Tumor boards are common at cancer hospitals, comprised of specialists who create treatment plans that draw upon several areas of expertise. But at Atrium Health Levine Cancer Institute, one tumor board extends this concept beyond clinical care to address an important issue: the financial burden of cancer.
The Financial Toxicity Tumor Board (FTTB) is made up of a multidisciplinary team – including physicians, nurses, financial counselors, nurse navigators, social workers, pharmacy personnel and administrators – who help patients navigate complex financial difficulties related to cancer treatments. It’s the first tumor board of its kind.
Recent innovations in cancer treatments, such as targeted therapies, immunotherapy, and CAR T-cell therapy, mean more cancer patients are becoming long-term survivors. But the costs of some treatments mean that financial distress, also known as “financial toxicity,” is a growing problem nationally. In the U.S., cancer patients face one of the most expensive medical conditions to treat – as well as side effects that can interfere with their ability to work.
“We set up the Financial Toxicity Tumor Board because we’re finding that there are more patients facing financial distress, and the problems they’re facing are becoming more complex,” says Derek Raghavan, MD, PhD, FACP, FRACP, president of Levine Cancer Institute. “For example, someone with health insurance who has a 10% copay may be used to spending $10 on a $100 visit. But when that person has a $1 million set of treatments, that comes to $100,000, which can be crippling. It can be the cost of a college education or it can mean mortgaging a house.”
According to Dr. Raghavan, the costs of treatment aren’t set by cancer centers – they’re controlled by the pharmaceutical industry. To make an impact, he knew Levine Cancer Institute needed a unique approach. That’s why Dr. Raghavan approached Nicole Keith, a member of Atrium Health’s Business Operations team, to help develop a new tumor board focused on avoiding patient expenditure: the FTTB.
In just two years, the FTTB has helped nearly 2,000 Levine Cancer Institute patients save more than $60 million in personal expenses, in addition to $1.3 million in copay assistance for financially challenged patients.
‘This Program is So Needed’
Through financial counselors and nurse navigators, Levine Cancer Institute already offered patients support for financial challenges. But now, more complex problems are referred to the FTTB.
The FTTB meets monthly to assist individual patients who face complex financial problems. The board’s problem solving may lead to copay assistance, an introduction to a foundation that can help the patient, or assistance navigating complex or evolving insurance rules. All patients and their families, as well as the clinical team, have access.
Working in tandem with the FTTB is the Patient Assistance Program, led by Donna Feild, vice president of Atrium Health’s Department of Pharmacy. The program, a collaboration between Levine Cancer Institute and the Department of Pharmacy, offers a systematic approach to review each patient’s eligibility for relief in dealing with drug costs and copays.
Feild knows firsthand how important this kind of support can be. When she got a 2 a.m. phone call and saw her mom’s name light up the caller ID, her heart stopped. Her mom – who was in cancer treatment in Georgia at the time – never made late-night calls.
Her mom called while holding a bill for her cancer treatments. She cried that the bill was so high that she feared she’d lose her home. Feild calmed her and told her she’d do whatever was needed to take care of that bill and make sure she kept her home – and she did.
That call came about 15 years ago, but it inspires Feild’s work today. She is part of a groundbreaking initiative to help patients alleviate the financial burden of cancer.
“This work is personal to me because I experienced it with my mom. And it’s personal to every patient,” Feild says. “When you have cancer, you shouldn’t need to worry about money. You need to worry about getting yourself well, getting through the treatment, and hopefully, getting cured.”
Through the Patient Assistance Program, dedicated pharmacy technicians embed their services in doctors’ offices, handling prior authorizations for oral medications. Another group of pharmacy technicians works on obtaining free infusion drugs and copay assistance.
The Patient Assistance Team also ensures that the correct drugs are authorized for each patient. Because insurance companies have different rules for which drugs and biosimilar drugs they cover, this is crucial work: Not getting the right prior authorization for the right drug could leave patients with bills in the tens of thousands of dollars. Without these programs, much of this work would be done by nurses; by shifting this work to pharmacy technicians, nurses can focus on what they love to do: caring for their patients.
“This program is so needed. The cost of cancer care is so expensive,” Feild says. “Even if you have insurance, it’s still a significant financial burden. And if you don’t have insurance, it’s even harder.”
The collaboration provides patients with expert support. One of the first patients the FTTB supported was a 64-year-old pancreatic cancer patient. While the patient’s insurance company initially advised that it didn’t need precertification for their chemotherapy treatment, it later turned out that a single drug in the regimen actually did require precertification by the patient’s pharmacy benefits. This misunderstanding meant an unexpected $42,000 bill. Through the FTTB, however, a financial counselor secured retroactive and ongoing precertification for the entire course of treatment – effectively eliminating the patient’s $42,000 bill.
A Model for the Future
Even though financial challenges due to cancer treatment are common, some patients still feel a stigma about needing help. But without support, these financial challenges can become physical and mental health challenges as well. A study by the Association of Oncology Social Workers revealed that two-thirds of cancer patients who have financial distress suffer from depression or anxiety.
“I haven’t met a patient out there who doesn’t worry about the financial aspect of cancer,” Feild says. “It doesn’t matter what your income is. The cost of medical care can be very high at times, and there is no shame at all in taking advantage of programs that are meant to help you.”
Dr. Raghavan has heard from other hospitals that want to start their own Financial Toxicity Tumor Boards, and he believes the concept that began at Levine Cancer Institute could be adapted to any hospital and for many conditions.
“There's absolutely no reason why this principle couldn't be applied to heart disease or surgery or anything else that might have expensive therapies associated with it,” Dr. Raghavan says. “We see this as a model for the future.”
The board is an extension of the belief at Levine Cancer Institute that supporting the patient – not just treating the cancer – belongs at the center of all the work that’s done by providers and staff.
“What I love about the concept of the Financial Toxicity Tumor Board is that it takes people of all disciplines: nurses, physicians, finance counselors, pharmacists, nurse navigators,” Feild says. “Everybody works together toward one common goal: helping ensure patients who have a significant financial burden get help.”
To learn more about Levine Cancer Institute’s Financial Toxicity Tumor Board, email Media@AtriumHealth.org.
