||1R01CA240092-01 Interpret this number
||Univ Of North Carolina Chapel Hill
||Addressing Cancer-Related Financial Toxicity in Rural Oncology Care Settings
PROJECT SUMMARY & ABSTRACT
Financial toxicity (FT), a term used to describe the high cost and cost-related psychosocial burden that cancer
care places on patients and their families, is a major and underappreciated problem affecting at least 20% of all
cancer patients, with potentially devastating effects on outcomes. FT disproportionately affects patients in rural
settings due to multiple socioeconomic, access, and clinical factors. A recent review of cancer-related financial
hardship characterized the burden of FT as belonging to one of three domains: (1) material hardship, including
high out-of-pocket expenses and lost wages; (2) psychological burden from distress and anxiety caused by high
cancer costs; and (3) behavioral changes resulting from high cancer care costs, including changes in both
medical and non-medical spending. Across cancer sites and stages, the considerable material hardship caused
by cancer has been linked consistently to negative psychological and behavioral outcomes, including lower
health-related quality of life, higher emotional distress, treatment delay/discontinuation, and filing for bankruptcy.
Importantly, FT is also associated with increased mortality. Harmful psychological effects and care-altering
behavioral responses, such as delaying or foregoing treatment, are more common in rural patients who also face
considerable geographic barriers to care and greater financial vulnerability (e.g., lack of health insurance), likely
contributing to widely-observed rural/urban disparities in cancer mortality. Interventions are urgently needed to
prevent and mitigate high FT for cancer patients living in rural areas. Our prior work with patients, cancer care
professionals, and a regional network of rural oncology practices argues strongly for intervening with financial
navigation (FN), due to the complex material, structural, and psychological needs in this setting, fragmentation
of existing financial support resources, and complicated assistance eligibility requirements. FN is one type of
evidence-based intervention implemented at the practice or system level that can identify patients at high risk
for FT, assess eligibility for existing federal, nonprofit, manufacturer, and local financial support resources, clarify
treatment cost expectations, and develop strategies to cope with high costs of care. Our long-term goal is to
improve cancer care delivery, reduce FT, and improve outcomes in underserved, rural populations through
sustainable, scalable interventions. The objectives of this application are to: (1) understand the rural oncology
practice context to optimize tailored strategies to support FN implementation; (2) assess FN intervention
implementation in rural oncology practices; and (3) evaluate the effects of FN implementation on patient
outcomes, including FT and health-related quality of life, in rural oncology practices. Our proposal is directly
responsive to RFA-CA-18-026, which seeks to “improve the reach and quality of cancer care in rural populations”.
Expected outcomes are the development and refinement of the operational and logistical processes needed to
deliver effective FN in rural settings and reduction in FT, with potential to reduce rural outcome disparities.
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