The Preliminary Impact of a Cancer-Specific Financial Navigation Intervention Program across Age Groups

Background: Financial burden (FB) is common among cancer survivors who are undergoing active cancer treatment, and this may subsequently develop into financial toxicity (FT). FT is defined as the negative financial consequences resulting from cancer survivors’ exorbitant treatment costs. Without addressing FB or FT, it may adversely impact patients’ treatment adherence rates, access to care, and quality of life. Despite FT being widely documented, limited interventions have been conducted to mitigate FT. Furthermore, even though adolescent and young adults (AYAs; 15-39 year olds) and adults (i.e., 39-64) are disproportionately affected by FT than older adults (OA; 65 and above), FT interventions have not compared age effect differences. The purpose of this study is to examine the impact of a financial treatment program (FTP) on financial toxicity in cancer survivors, across age groups. We hypothesize that (1) AYAs and adults will have higher FT than OAs, and (2) participants FT, treatment adherence, and quality of life scores will improve after the FTP.

Methods: A total of 152 cancer survivors who were receiving active cancer treatment, and whose household family income fell under the 400% federal poverty line were enrolled. Participants were recruited from two urban NCI-designated cancer sites. All participants received FTP, which is inclusive of an individualized resource navigation, financial education service, and a $1000 grant that may be used towards any non-treatment expense. Participants who completed both baseline and 2-month follow-up survey were included in this analysis (N=106). The surveys collected information consisting of the FACIT Measure of Financial Toxicity (COST), Functional Assessment of Cancer Therapy – General – 7 version (FACT-G7), and treatment adherence measure.

Results: Majority of participants were roughly 69% female, 36% White, 48% African American/Black, and 4% Asian. In this sample, 18.9% were AYAs, 61.3% were adults, and 19.8% were OAs. Mean baseline COST scores were: 10.9 (SD=5.7), 9.7 (SD=7.0), 14.6 (SD=7.5), respectively. Mean follow-up COST scores were 12.3 (SD=8.3), 11.2 (SD=7.2), 19.6 (SD=7.1). Using a one-way ANOVA, a significant difference in COST scores were observed across the three groups (f=4.02, p<0.05). Mean baseline FACT-G7 scores measuring quality of life slightly increased from 12.7 (SD=5.2) to 13.0 (SD=5.9), with the greatest improvement in AYAs. At baseline, 8.6% of participants delayed or skipped getting a prescription filled because of cost and 34.3% spent less money on food, housing, utilities, transportation, or other necessities to afford their medication. At follow-up, this rate slightly decreased to 6.1% and 28.6%.

Conclusion: As hypothesized, participants FT score and treatment adherence rates increased after the FTP. Additionally, COST scores were different according to each age group, with adults experiencing the highest FT. Although quality of life did not demonstrate significant improvement, there was still a slight increase. Additionally, participant’s FT scores are still lower compared to other cross-sectional studies, even after the FTP. This indicates that additional FT interventions are needed. Furthermore, cancer patients from lower socioeconomic backgrounds and those younger than 65 years of age may require additional resources or intervention boosters.

Funding: One family foundation and social impact fund