocate for affordable healthcare costs. As leaders in promoting cost-effective decision making for individual patient care, we have a responsibility to advocate for treatment coverage. In the broader patient community, we must also join with ONS and the greater nursing and healthcare community as a voice for our patients to lobby for essential legislative priorities (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/policy-priorities): affordable treatment and oral parity (https://voice.ons.org/advocacy/healthcare-economics-through-the-inflation-reduction-act-of-2022-and-beyond), palliative care (https://voice.ons.org/advocacy/senators-baldwin-capito-reintroduce-bipartisan-bill-to-improve-palliative-and-hospice-care), and health equity (https://voice.ons.org/advocacy/diverse-healthcare-equity-requires-providers-and-policymakers-to-unite-for-change).

Copyright © 2023 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact pubpermissions@ons.org for quantity reprints.