After being diagnosed with a blood disorder such as leukemia, many patients don’t just suffer physically and mentally — their disease and treatment can also cause major financial distress. Whether it’s struggling with insurance, not being able to afford medications, or facing increases in indirect expenses such as transportation and childcare, the financial burden of a life-threatening condition can lead a significant number of patients to debt and bankruptcy.
Known as “financial toxicity,” this is a problem that Dr. Thomas G. (Greg) Knight, assistant professor in the Division of Leukemia, Department of Hematologic Oncology & Blood Disorders at Atrium Health Levine Cancer Institute (LCI), has been interested in solving since he became a doctor.
“A lot of my patients come from underserved or disadvantaged backgrounds,” Dr. Knight says. “Maybe they've never even thought about budgeting, and then they lose their entire income because of their diagnosis — it can be devastating.”
Making matters worse, the stress and lack of resources that goes along with this can impact patients’ physical health.
“Financial toxicity is a major risk factor for complications and worsened outcomes,” Dr. Knight says.
At the recent American Society of Hematology annual meeting, Dr. Knight and his colleagues presented research that focused on patients with blood cancers and the financial hardship they experience.
Powered by a grant from the Foundation for Financial Planning (FFP) and connected to about 25 pro bono financial planners through FFP and the Financial Planning Association, about 200 patients enrolled in the study during 2019. All the patients had been diagnosed with a blood disorder. The study looked at whether patients who received a comprehensive intervention that included financial support, pharma assistance, and pro bono financial planning had a higher survival rate than patients who did not.
“We found that patients who received the intervention had a significantly higher survival rate, and we also uncovered some key insights that could enable cancer centers across the country to help more patients cope with financial toxicity and have better outcomes,” Dr. Knight says.
Helping Patients Cope with Financial Stress
The study made several key findings about financial toxicity, and how to help patients prevent and manage it. The findings include:
- Patients with blood cancers are at a high risk for financial complications: This increases the chances that they won’t follow treatment, by doing things like skipping medication to save money. Their financial distress is also associated with worsened physical and mental quality of life, which can increase the risk of death.
- Screening for financial issues in a busy clinical environment is feasible: In the study, a simple 2-question screening test was utilized to identify patients at high risk for financial complications. Patients who screened positive met with a nurse navigator to see if they had any trouble getting medication, food or transportation. Identifying potential financial issues enabled the study team to offering financial guidance and support to patients who need it.
- Intervention on financial toxicity takes a team approach: This includes physicians, nurses, nurse navigators, pharmacists and pro bono financial planners. By working together, this team can improve the physical and mental quality of life for patients.
- Intervention can save lives: Intervening on financial toxicity in a comprehensive way appears to decrease a patient’s risk of dying from their condition and increases quality of life.
An Innovative Approach to Managing Financial Issues
Some study participants received an innovative intervention that helped identify what kind of help they needed and matched them with financial support. The intervention included:
- Financial assistance for patients who need it: After the screening questionnaire was filled out, the nurse navigator or social worker would work to match patients with financial support programs from the Leukemia and Lymphoma Society, LCI and other organizations. The goal was to make sure all the patient’s needs were met, by providing anything from gas cards to childcare to help with food.
- Finding ways to make medication affordable: A clinical pharmacist would talk to the patient and find out how much they were spending on medications. During this assessment, Dr. Knight and his team discovered that some medications were either unaffordable or people were stretching their medications. If this was the case, the pharmacist’s job was to work with the patient’s insurance company to get the medication for free or at a reduced cost.
- Connecting with a pro bono financial planner: Dr. Knight and his team would ask patients if they would like to meet with a pro bono financial planner. For those who were interested, they met a financial planner 3 times for 6 months. During this time, the financial planner would assess the patient’s financial history and provide key advice and tips on how to budget during treatment. “Having a trusted advisor, who has a fiduciary duty, who's willing to work with the unpredictability of the treatment schedule, can be very useful to a patient,” says Jon Dauphiné, CEO at the Foundation for Financial Planning.
2021 Goal: Expand Financial Support for Patients
Dr. Knight and his team have proven that financial toxicity has a major impact not only on patient's quality of life, but also on the ultimate outcome of their disease. Now Dr. Knight wants LCI to continue to be a leader in addressing patient finances.
For example, the 2-question screening test is designed to identify high-risk populations in a variety of settings. Dr. Knight hopes other hospitals can adopt something similar at their institutions.
At LCI, Dr. Knight plans to expand the financial support program that his team looked at in the study. The pro bono financial planners were popular with patients, and Dr. Knight and the Foundation for Financial Planning wants to make this service available to patients in a virtual setting. In the meantime, Dr. Knight wants to encourage a dialogue between doctors and patients about finances.
“Patients experiencing any financial concerns should immediately report them to their medical team, as we show improvement in all aspects of patient life with financial intervention,” Dr. Knight says. “There are tremendous resources focused on this issue at LCI, so they should not be shy about voicing any concerns.”
