1. Nalley, Catlin

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With the growing recognition of financial toxicity, a new analysis suggests that patients at greater risk of this issue can be proactively identified through demographic factors and health care utilization metrics, according to findings released by the Society of Gynecologic Oncology (Abstract 144).

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"A number of studies demonstrate that individuals with cancer are at higher risk of experiencing financial difficulty than individuals without cancer," noted study author Emeline Mariam Aviki, MD, of Memorial Sloan Kettering Cancer Center. "Other studies have shown that cancer patients who experience financial problems have worse outcomes including a higher rate of death.


"Almost 2 years ago, as part of an initiative to improve the affordability of cancer care for patients treated at Memorial Sloan Kettering Cancer Center, a multidisciplinary team was assembled including Strategy and Innovation, Patient Financial Services, medical oncologists, radiation oncologists, and surgical oncologists," she continued.


"The goals of our initial phase of work were to develop a way to measure the prevalence of financial burden using available institutional data and to use that data to identify risk factors that we could use to proactively identify at-risk patients for future initiatives."


Research Specifics

This study sought to better understand the risk factors of financial toxicity and its prevalence among actively treated gynecologic cancer patients. The researchers used institutional data to identify gynecologic cancer patients treated between January 2016 and December 2018.


Financial toxicity was defined as the presence of one or more of the following metrics: two or more bills sent to collections, application for and granting of a time-payment plan, settlement, bankruptcy, enrollment into financial assistance programs, or documentation of a finance-related social work visit.


"Of the 5,188 patients who underwent treatment for gynecologic cancers, we found that more than 1 in 5 patients developed financial toxicity," Aviki explained. "When it comes to patient demographics, we found that younger patients, non-partnered patients, those who were Black or Hispanic, and those with commercial insurance were significantly more likely to develop financial toxicity.


"We found that increasing health care utilization was also associated with a higher risk of developing financial toxicity," she continued. "For example, with more imaging studies and more outpatient physician visits, we observed a significantly higher risk of financial toxicity."


This research highlights the need for the development of interventions to minimize financial toxicity among at-risk patients. "In any clinical study reporting that over 20 percent of patients develop a serious complication as a result of treatment, financial toxicity in this case, future efforts to address the complication are critically important," Aviki emphasized.


"Our study demonstrates that it is feasible to use demographic and health care utilization data to proactively identify patients at greater risk of financial toxicity," she explained. "This has important implications as it allows for early and targeted intervention of high-risk patients."


Aviki noted that they were surprised to see the significant increase in financial toxicity associated with patients undergoing more frequent imaging studies. "There are randomized controlled studies showing that patients with ovarian cancer do not benefit from more frequent surveillance imaging," she said. "However, many providers across the country still order scans every 3 or 4 months.


"With this new data showing increased financial toxicity in patients who undergo more frequent scans, I think many will pause before ordering their next surveillance scan or at least have the conversation with patients to make sure no financial harm is being done."


Looking Forward

Building on this work, Aviki and colleagues used the risk factors identified in their analysis to develop a risk stratification tool that will flag gynecologic cancer patients who are at increased risk of financial toxicity.


"These patients will then be proactively contacted and offered enhanced financial navigation through patient financial services," she said. "We are also working to improve provider awareness of the cost of surveillance imaging so that unnecessary and potentially financially burdensome imaging can be minimized."


When considering interventions that might reduce patient financial burden, the researchers also questioned what role providers should play in patient affordability issues.


"Many providers may believe it is unethical to be informed of their patient's risk of financial toxicity as it may affect their treatment recommendations," Aviki told Oncology Times. "Others may believe it is important for them to be fully aware of any and all treatment-related risks their patients face.


"To better understand provider perceptions regarding the extent and appropriateness of their role in patient affordability issues, we administered a survey to all MSK attendings," she said. "With over 350 responses, we look forward to using these results to inform development of provider-focused interventions and to disseminating them to the public."


Additional provider-facing interventions are currently being developed, according to Aviki, that will lean significantly on the results of this survey.


"Our MSK Affordability team believes strongly in the importance of this work and its ability to improve the lives of cancer patients and their families," she concluded.


Catlin Nalley is a contributing writer.