Curated Papers > Recent high-impact research on "AI drug discovery" (IF ≥ 30, last 5 years)

Time to add screening for financial hardship as a quality measure?

Literature Information

DOI	10.3322/caac.21653
PMID	33226648
Journal	CA: a cancer journal for clinicians
Impact Factor	232.4
JCR Quartile	Q1
Publication Year	2021
Times Cited	24
Keywords	cancer, disparities, financial hardship, quality measurement, screening
Literature Type	Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't
ISSN	0007-9235
Pages	100-106
Issue	71(2)
Authors	Cathy J Bradley, K Robin Yabroff, S Yousuf Zafar, Ya-Chen Tina Shih

TL;DR

This study highlights the growing financial burden of cancer treatment on patients and families, emphasizing the lack of routine screening and management for financial hardship in clinical oncology practices. It advocates for the implementation of financial hardship screening as a quality metric to improve patient care and reduce disparities, urging support from key stakeholders and organizations in the field.

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cancer · disparities · financial hardship · quality measurement · screening

Abstract

Cancer treatment is associated with financial hardship for many patients and families. Screening for financial hardship and referrals to appropriate resources for mitigation are not currently part of most clinical practices. In fact, discussions regarding the cost of treatment occur infrequently in clinical practice. As the cost of cancer treatment continues to rise, the need to mitigate adverse consequences of financial hardship grows more urgent. The introduction of quality measurement and reporting has been successful in establishing standards of care, reducing disparities in receipt of care, and improving other aspects of cancer care outcomes within and across providers. The authors propose the development and adoption of financial hardship screening and management as an additional quality metric for oncology practices. They suggest relevant stakeholders, conveners, and approaches for developing, testing, and implementing a screening and management tool and advocate for endorsement by organizations such as the National Quality Forum and professional societies for oncology care clinicians. The confluence of increasingly high-cost care and widening disparities in ability to pay because of underinsurance and lack of health insurance coverage makes a strong argument to take steps to mitigate the financial consequences of cancer.

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Primary Questions Addressed

1. What specific metrics could be used to evaluate the effectiveness of financial hardship screening in oncology practices?
2. How can healthcare providers be trained to effectively discuss financial hardship with cancer patients?
3. What role do patient advocacy groups play in promoting the integration of financial hardship screening into cancer care?
4. How might the implementation of financial hardship screening impact patient outcomes and treatment adherence in oncology?
5. What are the potential barriers to adopting financial hardship screening as a quality measure in clinical practice?

Key Findings

Research Background and Purpose

The rising costs of cancer treatment in the United States have led to significant financial hardship for many patients and their families, often resulting in what is termed "financial toxicity." This commentary advocates for the integration of financial hardship screening into oncology practices as a quality measure to improve patient care and outcomes. The authors aim to address the urgent need for mechanisms to mitigate financial distress associated with cancer treatment.

Main Methods/Materials/Experimental Design

The authors propose a systematic approach to develop and implement a financial hardship screening tool within oncology practices. The following steps outline the proposed process:

The screening tool will assess various domains such as insurance adequacy, out-of-pocket expenses, and the impact of financial burden on employment and treatment adherence. The tool will be integrated into clinical workflows and complemented by a management plan that includes referrals to financial assistance resources.

Key Results and Findings

1. Financial Hardship Prevalence: The commentary highlights that financial hardship is prevalent among cancer patients, with many facing increased household debt and reduced quality of life.
2. Impact on Treatment: Financial distress correlates with treatment delays, abandonment, and reduced adherence to care protocols, ultimately affecting cancer survival rates.
3. Existing Practices: While some oncology centers have begun implementing financial screening, practices vary widely, indicating a need for standardized measures.

Main Conclusions/Significance/Innovation

The authors conclude that incorporating financial hardship screening as a quality metric in oncology practices is essential for improving patient care. By formalizing discussions around treatment costs and providing appropriate referrals, healthcare providers can alleviate financial burdens, enhance treatment adherence, and improve overall patient outcomes. This approach is innovative as it shifts the focus from solely clinical outcomes to include financial well-being as a critical component of quality cancer care.

Research Limitations and Future Directions

1. Implementation Challenges: The successful integration of financial screening into clinical workflows may face resistance from providers due to time constraints and perceived additional burdens.
2. Need for Standardization: Variability in current practices suggests that without a standardized approach, efforts to address financial hardship may be ineffective.
3. Future Research: Further studies are needed to evaluate the effectiveness of financial navigation programs and to develop a robust evidence base for the proposed screening tools.

The authors advocate for ongoing research and collaboration among stakeholders, including healthcare providers, patients, and insurers, to refine and implement effective financial hardship screening and management strategies in oncology care.

