Financial Toxicity Tumor Board approach provides relief from cancer treatment costs

Financial toxicity, the financial distress linked to cancer treatment, significantly impacts patient outcomes. To combat this, the Atrium Health Levine Cancer Institute established a Financial Toxicity Tumor Board in 2019. 

The board is the first known institutional-level intervention of its kind, functioning like a traditional disease-focused multidisciplinary tumor board, but with a singular focus on financial distress. It includes participants from all areas of the cancer center including clinical, supportive and administrative domains. 

A new study published online in the Journal of the National Comprehensive Cancer Network analyzes the board's impact over the past five years. 

Financial toxicity significantly impacts the quality of life and overall well-being of cancer patients. It has also been linked to reduced treatment effectiveness and an increased risk of death."

Thomas G. Knight, M.D., chair of the Financial Toxicity Tumor Board, oncologist at Atrium Health Levine Cancer, and clinical associate professor in the division of hematology and oncology at Wake Forest University School of Medicine

The board consists of two main parts. The first involves participant referrals, made by patients, family members, caregivers, physicians, nurses, social workers, financial counselors, pharmacists and staff. The second part involves the Patient Assistance Program, which was created to systematically review each new treatment plan to see if patients qualify for free medication or help with copays. Pharmacy technicians also assist with this process. 

Key findings from the study include: 

• Over 70 cases were presented to the tumor board with over 90% resulting in immediate solutions for individual patients and systemic changes. 

• 9,321 patients were assisted with copay assistance, totaling over $10 million in savings to the patients. 

• 16,495 patients received free drugs, valued at nearly $393 million.

The board established a process for patients to apply for grants from various foundations and nonprofits. Financial navigators kept records of available grants and assisted patients with applications, providing financial relief to many struggling to afford treatments. 

The board also addressed denied health insurance claims, investigating reasons for denials and advocating for patients. This led to many claims being approved, ensuring necessary coverage without financial hardship. 

"To show the uniqueness of our model, consider a patient who loses their employer-based insurance because they are unable to work. There's difficulty paying for treatment, transportation and household expenses," Knight said. "After the case is presented, the board obtains transportation, food and expense grants, in addition to COBRA." 

Knight also highlighted how helping one patient can help others. 

"The real value of this model is that all stakeholders are in the room together and can recognize this is a foreseeable problem for other patients with a similar circumstance," Knight said. "We can then form a workgroup to identify patients in those similar circumstances and intervene before they get into a crisis." 

Knight said that the out-of-pocket cost savings for patients justify the need for other cancer centers to explore this same approach. 

"Our analysis shows that focused systemic intervention on financial toxicity can lead to substantial improvements," Knight said. "This model should become a new standard of care to improve the financial well-being of cancer patients."