The PFX Voice

Mike Sowinski

Survey finds that financial stress can mean real barriers to care.

Financial toxicity in cancer patients is a real risk that can even have wide-ranging effects on the patient and their financial experience. A recent survey offers support that the patient financial experience can have impacts that reach far beyond bills and payment plans.

Financial toxicity in cancer patients, the financial stress that out-of-pocket costs present to patients, affects patient wellbeing and can even contribute to an adverse event of treatment. Studies have also found that these costs can impact not only patient adherence to treatment regimens, but also increase mortality and affect the quality of life patients enjoy.

According to Specialty Pharmacy Times, COST (Comprehensive Score for Financial Toxicity) is a short questionnaire made up of 11 statements around topics including costs, concerns and resources and is designed to measure financial toxicity. A team of specialists used the survey to collect data from 233 patients who were undergoing treatment for advance forms of cancer.

The results revealed a “strong association” between a patient’s sense of financial toxicity and their use of healthcare resources. According to lead study author, Jonas de Souza, MD, MBA, “This is something we need to look for to recognize early and make sure it does not become a barrier to care.”

The Responses

For the questionnaire, patients were directed to choose one out of five possible responses for each of the questions designed to assess their level of concern. Statements such as “My out-of-pocket medical expenses are more than I thought they would be,” or “I feel financially stressed.”

Researchers examined the responses and were able to identify patients who were under financial distress. They found that this metric was a “clinically relevant patient-centered measure.” The study author also found that hospital admission had a “significant impact” on a patient’s feelings of financial toxicity — specifically when the admission count was higher than two, a reasonable finding since hospital care tends to be significantly more expensive than office-based care.

Multiple factors were found to be linked with financial toxicity including: 
  • Employment Status
  • Household Income
  • Psychological Distress
  • Number of Hospital Admissions
  • Race
Perhaps most interesting, was the fact that drug discounts did little to improve financial toxicity in cancer patients. According to de Souza,

“Usually the maker of an innovative device or the company that supplies a new drug will pick up the costs related to the investigational drug. But that did not reduce our patients’ sense of financial toxicity.”

Somewhat surprising is the fact that the survey included respondents with higher incomes who also exhibited other factors that would lean toward no financial burden. All participating patients were either insured, or had Medicare fee-for-service coverage with additional supplemental insurance that assisted with out-of-pocket expenses. The average income and educational level also came in above the national average.

The authors concluded,
“While enthusiasm surrounding modern advancements in cancer treatment is warranted, we must also acknowledge the untenable rise in treatment costs and its impact on patients. In the interim, strengthened collaboration among patients and health care stakeholders is needed to promote health care reforms that not only reward treatment innovation, but also promote high value and affordable cancer care.”

Mike Sowinski is a Regional Vice President working with Avadyne’s health system accounts to help them manage their pre-service, self-pay and bad debt programs. For more information please call 800-973-9890 or send us a note

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Topics: Patient Financial Experience