The First Financial Toxicity Tumor Board Reports Success in Individual Patient Savings

Financial toxicity refers to the negative financial impact that cancer treatment can have on the patient’s well-being. Factors contributing to financial toxicity can include loss of work income due to illness, loss of employer-sponsored health insurance due to loss of work, and increased medical costs that are not covered by health insurance, among others.

Financial toxicity can affect patient outcomes and quality of life. For example, a patient may forgo treatment or medications to save money, or they may incur high medical debt or go into bankruptcy to pay for medical care.

Cancer treatment can lead to lost income, lost insurance and overwhelming medical bills.

To address these challenges, the Atrium Health Levine Cancer Institute in Charlotte, NC, established the first Financial Toxicity Tumor Board in 2019. It is the first known institutional-level intervention taking on these issues. The board was designed to function similarly to disease-focused multidisciplinary tumor boards, but it focuses on matters pertaining to financial distress. In 2022, the program was expanded to the Atrium Health Wake Forest Baptist system in Winston-Salem, NC.

A study published last month in the Journal of the National Comprehensive Cancer Network analyzed and detailed the impact of the board over the past five years. The analysis, led by Thomas G. Knight, M.D., clinical associate professor of hematology at Wake Forest University School of Medicine and oncologist at the Atrium Health Levine Cancer Institute, outlined the board’s function and outcomes over five years for the purpose of easing the adoption of its model by other institutions.

The board is composed of two arms. The first one is tasked with processing participant referrals, which may be made by physicians, nurses, pharmacists, social workers, financial counselors, patients, caregivers, and family members. The second arm consists of the Patient Assistance Program, a joint initiative between the Levine Cancer Institute and the department of pharmacy, which reviews each new treatment plan to determine if patients qualify for enrollment in copay assistance or free drug programs.

To facilitate workflow, the board identified three categories based on the level of follow-up each case needed: 1) Immediate Assistance Required, 2) System-Level Issue Identified, and 3) Policy/Legislative Issue Identified.

Immediate Assistance Required cases were those with urgent need and required a resolution by the end of the meeting. An example would be a newly diagnosed patient with a sudden loss of income and health insurance, requiring financial relief to afford treatments. Cases identified as system-level issues needed changes within the healthcare system to achieve resolution. An example is payer treatment denials requiring a change in wording in patient clinical notes for approval. Cases in the Policy/Legislative Issue Identified category required the most time to resolve and involved the formation of an additional workgroup to lobby for policy changes and explore local solutions. An example is the case of a patient requiring enteral feeding that Medicaid did not cover. The workgroup acquired financial support from a local foundation to fund the patient’s enteral feeding while lobbying local and national policymakers for changes in Medicaid coverage of enteral feedings.

Throughout five years of operation, 50 cases have been presented to the tumor board, with 94% resulting in immediate solutions for individual patients. Additionally, the Patient Assistance Program has facilitated $10,316,695 in copay assistance to a total of 9,321 patients. An additional 16,495 patients received $395,895,101 worth of free drug assistance.

Knight and his colleagues conclude that a financial toxicity-focused tumor board model can be easily replicated at other cancer centers and offers sustained and substantial improvement in issues of financial toxicity. They recommend the development of this model as a new standard of care.

“It is our hope that the publication of our methods and results will assist other centers in replicating this work and ultimately expand the availability of real solutions for one of the most rapidly emerging toxicities in cancer care,” the authors wrote.