Intervening Financial Toxicity: What we can do today?

Financial burden of health care treatment affects patients’ financial well-being, quality of life and access to care. Dr. Zafar’s message included preventing financial toxicity, assessing financial toxicity, and reducing financial toxicity. To prevent we should focus on high value care.

Discussing goals of care is critical in assessing this and is important for finance to come in this discussion. Value of care is directly related to the benefit and the cost. He describes three possible levels of intervention: policy, provider and patients. He gave an insightful discussion on how we can intervene now to affect our patients today as well as affect long term goals. He applauded the SWOG S1417 trial that includes financial toxicity via the COST-PROM questionnaire, currently being used in patients with metastatic colorectal cancer. It is a simple instrument that is easily used and will provide important variables in assessing results and provides excellent patient centered outcome measure. It should be implemented in more trials and is critical in assessing value benefit. 

Dr. Zafar targeted each manufacturer & industry, government, insurer, and health system as areas of potential change. He states that in recent health care policy, the U.S. the government is not allowed to negotiate drug acquisition price with pharmaceutical companies and that this is unique to the United States.  This contrasts other non US-based health care systems that allow for negotiation. He believes that this should be an avenue in which we in the US try to reduce drug prices. 

He further describes how insurers, who are the payers, implement a shot-gun approach to providing specific cost savings which is not patient orientated. Often the patient does not benefit from lower drug costs that the payer receives.  Policy changes regarding specific benefits can be included in personalized plans that may increase coverage to some patients and flexibility can be included. He describes that through more efficient health care systems, costs can be cut and toxicity burden can be reduced. Furthermore, the provider should have a role in being cost considerate through the frequency and cost of interventions, visits and investigations. The provider should be able to make compromise with the patient regarding drugs and be open in discussing the cost, risks and benefits of each. And lastly, for financial toxicity prevention, he empowered the patient to get educated and shop around for insurance coverage, and allow the health care providers to help reduce the highly variable costs. 

In Dr. Zafar’s discussion on reducing financial toxicity he looks at patient communication. In a study with 298 patients, 52% of the patient wanted to discuss costs and 19% actually had discussion.  Recognizing that a barrier to this discussion is patient fear where they fear that the discussion will result in them receiving a lesser quality of care. When they looked at the 19% of patients who had a discussion with the physician about drug costs, 57% of the time prices were reduced. Costs were reduced by simple changes including decreased frequency of visits, using different tests, and or patients being switched to less expensive medications, as well as providing involvement of financial support, and further advocacy in dealing with the patients insurance companies. 

Presented By S. Yousuf Zafar, MD, MHS - Duke Cancer Institute.

Written by:
Michael J Metcalfe, MD.  Fellow of Urologic Oncology Urology, MD Anderson Cancer Center, Houston TX

Ashish M. Kamat, MD, MBBS, FACS
President, International Bladder Cancer Network
Chair, Society of Immunotherapy for Cancer (SITC), BCTF
Director of Urologic Oncology Fellowship
Professor of Urology
Attending Surgeon, Division of Surgery
The University of Texas, MD Anderson Cancer Center