CANCER IS AN EXPENSIVE MEDICAL CONDITION, and the cost of treatment continues to rise. Studies show that for many patients, the cost of cancer care can be as devastating as the diagnosis itself. Patients prescribed some of the newest targeted therapies to treat their type of cancer may learn their treatments cost $10,000 a month or more. Large deductibles and copays add to the burden. Researchers coined the term financial toxicity to describe the distress patients and their families face when confronted by high out-of-pocket costs.
Since the 1990s, studies have shown that patient navigators can help eliminate barriers patients face in accessing high-quality cancer screening and treatment. The patient navigator movement led to programs that provide patient navigators and other health care staff with additional training in how to help patients and their families face the financial burden of a cancer diagnosis. This can include helping patients enroll in new or better health insurance programs, access pharmaceutical patient assistance programs, and find financial support for travel and housing.
Todd Yezefski, an oncologist at the Seattle Cancer Care Alliance, investigated the impact financial navigators had on 11,186 patients who were treated for cancer between 2012 and 2016 at four U.S. hospitals. The study, published in 2018 in the
American Journal of Managed Care, found that 3,572 patients learned they qualified for financial assistance after working with a financial navigator. On average, these patients saved $33,265 each year on medication through enrollment in insurance plans, premium assistance and copay assistance. The hospitals saved an average of $2.1 million per year by helping patients access these programs. Yezefski spoke with
Cancer Today about his study and the role of financial navigation in patient care.
Q: Why did you study financial navigators?
A: My mentor and my colleagues thought this would be a good way for us to dig in and do research on training programs for health care staff that could have a big impact on patients.
Q: How did you do the study?
A: We worked with a company that provides financial navigator training for health care facilities. The company, NaVectis Group, makes software that companies can use to track the services and support the navigators provide. We used the software to track what type of help patients received. This included assistance paying for medication, helping patients get free medications, enrolling patients in health insurance programs, and other services like transportation, meals or programs outside of the health care system.
Q: What did you find?
A: We found that the hospitals helped a significant percentage of the patients. Due to the demographics of each hospital population, some had more patients in need of assistance than others. But, in general, they were able to help patients get assistance for cancer care they might not otherwise have been able to afford.
Q: How common are financial navigators?
A: A lot of cancer centers and clinics do offer some sort of help, but there is variation in how sufficient it is, how much training the staff who provide navigation have and whether there are dedicated navigators. The navigators we studied were highly trained and only did financial navigation, so they knew all of the avenues of assistance they could rely upon to help patients.
Q: Did you study how the navigators affected patient outcomes?
A: We weren’t able to measure that. But we know from prior research that patients have a lot of stress related to the financial hardships of cancer and that people who have more hardships have worse outcomes.
Q: How do financial navigators help cancer centers?
A: The cancer centers were able to increase revenue. A lot of the patients, without the assistance, wouldn’t have been able to afford care. So, the hospitals may have had to provide it as charity care or provide free care. Or the patient may not have been able to get care at the hospital.
Q: So, is financial navigation a win-win?
A: Yes. Patients can access and afford care they would not have been able to get otherwise. It reduces their stress and it reduces their risk of bankruptcy. And at the same time, hospitals and cancer centers increase revenue.
Q: Should patients ask their doctors about costs?
A: Finances need to be discussed much more than they are. I work as an oncologist, and costs and affordability rarely come up in day-to-day conversation with patients. But I know that patients have it in their minds at all times.
This interview has been edited and condensed for clarity.
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March 24, 2020