Dr Yousuf Zafar: Predicting Financial Hardship Is Challenging

Financial hardship doesn’t mean the same thing for anybody, and accurately predicting who will experience financial toxicity is challenging, said Yousuf Zafar, MD, MHS, of the Duke Cancer Institute and a member of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee.

Transcript

Do patients and providers usually have the same idea of what financial hardship is and means?

I don’t think financial hardship means the same thing for anybody. And that’s really important to understand. There are very few markers that will adequately and accurately predict who is going to experience financial toxicity. And that is why having a screening conversation on whether or not a patient is experiencing financial hardship is important across the board. Regardless of anybody’s income.

Obviously, patients who have lower income might be at greater risk, but I’ve also seen patients with above-average income, who have poor insurance coverage and are being treated with a very expensive drug, experience financial hardship. That’s why screening across our population of patients is important.

How do you screen patients and assess them for financial distress?

I think there’s a couple of ways to screen patients. The first is to think about validated measures, so there are tools out there that patients can complete: brief surveys that score their financial toxicity, and that score can be used to see where they fall on the spectrum. That’s complicated, it takes time, it takes money.

Even much simpler than that is to think about simple screening questions, like, “Are you able to afford your treatment? Are you having any trouble paying for your cancer treatment?” Those simple questions, I think, really get to the crux of the problem very quickly, and without a lot of infrastructure.

Where does the average patient’s cost-related health literacy stand, and how can we try to improve it?

I saw some interesting statistics, somewhere along the line of 60% of Americans don’t know what a deductible is. And that’s even before getting hit with a catastrophic illness. So, unfortunately, I think our overall health literacy, as a country is low. Our health-related financial literacy, I think, is even lower. And something that I’m working on is to improve that health-related financial literacy to find ways to educate patients about the financial aspects of healthcare, to link patients to resources, and to sort of guide them along on this journey of cancer care, specifically related to the finances.