Results from the randomized nationwide CREDIT trial showed that a financial navigation support program does not broadly reduce financial hardship for people being treated for advanced cancer. However, it can help a subgroup of people: those with existing financial and social resources that make them stable enough to benefit from this additional support. The research will be presented at the 2026 ASCO Quality Care Symposium (Abstract 634).
About the Study
“Most people with cancer experience financial hardships, which are associated with worse quality of life and poorer survival. Our study is one of the first large national randomized studies testing the impact of a comprehensive financial navigation intervention on financial and other outcomes in people with cancer. It investigates how to move beyond simply measuring and quantifying the financial impact of cancer to addressing it in a way that helps mitigate the financial burden,” said lead study author Veena Shankaran, MD, MS, a medical oncologist at Fred Hutchinson Cancer Center.
The CREDIT trial evaluated whether 6 months of financial navigation support can reduce financial toxicity. It included 329 participants with advanced cancer, which often requires high-cost, long-term therapy. The median age of participants was 62 years, half were female, half had private insurance, and one-third had Medicare coverage.
Participants in the control group (n = 165) received educational videos about financial literacy, while those in the financial navigation group (n = 164) received the same videos and had six monthly remote meetings with financial navigators.
Key Findings
The trial assessed participants’ financial status using self-reported data from the Comprehensive Score for Financial Toxicity (COST) questionnaire and events noted in their credit reports, including new loans, payment delinquencies, bankruptcy, among other factors. Twelve months after the program began, according to credit reports, 47% of people in the financial navigation group and 50% of people in the control group faced financial hardship. The difference was not statistically significant.
The mean COST score was 24 in the financial navigation group and 23 in the control group. Financial strain was defined as a COST score of 26 or less.
Participants with greater financial and social capacity who received financial navigation support were 52% less likely to have financial hardship than those who did not get the support. Financial and social capacity was defined as having four or more of six characteristics that researchers selected: having private insurance, emergency savings, higher education, caregiver support, and nonrecurrent disease, and being female.
Next Steps
The researchers are continuing to analyze the data to see how closely participants followed the program and whether this adherence impacted the trial’s results. They are also evaluating if the program affected other aspects of cancer care, including treatment adherence, caregiver burden, quality of life, and hospital visits.
Future research might evaluate baseline characteristics to help group patients for financial support at the time of diagnosis. Because navigation support was not enough for people at the highest risk, future studies could evaluate other support models designed specifically for this group. The researchers are already investigating alternative financial support options to see what models might successfully fill the gaps.
Expert Perspective
“This study emphasizes the financial strain that a diagnosis of cancer can cause. Half of participants experienced significant financial strain following a diagnosis of cancer, even with a structured intervention. Encouragingly, a subgroup of people with attributes that made them more likely to benefit from navigation support were identified, which will help inform future research that is needed to support this vulnerable population as they navigate a terrifying time in their life,” said Joel Saltzman, MD, FASCO, Vice Chair of Regional Oncology at the Cleveland Clinic and an ASCO Expert in health services research.
DISCLOSURE: This work was funded by grants from the National Cancer Institute. For full disclosures of the study authors, visit coi.asco.org.
