Patients Suffering Financial Toxicity During Cancer: What Radiologists Need to Know

By Richard Dargan

Carlos

The financial burden of cancer care exacts a significant mental and physical toll on patients — one that radiologists could help alleviate with financial fragility screening and other interventions, according to a presenter at RSNA 2020.

Cancer treatment grows more expensive every year as new therapies arrive and trends like cost-shifting from the employer to the employee take hold. Consequently, many patients wind up in a state of financial toxicity, defined as a combination of subjective financial concerns like anxiety, objective financial consequences of treatments like decreased income and medical debt, and coping behaviors like medication nonadherence.

"Financial burden in cancer survivors leads to higher out-of-pocket costs and higher out-of-pocket costs lead to lower medication adherence," said Ruth C. Carlos, MD, professor of radiology at the University of Michigan, Ann Arbor. "It worsens their physical and mental health and patients who have less than 12 months financial reserve report increased symptoms and lower quality of life."

Dr. Carlos, whose research encompasses cost-effectiveness analysis and patient preference measurement among other topics, said there are multiple factors driving financial distress, including each person's environment.

"Increasingly we recognize that social determinants of health play a large role in health outcomes," Dr. Carlos said. "Specifically, economic stability, having the financial resources to purchase health care, neighborhood and physical environment including transportation, and access to a health care system are large drivers of health and health outcomes."

Radiology Can Help with Financial Challenges

Opportunities exist in radiology to deliver cancer care in a way that alleviates the stress of financial toxicity, Dr. Carlos said.

Radiology practices can screen for financial burden in the imaging setting, for example, by integrating one to three questions related to financial fragility to patients entering the outpatient imaging center. Patients who have financial burdens can be referred to the institutional financial navigation services.

"To make it appealing to the practice, we would measure a practice-level outcome such as reduction in unrecovered patient cost-share," Dr. Carlos said.

Radiologists can also make the cost of care more transparent and explore alternative out-of-pocket payment models.

While breast cancer screening is free in the current fee-for-service model, patients pay for every additional test if their screening is positive. In an alternative, bundled out-of-pocket model, patients would pay a nominal fee and, if the test was positive, they would incur no additional costs no matter how many tests were necessary.

Any interventions need to be implemented both at the patient level and at the system level, Dr. Carlos said. Financial counseling must be specific to the patient, including their insurance type, benefit design and where they are in the deductible cycle.

"As we work to expand precision diagnostics and precision treatment, we need to match that with precision communication, particularly around the financial aspects of care," Dr. Carlos said.

For More Information

View the RSNA 2020 session Financial Toxicity: What Radiologists Need to Know — RC632 at RSNA2020.RSNA.org.