Researchers Attempt to Ease Stress Associated with Financial Burden of New Oncological Treatments

There have been new developments in cancer treatment therapy in recent years. Oral antineoplastic agents and immunotherapy have positively impacted patient outcomes, but access to these therapies comes at a cost. Patients often face stress related to the high cost of these medications, known as financial toxicity. Questions of affordability may lead to negative side effects unrelated to the cancer, impacting their quality of life, symptom burden, treatment adherence, and survival. 

To combat this, researchers at NorthShore University Health System in Evanston, Illinois, sought to improve patient education using the Quality Training Program of the American Society of Clinical Oncology (ASCO). Thomas A. Hensing, MD, of NorthShore, headed up the project and put together a multidisciplinary panel that included George Carro, RPh MS BCOP, director of oncology pharmacy services, and Anna Palafox, PharmD BCOP, a clinical pharmacy specialist, both of NorthShore. 

The goal was to provide patients with cost-related treatment information and potential risks at the time of informed consent. The project’s first phase was not successful: Researchers focused on targeted immune checkpoint inhibitors but discovered that patients were not receiving information about risks or financial support services pertaining to this treatment; their inability to make informed decisions resulted in financial distress. The team used a cause-and-effect diagram to determine why clinicians did not discuss financial risks with their patients and ultimately attributed it to a lack of appropriate educational tools and a misunderstanding of the prior-authorization process. With this in mind, researchers developed an educational tool for use during the informed-consent process; this was the first rapid-cycle plan-do-study-act (PDSA) initiative and was approved by the institution’s patient advisory board. The second PDSA initiative pertained to improving the prior-authorization process. Finally, the third PDSA initiative tracked patient distress and financial toxicity using the National Comprehensive Cancer Network’s distress and patient-reported-outcome tools.  

The rapid-cycle PDSA initiatives significantly improved outcomes. In the preintervention groups, zero patients were provided information pertaining to financial toxicity risk during the informed-consent process; in the postintervention group, 53% of patients (n=9/17) received this information. Half (n=10/20) of the preintervention group received prior authorization before starting therapy compared with nearly all patients (94%; n=16/17) in the postintervention group. After interventions, time spent achieving prior authorization was cut down significantly thanks to an optimized workflow, improved education for staff regarding financial toxicity, and the inclusion of financial advocates earlier in the process.  

The researchers plan to expand their reach to encompass all therapies, including oral chemotherapeutics. Additionally, the project shed light on the need for expanded financial assistance. This led to an increase in financial advocates at NorthShore. 

The project showed that it is possible to offer patients and providers necessary tools to discuss the high costs associated with certain cancer treatments at the time of consent. While the short-term outcomes have been primarily positive, close monitoring will be necessary to determine the long-term effects.  

During an interview with ASCO featuring pharmacy professionals, Dr. Carro spoke highly of his experience working with staff in other disciplines, noting that all the stakeholders were dedicated to improving patients’ cancer care. 

Source: HOPA News