1Hutchinson Institute for Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
2Consumer Education and Training Services, Seattle, Washington.
J Natl Compr Canc Netw. 2020 Oct 1;18(10):1366-1373. doi: 10.6004/jnccn.2020.7581. Print 2020 Oct.
Few studies have engaged patients and caregivers in interventions to alleviate financial hardship. We collaborated with Consumer Education and Training Services (CENTS), Patient Advocate Foundation (PAF), and Family Reach (FR) to assess the feasibility of enrolling patient-caregiver dyads in a program that provides financial counseling, insurance navigation, and assistance with medical and cost of living expenses.
Patients with solid tumors aged ≥18 years and their primary caregiver received a financial education video, monthly contact with a CENTS counselor and PAF case manager for 6 months, and referral to FR for help with unpaid cost of living bills (eg, transportation or housing). Patient financial hardship and caregiver burden were measured using the Comprehensive Score for Financial Toxicity-Patient-Reported Outcomes (COST-PRO) and Caregiver Strain Index (CSI) measures, respectively, at baseline and follow-up.
Thirty patients (median age, 59.5 years; 40% commercially insured) and 18 caregivers (67% spouses) consented (78% dyad participation rate). Many participants faced cancer-related financial hardships prior to enrollment, such as work change or loss (45% of patients; 39% of caregivers) and debt (64% of patients); 39% of caregivers reported high levels of financial burden at enrollment. Subjects received $11,000 in assistance (mean, $772 per household); 66% of subjects with income ≤$50,000 received cost-of-living assistance. COST-PRO and CSI scores did not change significantly.
Patient-caregiver dyads were willing to participate in a financial navigation program that addresses various financial issues, particularly cost of living expenses in lower income participants. Future work should address financial concerns at diagnosis and determine whether doing so improves patient and caregiver outcomes.
很少有研究让患者及其照护者参与到缓解经济困难的干预措施中。我们与消费者教育和培训服务机构（CENTS）、患者倡导基金会（PAF）和家庭救助（FR）合作，评估招募患者-照护者二人组参加一个项目的可行性，该项目提供财务咨询、保险导航以及医疗和生活费用援助。
年龄≥18 岁的实体瘤患者及其主要照护者观看了一个财务教育视频，在 6 个月内每月与 CENTS 顾问和 PAF 个案经理联系一次，并转介至 FR，以帮助支付未付的生活费用（例如交通或住房）。使用综合财务毒性患者报告结局评分（COST-PRO）和照护者压力指数（CSI）分别在基线和随访时评估患者的财务困难和照护者负担。
30 名患者（中位年龄 59.5 岁；40%有商业保险）和 18 名照护者（67%是配偶）同意参加（78%的二人组参与率）。许多参与者在入组前就面临与癌症相关的经济困难，例如工作变化或失业（45%的患者；39%的照护者）和债务（64%的患者）；39%的照护者在入组时报告经济负担沉重。受试者共获得了 11000 美元的援助（平均每户 772 美元）；收入≤50000 美元的受试者中，66%获得了生活费用援助。COST-PRO 和 CSI 评分没有显著变化。
患者-照护者二人组愿意参与解决各种财务问题的财务导航项目，特别是为低收入参与者提供生活费用援助。未来的工作应该在诊断时解决财务问题，并确定这样做是否能改善患者和照护者的结局。
