Preliminary Results from the Guaranteed Income and Financial Treatment (GIFT) Trial: Impacts of Unconditional Cash Transfers on Financial and Health Outcomes in Medicaid Beneficiaries with Advanced Cancer

Background:
Low-income individuals with advanced cancer face disproportionate financial hardship due to high out-of-pocket costs, income loss, and limited access to social safety net supports. Financial toxicity—defined as the material, psychological, and behavioral burden of cancer-related costs—is associated with lower quality of life, reduced treatment adherence, and worse survival. Guaranteed income programs, which provide unconditional cash transfers, have been proposed as a structural intervention to mitigate financial hardship among medically vulnerable populations. The Guaranteed Income and Financial Treatment (GIFT) Trial is the first randomized controlled trial to evaluate the impact of a guaranteed income on financial and health outcomes in cancer patients.

Methods:
GIFT is a two-arm randomized controlled trial enrolling 250 Pennsylvania Medicaid beneficiaries with advanced cancer receiving care at academic and community cancer centers in Philadelphia. Participants were randomized 1:1.5 to receive either: (1) $1,000 per month in unconditional cash payments for 12 months (intervention), or (2) usual care (control). This preliminary analysis assesses short-term outcomes at 3 months post-baseline. Primary outcomes include financial toxicity (measured using the Comprehensive Score for Financial Toxicity (COST), and secondary outcomes include health-related quality of life (HRQoL), anxiety and depression (measured using Hospital Anxiety and Depression scales), and food security (USDA 6-item short form). T-tests were used to compare within and between group changes in primary outcomes.

Results:
At 3 months, 51% of participants completed follow-up assessments. The groups were balanced on sociodemographic and outcome measures. Compared to the control group, the intervention group showed greater reductions in financial toxicity (mean COST score change: intervention = -5.3, control = -1.27 p < .001) and food insecurity (mean FS score change: intervention = -0.98, control = + 0.15 p < .001) Significant improvements were also observed in HRQoL domains of energy/fatigue and pain among intervention participants.

Conclusions:
Preliminary findings from the GIFT Trial suggest that unconditional monthly cash transfers may significantly reduce financial toxicity and improve health-related quality of life and food security within 3 months. These results underscore the potential of guaranteed income as a scalable, non-medical intervention to address structural determinants of health in oncology. Longer-term follow-up and cost-effectiveness analyses are underway to inform policy and practice implications.