The Health Care Mortgage: Understanding the Complexities of Financial Toxicity

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Many oncologists fail to provide adequate guidance to patients and their families about financial issues.
Many oncologists fail to provide adequate guidance to patients and their families about financial issues.
The following article features coverage from the 2018 Oncology Nurse Advisor Navigation Summit. Click here to read more news highlights and expert perspective from the Summit on Oncology Nurse Advisor. 

After a cancer diagnosis, patients and their families face many stressors, including the possibility of significant short-term and long-term financial consequences. Rising premiums, deductibles, coinsurance, and co-payments for oncology treatments expose patients to significant out-of-pocket (OOP) health care spending. These direct medical costs, in combination with the indirect costs related to patients' and families' decreased work hours or loss of employment, create a perfect storm for financial devastation. However, unlike clinical toxicities, financial toxicity is a potentially devastating consequence of cancer treatment that patients have often been left to manage on their own.

Many have argued that a critical step in addressing the financial side effects of cancer care is improving communication about costs between patients and oncologists. However, most oncologists fall short in providing adequate guidance to patients and their families about financial issues. In fact, although a majority of oncologists feel that it is important to discuss how treatment may affect financial well-being, nearly one-third feel uncomfortable doing so and one-fifth do not think that cost should ever be considered when making treatment decisions. Improving cost communication between patients and oncologists is therefore not sufficient in order to truly address financial issues; clinics must either collaborate with outside organizations that have expertise in financial counseling and medical costs or invest in internal financial navigation resources to provide consistent and proactive financial support to all patients beginning at diagnosis. Despite this, however, it is often the case that the work of financial navigation frequently falls on poorly trained staff who do not have the required education or credentials to be able to offer true expertise in dealing with the complexities of financial toxicity.

Financial toxicity can have far-reaching impacts on treatment adherence and the emotional wellbeing of the patient and the psychological and there are practical characteristics of financial toxicity that should be taken into account when working with patients struggling with this issue. To properly address financial toxicity, the financial navigator should have some basic understanding of the psychology behind the distress as well as understanding the many solutions available that help alleviate the cost burden for the patient.  Some practical solutions include proactive engagement, insurance optimization, and optimization of external assistance programs.

The benefits of a financial navigation program are substantial. Not only can it reduce an individual patients' financial burden and increase profit margins, it can also alleviate patient distress, improve access to care, and improve patient satisfaction scores. As the statistical data related to financial toxicity in the oncology setting continue to grow, cancer programs should explore the current health of their financial advocacy program and evaluate if improvements are needed.

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