Addressing Psychosocial Needs and Navigating Financial Toxicity Shared the Spotlight at ACCC

Financial toxicity and navigation constituted a major topic of interest at the Association of Cancer Care Centers (ACCC) 41st National Oncology Conference (NOC). The interplay between financial navigation, burden, and patient well-being dominated the meeting’s opening poster exhibit. Members from Cancer Support Community, Highlands Oncology Group, and others presented on their respective organization’s endeavors to advance health equity and awareness of the pertinent issues that financial toxicity creates for patients seeking out or navigating their cancer care.

Financial toxicity not only impacts patients but also can contribute to considerable administrative burden. | image credit: Kawee - stock.adobe.come

Psychosocial Support Matters

Cancer Support Community spearheaded an effort to address unmet psychosocial needs in oncology care, stressing the important role of social support for improving outcomes in cancer health. Their research considered the needs of Black and Spanish-speaking Hispanic or Latino patients, as well as patients living in rural communities, and they found that financial toxicity and care access remain great concerns.¹

Top of mind in their research was analyzing how notions of “support” tend to fall short within communities of color and those residing in rural areas because “the beliefs, values, modes of providing health care, interpersonal communication styles, and behavioral theories of White dominant culture are viewed as the norm against which all other ways of being are evaluated,” wrote Audrey Davis, MA, LPC, PM-LPC, senior director of health equity, Cancer Support Community, and colleagues.

Although medical teams do fantastic work, noted Davis, this initiative was concerned with the importance of addressing emotional health and other factors alongside medical treatment. To assess these factors and barriers to care, this qualitative study gathered feedback from 3 focus groups and performed an extensive literature review. The focus groups engaged with 5 Black patients, 6 Latino and Hispanic patients, and 7 patients from rural communities.

Participants called for more culturally responsive health care, with responses often highlighting mistrust in the medical system. A Black patient with breast cancer spoke to the stigma patients of color experience that can lead to the disbelief or downplay of their symptoms or pain. For this reason, she expressed a preference for providers of color who may come from similar backgrounds and who can provide more culturally competent care. Another Latina patient with breast cancer echoed these sentiments, pointing out the importance of having a provider who speaks one’s language because interpreters may fail to accurately relay information from the doctor.

“Translation does not always mean that there's cultural competence,” Davis said, “and often there are things that are getting, no pun intended, lost in translation.”

In addition to concerns about cultural fluency, patients from rural areas brought attention to access issues, with a White patient with ovarian cancer detailing an extreme situation where she had to travel 200 miles every 3 weeks to receive chemotherapy. Stories like this one showcase how much financial burden can be brought about when travel, lodging, and time off work are considered in a patient’s care.

Considering these issues, the study also found that community, spirituality and social connection were major sources of resilience that helped individuals cope with cancer. These results underscored the value of emotional support systems for patients, indicating how crucial they are to individual well-being.

As Davis and her team continue expanding this research, they plan to conduct similar analysis to highlight points of medical stress for members of the LGBTQIA+ community and patients living on tribal lands.

Financial Navigation and People Power

Financial toxicity not only affects patients but those who care for them as well. Although the consequences can contribute to patient debt and treatment nonadherence, it can also create great administrative burden that burns out staff and leads to uncompensated care. Highlands Oncology Group established its own financial navigation program to mitigate these challenges; however, a manual workflow continually complicated these processes and limited how many patients could benefit.²

As a result, Highlands Oncology Group partnered with TailorMed in 2020 to optimize their program. TailorMed’s platform has the capability to proactively identify patients who are at risk for financial distress and pull from over 7000 sources to procure a list of funding opportunities.

So far, this initiative has expedited enrollment and access, expanded claimed assistance, and led to revenue growth. In the first phase of its implementation, Highlands Oncology Group saw a return on its investment after just 28 days, and this benchmark was accompanied by an 18% revenue increase and a 782% increase in program approvals over the course of 1 year.

Although these benefits were clear, “In 2023, Highland determined that its program required a workforce solution to supplement the technology solution, wrote Clara Lambert, CPH, director of financial navigation, TailorMed, and Melissa Fell, MBA, director of revenue cycle, Highlands Oncology Group. A support group of remote financial navigators were then added to the existing team; they took responsibility for managing claims and enrollment while Highlands Oncology Group's counselors were able to provide better financial care for more patients than ever before. This combination of technology and human support helped assist 35% more patients, increased program approvals by 37%, and contributed to an additional $1.2 million of assistance for claims copays. At this current pace, the authors wrote, Highlands Oncology Group is projected to secure an increase of 45% in patients assisted, 42% increase in program approvals, and additional $1 million in claimed assistance.

“I think the biggest takeaway is technology is awesome, amazing, and you can see how huge that was. But then you supplement it with people power, and that really helped them a lot because they weren't getting burned out, which we see a lot in all of health care,” Lambert remarked.

References

1. Davis A, Newell A. Psychosocial support needs for medically underserved communities: a landscape analysis study of Spanish-speaking hispanic or latino, rural, and black people with cancer. Presented at: ACCC NOC; October 9-11; Minneapolis, Minnesota.

2. Lambert CN, Fell M. Technology and people power: a combined approach to enhancing financial navigation. Presented at: ACCC NOC; October 9-11; Minneapolis, Minnesota.