The Atrium Health Levine Cancer Institute established a Financial Toxicity Tumor Board in 2019. The board is the first known institutional-level intervention of its kind and functions like a traditional disease-focused multidisciplinary tumor board—with a singular focus on financial distress.
Now, investigators have examined the 5-year impact of the program; they published their findings in a report authored by Knight et al in JNCCN–Journal of the National Comprehensive Cancer Center.
“Financial toxicity significantly impacts the quality of life and overall well-being of [patients with] cancer. It has also been linked to reduced treatment effectiveness and an increased risk of death,” stressed lead study author Thomas G. Knight, MD, Clinical Associate Professor in the Division of Hematology and Oncology at the Wake Forest University School of Medicine, Chair of the Financial Toxicity Tumor Board, and an oncologist at the Atrium Health Levine Cancer Institute.
The Financial Toxicity Tumor Board includes participants from all areas of the cancer center—including clinical, supportive, and administrative domains—and consists of two main components:
- The first component involves participant referrals made by patients, family members, caregivers, physicians, nurses, social workers, financial counselors, pharmacists and staff.
- The second component involves the Patient Assistance Program, which was created to systematically review each new treatment plan to determine whether patients qualify for free medication or help with copays; pharmacy technicians also assist with this process.
Efficacy of the Board
Over 70 cases were presented to the Financial Toxicity Tumor Board and over 90% of them resulted in immediate solutions for individual patients as well as systemic changes. The study authors reported that 9,321 patients were provided with copay assistance, totaling over $10 million in savings to the patients, and 16,495 patients received free drugs, valued at nearly $393 million.
The tumor board established a process for patients to apply for grants from various foundations and nonprofit organizations. Financial navigators kept records of available grants and assisted patients with applications, providing financial relief to a number of those who were unable to afford treatment. The board also addressed denied health insurance claims, evaluating reasons for denials and advocating for patients. These actions led to many claims being approved, ensuring necessary coverage without financial hardship.
Conclusions
“To show the uniqueness of our model, consider a patient who loses their employer-based insurance because they are unable to work. There’s difficulty paying for treatment, transportation, and household expenses. After the case is presented, the board obtains transportation, food, and expense grants, in addition to COBRA,” Dr. Knight detailed. “The real value of this model is that all stakeholders are in the room together and can recognize this is a foreseeable problem for other patients with a similar circumstance. We can then form a workgroup to identify patients in those similar circumstances and intervene before they get into a crisis,” he added.
The authors indicated that the out-of-pocket cost savings among patients could justify the need for other cancer centers to explore the same approach.
“Our analysis shows that focused systemic intervention on financial toxicity can lead to substantial improvements,” underscored Dr. Knight. “This model should become a new standard of care to improve the financial well-being of [patients with] cancer,” he concluded.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