References

1. Health Insurance Literacy and Financial Hardship in Women Living With Metastatic Breast Cancer. - Courtney P Williams;Maria Pisu;Andres Azuero;Kelly M Kenzik;Ryan D Nipp;Monica S Aswani;Stephen T Mennemeyer;Jennifer Y Pierce;Gabrielle B Rocque - JCO oncology practice (2020)
2. Patient and plan characteristics affecting abandonment of oral oncolytic prescriptions. - Sonya Blesser Streeter;Lee Schwartzberg;Nadia Husain;Michael Johnsrud - Journal of oncology practice (2011)
3. Oncology navigators' perceptions of cancer-related financial burden and financial assistance resources. - Jennifer C Spencer;Cleo A Samuel;Donald L Rosenstein;Katherine E Reeder-Hayes;Michelle L Manning;Jean B Sellers;Stephanie B Wheeler - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2018)
4. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. - Marie A Bakitas;Tor D Tosteson;Zhigang Li;Kathleen D Lyons;Jay G Hull;Zhongze Li;J Nicholas Dionne-Odom;Jennifer Frost;Konstantin H Dragnev;Mark T Hegel;Andres Azuero;Tim A Ahles - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2015)
5. Is Health Insurance Literacy Associated With Financial Hardship Among Cancer Survivors? Findings From a National Sample in the United States. - Jingxuan Zhao;Xuesong Han;Zhiyuan Zheng;Matthew P Banegas;Donatus U Ekwueme;K Robin Yabroff - JNCI cancer spectrum (2019)
6. Financial Support Models: A Case for Use of Financial Navigators in the Oncology Setting. - Daniel Sherman;Kristen L Fessele - Clinical journal of oncology nursing (2019)
7. Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions. - Nandita Khera;Jessica Sugalski;Diana Krause;Richard Butterfield;Nan Zhang;F Marc Stewart;Robert W Carlson;Joan M Griffin;S Yousuf Zafar;Stephanie J Lee - Journal of the National Comprehensive Cancer Network : JNCCN (2020)
8. Cancer Drugs: An International Comparison of Postlicensing Price Inflation. - Philip Savage;Sarah Mahmoud;Yogin Patel;Hagop Kantarjian - Journal of oncology practice (2017)
9. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. - Ethan Basch;Allison M Deal;Amylou C Dueck;Howard I Scher;Mark G Kris;Clifford Hudis;Deborah Schrag - JAMA (2017)
10. Changes in Insurance Coverage and Access to Care for Young Adults in 2017. - Kevin N Griffith - The Journal of adolescent health : official publication of the Society for Adolescent Medicine (2020)

Literatures Citing This Work

1. Medical Financial Hardship in Survivors of Adolescent and Young Adult Cancer in the United States. - Amy D Lu;Zhiyuan Zheng;Xuesong Han;Ruowen Qi;Jingxuan Zhao;K Robin Yabroff;Paul C Nathan - Journal of the National Cancer Institute (2021)
2. Financial Hardship in Adolescent and Young Adult Oncology: The Need for Multidimensional and Multilevel Approaches. - John M Salsman;Sheetal M Kircher - JCO oncology practice (2022)
3. Patient-reported benefit from proposed interventions to reduce financial toxicity during cancer treatment. - Emeline M Aviki;Bridgette Thom;Kenya Braxton;Andrew J Chi;Beryl Manning-Geist;Fumiko Chino;Carol L Brown;Nadeem R Abu-Rustum;Francesca M Gany - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2022)
4. Strategies to Mitigate Chemotherapy and Radiation Toxicities That Affect Eating. - Peter M Anderson;Stefanie M Thomas;Shauna Sartoski;Jacob G Scott;Kaitlin Sobilo;Sara Bewley;Laura K Salvador;Maritza Salazar-Abshire - Nutrients (2021)
5. Treating the Whole Patient With Cancer: The Critical Importance of Understanding and Addressing the Trajectory of Medical Financial Hardship. - K Robin Yabroff;Ya-Chen Tina Shih;Cathy J Bradley - Journal of the National Cancer Institute (2022)
6. Financial toxicity impact on younger versus older adults with cancer in the setting of care delivery. - Kelsey L Corrigan;Shuangshuang Fu;Ying-Shiuan Chen;Kelsey Kaiser;Michael Roth;Susan K Peterson;Ya-Chen T Shih;Reshma Jagsi;Sharon H Giordano;Robert J Volk;K Robin Yabroff;Mathew P Banegas;Chiara Acquati;Rena M Conti;Hilary Y Ma;Kimberly Ku;Y Nancy You;Grace L Smith - Cancer (2022)
7. Policies and Practices to Address Cancer's Long-Term Adverse Consequences. - Cathy J Bradley;Sara Kitchen;Smita Bhatia;Julie Bynum;Gwen Darien;J Leonard Lichtenfeld;Randall Oyer;Lawrence N Shulman;Lisa Kennedy Sheldon - Journal of the National Cancer Institute (2022)
8. Financial Hardship in Adult Survivors of Childhood Cancer in the Era After Implementation of the Affordable Care Act: A Report From the Childhood Cancer Survivor Study. - Paul C Nathan;I-Chan Huang;Yan Chen;Tara O Henderson;Elyse R Park;Anne C Kirchhoff;Leslie L Robison;Kevin Krull;Wendy Leisenring;Gregory T Armstrong;Rena M Conti;Yutaka Yasui;K Robin Yabroff - Journal of clinical oncology : official journal of the American Society of Clinical Oncology (2023)
9. Defining the Role of the Modern Oncology Provider in Mitigating Financial Toxicity. - Christopher T Su;Veena Shankaran - Journal of the American College of Radiology : JACR (2023)
10. Knowledge, Attitudes, and Resources of Frontline Oncology Support Personnel Regarding Financial Burden in Patients With Cancer. - Katherine E Reeder-Hayes;Caitlin B Biddell;Michelle L Manning;Donald L Rosenstein;Cleo A Samuel-Ryals;Jennifer C Spencer;Sophia Smith;Allison Deal;Mindy Gellin;Stephanie B Wheeler - JCO oncology practice (2023)

... (14 more literatures)

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