A financial navigation intervention was associated with significant reductions in financial toxicity among patients with cancer across rural and nonrural oncology practices, according to findings from the Lessening the Impact of Financial Toxicity (LIFT) trial reported by Wheeler et al in the Journal of Clinical Oncology. The investigators evaluated the effectiveness of a patient-centered financial navigation program designed to help patients access financial assistance and manage cancer-related costs.
Study Details
The pragmatic, single-arm, hybrid II implementation-effectiveness trial was conducted at eight oncology practices across North Carolina, including four rural and four nonrural sites. Eligible participants were adults with any cancer type who were within 5 years of diagnosis or living with advanced disease, understood English, and had moderate-to-severe financial toxicity, defined as a score of ≤ 22 on the Comprehensive Score for Financial Toxicity (FACIT-COST).
The intervention was delivered by trained financial navigators, including social workers, financial counselors, and oncology nurse navigators. Participants underwent a comprehensive financial assessment, followed by individualized assistance identifying resources, completing financial assistance applications, and monitoring their progress. Follow-up appointments occurred approximately every 2 to 3 weeks, either in person or remotely. The median intervention duration was 5 months.
The primary endpoint was the change in FACIT-COST score from baseline to follow-up. Scores range from 0 to 44, with higher scores indicating less financial toxicity; a 5-point increase is considered clinically meaningful. Secondary outcomes included intervention uptake, patient satisfaction, perceived usefulness, and alignment with patient needs.
Key Results
Of 258 patients who consented, 233 screened positive for moderate-to-severe financial toxicity, 179 received financial navigation, and 134 completed baseline and follow-up assessments. Among the 134 participants included in the primary analysis, the mean age was 53 years, 65.7% were women, and 39.6% lived in rural areas. Most (81.1%) reported annual household incomes below $36,000. The most common cancer diagnoses were breast cancer (39.6%), leukemia or lymphoma (14.2%), and lung cancer (13.4%).
Following the intervention, mean FACIT-COST scores increased significantly from 6.6 at baseline to 14.7 at follow-up, representing an average improvement of 8.1 points (P < .001). Significant improvements were observed at both rural (6.3 points, P < .001) and nonrural sites (9.3 points, P < .001). Improvements were also observed among insured (5.6 points, P < .001) and uninsured participants (15.9 points, P < .001).
A total of 260 financial assistance applications and referrals were submitted. The most common involved charitable foundations (50.0% of participants), Supplemental Security Income or Social Security Disability Insurance (35.1%), and Medicaid enrollment assistance (28.4%).
Patient-reported satisfaction was high: 89.3% were satisfied with the intervention, 86.6% reported a better understanding of available financial assistance, and 83.9% found it easier to understand how to apply for assistance. Additionally, 61.6% reported fewer financial worries, and 93.6% would recommend the program to others.
“Patient-centered interventions like [financial navigation] can clearly reduce [financial toxicity] in diverse patient populations across clinical settings and should be considered best practice,” the authors concluded.
Stephanie B. Wheeler, PhD, MPH, of the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, and Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
