Amid ‘ever-escalating’ costs in cancer care, experts say its ‘imperative’ radiology screens for financial toxicity
Amid “ever-escalating” costs in cancer care for patients, experts believe it’s becoming “imperative” that radiologists and radiation oncologists help screen for signs of financial toxicity, according to new research published Thursday.
However, despite this dire need, there is wide variability in such processes, including the timing, setting, tools utilized and interpretation of the results. Researchers are calling for more uniformity in this space during a time when payers are increasingly shifting costs to patients in the form of premiums, deductibles and copayments.
“There is a wide gap in integrating routine assessment and management of [financial toxicity] in cancer care,” Northwestern University radiation oncologist Laila A. Gharzai, MD, and co-authors wrote May 16 in the Journal of the American College of Radiology [1]. “As all cancer patients routinely undergo imaging before treatment decisions, incorporating FT screening into radiologic processes could enable an early assessment of patients’ financial status and facilitate the integration of FT considerations into treatment decisions. Radiation oncology care, which involves daily or frequent treatments, may serve as a critical touchpoint for continuous FT evaluation over time.”
For their analysis, Gharzai et al. performed a systematic review of literature on financial toxicity measurement tools, along with related practices and patient risk factors. Their hope is to best inform “effective and widespread FT screening implementation pathways.” Patients with financial hardship also experience corresponding poorer health-related quality of life, decreased treatment adherence, greater symptom burden, and increased risk of death, the authors noted.
Their search turned up a total of 1,085 studies with 51 meeting the inclusion criteria. Gharzai and colleagues found wide variability in the timing of when providers measured financial toxicity—some do so during cancer treatment (33%), others at survivorship (28%) or both (29%). Only four studies measured FT at the time of diagnosis in addition to during treatment and/or survivorship (8%). Most gauged this concern at a single time point (90%).
Similarly, the study discovered variation in where providers screened for FT. Most do so in clinical settings or online (28%). Other studies also administered surveys by phone, mail or using mixed methods. All analyses used patient-facing surveys or questionnaires, and about half deployed unique, investigator-developed tools. Interpretation methods and cutoff scores also varied, the authors noted. Younger age, lower income, poor educational attainment levels, nonwhite race, employment status change, advanced cancer stage and systemic/radiation therapy were some of the factors associated with worse financial toxicity.
“While there is wide variability in FT screening practices in the U.S., our findings suggest that there is an unmet need for identifying optimal measures that can be deployed to meet a variety of clinical settings, to allow for identification of patients at risk of financial toxicity throughout treatment and survivorship,” the authors wrote in the study’s take-home points section. “Future interventions at the organizational, interpersonal, and individual levels are needed to promote effective, widespread and sustainable FT screening,” they added later.
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Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.