||6R01CA248656-03 Interpret this number
||Fred Hutchinson Cancer Center
||Addressing Cancer-Related Financial Hardship Through Delivery of a Proactive Financial Navigation Intervention
‘Financial toxicity’ is a well-documented side effect of cancer diagnosis that encompasses a range of material,
psychological, and behavioral hardships such as debt, bankruptcy, financial worry, and treatment non-
adherence. Studies suggest that all patients, regardless of insurance type or socioeconomic status, are
vulnerable to adverse financial consequences following cancer diagnosis. Financial hardship can impact entire
families, most severely affecting spouse caregivers, whose assets, income, and expenses are often inextricably
linked with patients’. A number of studies have shown that, collectively, these financial hardships contribute to
disparities in patients’ quality of life and survival as well as caregivers’ well-being and ability to perform caregiving
duties. Accordingly, interventions to mitigate financial toxicity should address the shared financial concerns of
cancer patients and their spouses. Given the pressing need for such interventions in the context of rising
healthcare costs, we developed a financial navigation intervention in collaboration with: 1) Consumer Education
and Training Services (CENTS), a Seattle-based financial education and counseling organization; and 2) Patient
Advocate Foundation (PAF), a national patient navigation organization. Based on our preliminary work
demonstrating feasibility of delivering this intervention in the oncology clinic setting, we propose a prospective,
randomized pragmatic trial in which 536 cancer patient - spouse caregiver dyads will receive proactive financial
navigation or usual care. The intervention will consist of a one-time financial literacy education video, monthly
contact for six months with CENTS counselors and PAF case managers who will help the couple with the
financial aspects of cancer care, including budget management, insurance enrollment and optimization, access
to copay assistance and other resources to manage medical and non-medical out-of-pocket costs. Usual care
will also receive the one-time financial literacy video in order to standardize their experience. Our goals are to:
1) Determine the impact of a remotely-administered financial navigation program on development of material
household financial hardship, 2) Investigate whether proactive financial navigation improves patient and
caregiver psychosocial and healthcare utilization outcomes, and 3) Describe the use of financial navigation
services by financially fragile, lower income, younger, and minority race households and evaluate the
intervention’s effect in these subgroups. We will assess outcomes using survey, credit report, and medical record
data obtained at baseline, six months, and twelve months post-enrollment. The primary endpoint of this study is
incidence of household financial hardship within one year of enrollment. We expect that the results of this study
will show that proactive financial navigation improves financial, psychosocial, and clinical outcomes in cancer
patients and their spouse caregivers and should therefore be an essential component of high-quality cancer care
in the United States.
Navigating financial toxicity in patients with cancer: A multidisciplinary management approach.
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CA: a cancer journal for clinicians, 2022 Sep; 72(5), p. 437-453.