Approximately 50% of patients with cancer will experience financial toxicity as a result of their diagnosis and treatment. Early financial toxicity screening and triage should be implemented to mitigate patients’ physical, psychological, and economic distress, according to the Oncology Nursing Society (ONS) Standards for Oncology Practice.

In a poster presentation at the 48th Annual ONS Congress, Katie Muse, DNP(c), MSN, MS, RN, OCN®, a nurse manager at Baylor St. Luke’s Medical Center in Houston, Texas, described a clinical practice guideline for financial toxicity screening, and outlined steps for its implementation.

The guideline includes 3 objectives to guide a multidisciplinary team in the oncology setting to appropriately screen for financial toxicity in patients and refer them to appropriate staff or services, as needed:

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  • Equip ambulatory oncology staff with basic knowledge for needs identification in oncology patients
  • Provide prompt, evidence-based care to oncology patients in the ambulatory setting
  • Conduct screening with a standardized, evidence-based tool and manage the results to enable referral of patients for support services

The author recommends using a validated tool, such as the Comprehensive Score of Financial Toxicity (COST) tool, embedded in the electronic health record. Clinical and support staff can use the results of this tool determine a patient’s need for referral and guide them toward resources that can help them.

Successfully implementation of the guideline requires a multidisciplinary team that includes key stakeholders who are likely to play a significant role in the implementation. This team should include information technology support to improve migration of the COST tool into the electronic health record.

Additional considerations include an awareness that some patients may be embarrassed about the prospect of sharing financial information and may become sad or frustrated.

Staff should also develop and implement a referral system that includes a variety of services, such as palliative care interventions, expanded referrals to community resources and assistance programs, psychological coaching, and others.

An additional recommendation is for the organization review the guideline annually, and update as necessary for clinical applicability.

Muse K. Clinical practice guideline development: managing financial toxicity in oncology patients. Poster presentation at: 48th Annual ONS Congress; April 26-30, 2023; San Antonio, TX.