“In much the same way as physical side effects of treatment like fatigue or cognitive changes, financial problems after cancer diagnosis are a major contributor to higher levels of stress, decreased quality of life, treatment nonadherence, and delayed medical care,” she said.

Burbage, an oncology clinical nurse specialist from Delaware, explained that some patients or families are forced to spend their savings, rely on credit, buy less food, and even file for bankruptcy. Often, patients make treatment decisions because of financial limitations, such as spreading out appointments beyond recommended intervals, delaying care, stopping medications, and declining tests.

Oncology Nurses’ Role in Managing Financial Barriers to Care

• Just as oncology nurses intervene to manage physical side effects, they can help to reduce financial toxicity:
• Identify patients at risk and refer them to available resources in the practice setting and community.
• Normalize financial concerns by talking about finances as part of holistic assessment.
• Reassess financial concerns throughout treatment as circumstances change over time.
• Address insurance and financial information at tumor board meetings.
• Discuss with pharmacists ways for patients to get lower-cost medications.

A Tactical Approach

Dan Sherman, MA, LPC, of Mercy Health, Saint Mary’s, in Grand Rapids, MI, said that many patients want to discuss costs of treatment but few end up having the right conversations to help.

To facilitate such talks, some institutions employ financial counselors, financial advocates, social workers, and financial nurse navigators, but sometimes the responsibility lies with oncology nurses. Sherman offered an acronym—TREAT—to help them remember the essential elements:

• Team
• Requires expertise
• Enhance insurance
• Assistance programs
• Tactical approach

“Financial navigation seeks to solve financial distress not just where the financial problem is currently, but to where the patient will end up on their healthcare journey,” he said.

Sherman mentioned software that helps healthcare teams reduce financial hardships for patients, such as AssistPoint, TailorMed, Vivor, and FundFinder. In addition, he suggested several training resources for healthcare professionals:

• Financial Advocacy Bootcamp, Association of Community Cancer Centers
• Local State Health Insurance Assistance Program
• Triage Cancer
• NaVectis Financial Navigation Training Program

Charitable Foundations

Ayesha Azam, MSHIA, vice president of medical affairs at the Patient Access Network (PAN) Foundation, said that charitable foundations “provide a safety net for low-income Medicare beneficiaries.” The national nonprofit organizations are funded by donations and offer three types of assistance for patients:

• Medication assistance (e.g., deductibles, copays, coinsurance)
• Health insurance premium assistance
• Travel assistance (e.g., transportation, ancillary expenses)

Azam explained that assistance is available on a first-come, first-served basis. Foundations are open or closed based on availability of funds. Nurses can monitor available programs at fundfinder.panfoundation.org (https://fundfinder.panfoundation.org/).

Three R’s of Financial Assessment

Although best practices are not yet developed, Burbage offered guidance:

• Recognize by asking, “Some of my patients have expressed concerns about how to pay for treatment. Is this a concern of yours?”
• Recommend that patients keep track of everything (e.g., explanations of benefits, bills).
• Refer patients to a financial navigator, social worker, or billing representative.

“Financial toxicity is multifaceted and requires a team approach to identify and assist patients at risk for financial toxicity,” Azam said.