How to Help Radiation Oncology Patients Avoid Financial Toxicity
By: Brenda Marie Palo and Tina Berry
This article is adapted, in part, from an article that appeared in SROA’s publication, Radiation Oncology for Administrators (Vol 31 No 5).
The National Cancer Institute describes financial toxicity as “problems a cancer patient has related to the cost of treatment.” Out-of-pocket costs, such as copayments, deductibles and coinsurance not covered by health insurance, can cause patients financial distress. Financial hardship due to treatment can cause higher household debt, depletion of savings and even the need to seek bankruptcy protection. Financial issues affect radiation oncology patients’ emotional and physical well-being and their survival. Some patients may even have to delay or abandon treatment.
Financial toxicity can be crippling, but patients may be reluctant to discuss their financial woes. They may raise the topic during a private conversation with a nurse, social worker or physician, but by that time they’re likely already well into their course of treatment. A better alternative would be to identify patients at high risk for financial toxicity before treatment starts.
We want to share some guidance on how to better identify cancer and radiation oncology patients experiencing financial stress. We also have suggestions about educating employees on how to have these financial conversations with patients.
- Financial Counselor/Navigator: A financial navigator should initiate a conversation when patients are newly diagnosed and when anything new is added to their treatment, such as a radiation course or a change in chemotherapy. The best time for patients to request an estimate is as soon as they have a treatment plan. Meeting with a financial counselor or financial navigator enables patients to have a name and a face to connect with, regardless of whether or not they need the service. It’s important that patients know cancer centers offer this service.
- Staff Training: Staff education is also important regarding how they should engage patients in converstion. triagecancer.org has many useful resources. Training staff on how to frame a financial conversation with patients is key: use language that shows empathy; ask open-ended questions; listen more than one speaks; and offer affirmations and summarize responses. Culture and setting are also important considerations—for example, whether the conversation is by phone or in front of children and/or care providers.
- Financial Toxicity Brochure: Create a brochure and place it at the check-in desk. Patients can discreetly pick it up. The brochure can be a conversation starter with patients.
- Spreadsheet with Key Contacts: A simple spreadsheet with contact names, phone numbers and emails addresses is a helpful tool to help staff identify those within their organization who provide patient resources.
- Cost Estimator: A predetermined cost estimate spreadsheet with manipulatable fields for any type of potential treatment the patient might receive is a helpful tool. The spreadsheet should make be able to create a quick cost estimate by easily changing items, such as the number of daily treatments, for example. More than one staff member should be trained to use cost estimate spreadsheets.
- Dedicated Personnel: If possible, cancer centers should consider having a full-time employee for financial counseling. Smaller institutions may group financial counseling with patient navigation or centralize it under a hospital billing department. There’s justification for offering financial counseling because it’s something patients want and need. Cost estimates and copays can be tricky for cancer care patients because of the complex nature of their treatment—chemotherapy, radiation therapy, medications—and the different associated costs.
Allocate time to educate radiation oncology staff on how to talk to patients. Staff need to know how to initiate a conversation about the costs for cancer care and to keep the conversation going throughout the course of therapy. If cancer center staff can get answers to patients’ questions, patients will be much more apt to complete their therapy and be able to do so with a better attitude.
How does your cancer center help radiation oncology patients who may be struggling to cover treatment costs?
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Related Content: Radiation Oncology for Administrators (Vol 31 No 5)
Society For Radiation Oncology Administrators (SROA)
National Cancer Institute