Overcoming Cancer’s Financial Toxicity with Real-World Data

In the United States, cancer is one of the most expensive diseases to treat, second only to heart disease, and cancer-related expenses are rising. This is, in fact, a global issue. Like other cancer treatment side effects, financial toxicity (FT) can affect patients in different ways and intensities. Unfortunately, many physicians, clinicians and medical staff have been detached from the challenges their patients face in relation to this issue.

FT is a growing concern for many cancer patients and caregivers, and with the continued rise in treatment costs, it can no longer be ignored. Even though a cancer diagnosis comes with a substantial financial burden to individuals and society is not new, it’s time for a significant change to take place to help ease patients’ situations as much as possible.

Real-World Evidence for FT

Real-world evidence (RWE), real-world data (RWD) and clinical studies have helped us prove FT is a major factor that can affect the outcomes and quality of life of patients battling different cancers and receiving specific treatments. A growing body of published evidence suggests treatment-related expenses drastically impinge on patient well-being, best described in a paper by Dr. S. Yousuf Zafar, which proves the direct relationship between FT and poorer wellbeing, lower health-related quality of life and below-par quality of care for cancer patients.

Over the past two years, we at Belong have been involved with research projects that aim to better understand the RWE and global extent of FT, which includes evaluating information from patients prior to the start of their treatments. All these studies were conducted by analyzing anonymized, aggregated data gathered from the Belong.Life app. The main objectives of these prospective studies included:

• To obtain qualitative RWD that could improve the understanding of how FT affects patients with a variety of cancers.
• To evaluate the role of the medical team in informing the patients and their caregivers about the potential of developing FT.
• To evaluate the role of the medical team in providing awareness, information and preparation to reduce the possibility of forthcoming economic burdens.

The Results

One of our first studies, which was accepted as an oral presentation at the 2019 Advanced Breast Cancer Meeting (ABC5), had 189 patients with advanced breast cancer (ABC) detailing their real-world experience of FT from the time of their diagnosis. This RWE was analyzed by machine learning and artificial intelligence parameters, with the most significant results showing that 87% of all ABC patient responders experienced FT during their disease. In addition, nearly half of the patients (47%) experienced work difficulties (stopped working, reduced work hours, etc.) and 93% had associated financial burdens because of this.

In another study which was accepted for a poster presentation at the 2020 ASCO-SITC congress, we reported on RWD on 105 patients on the onset of FT during their immunotherapy treatments. The most significant finding of this research was that at the start of immunotherapy treatment, nearly half of the patients (48%) were aware of possible FT, while 36% of them received pre-emptive information from their medical team. This is important because it demonstrates that patients who received information before the commencement of their immunotherapy experienced less FT.

Our latest study on FT was submitted to the ASCO 2020 Virtual meeting, documenting RWED in American patients receiving cancer immunotherapy. In this prospective study, 205 US-based patients replied to a survey. 48% reported that they developed FT during their treatment journey. Of those, only 29.3% received pre-treatment information and advice from their treating medical teams. The most common FT reported was due to high medical co-payments (50%), and high drugs and treatment co-payments (38%). When asked about their coping strategies, 62% of the patients used personal savings, 45% received financial support from friends and family, while 32% had to trim their daily household expenses.

Clinical Implications

The clinical implications of this data highlight just how important patient-physician communication is in preserving the quality of cancer care. Physicians should not wait for behavioral changes in their patients caused by financial distress but should prioritize discussing the topic of costs early in patient’s treatment journey. Doing this can help prevent cost-related behavior changes that are detrimental to the quality of cancer care.

In other words, if expectations of out-of-pocket costs are set by discussions early on in the treatment course, non-adherence could be avoided, and patients might be able to better prepare emotionally and financially for significant expenses, or at least be offered a less costly treatment alternative.

How Can I Help My Patient?

Patients should be informed of the financial implication they may face before beginning treatment. When communicating with your patients, their medical and social situation, cultural diversity and preferences should all be considered. Any discrepancies between the medical team and the patient’s understandings has the potential to result in miscommunication and affect treatment decisions.

Medical staff and society at large should address cancer patients’ high medical care costs, as well societal perspectives on value, so that patients with cancer will not suffer poorer outcomes and quality of life because of the induced financial burden. Early communication, better cost transparency, and navigation to financial support resources are just some of the ways that physicians can assist their patients in overcoming this difficult challenge.

In Conclusion

Our RWE and RWD studies have uncovered important initial findings, but there is still a need for further investigation and clarification regarding financial toxicity in patients affected by cancer. The oncology community must proceed with larger, confirmatory research programs to delineate national and international applied guidelines, interventions and strategic implementations to curb FT. These interventions should involve all related parties, including government agencies, health insurances and payer organizations, pharmaceutical companies, medical staff and patients.

The above data proves that financial toxicity remains a major and growing problem for many patients diagnosed with cancer. It is of the utmost importance to find ways to come together and address patients’ financial needs through tailored individual assessments and mitigation strategies to reduce the global effect of FT.

Dr. Daniel Vorobiof is the Medical Director of Belong.Life, a developer of social and professional networks for managing and navigating treatments, and the creator of the world's largest social network and navigator app for cancer patients – Belong – Beating Cancer Together.