From the Journals

Cost-of-care counseling can be done, but does it help?



Here’s a novel idea: Help patients figure out how large a bite health care will take from their life savings.

A pilot study of a randomized intervention showed that practice-based counseling of patients about the actual out-of-pocket costs of chemotherapy is both “feasible and acceptable.”

But the larger question about whether any of it does any good remains unanswered, reported Sheetal M. Kircher, MD, from Northwestern University in Chicago and her colleagues.

“The majority of participants found the FC [financial counseling] consultation helpful, but they felt the same about their finances after the intervention. Although it is reassuring that no participants felt worse about their cancer costs after the intervention, the variability in perceived value of the FC consultation highlights that the content of a financial intervention needs to be tailored to the patient’s individual needs,” they wrote in the Journal of Oncology Practice.

The investigators conducted a randomized trial with 95 patients at the Robert H. Lurie Comprehensive Cancer Center at Northwestern to study whether financial counseling about the estimated total costs to them of one cycle of chemotherapy could help patients weather financial distress.

The participants first completed a baseline assessment of their financial distress, health-related quality of life, and degree of health insurance literacy. They were then randomized to either standard of care or to a financial-counseling intervention consisting of education, financial-assistance screening, and a tool for estimating total billed charges and out-of-pocket costs. Participants in the experimental arm received a phone call and in-person visit from a financial counselor.

Financial distress was measured using the Comprehensive Score for Financial Toxicity (COST), InCharge Financial Distress/Financial Well-Being Scale, and a single European Organisation for Research and Treatment of Cancer (EORTC) question.

Patients in the standard-of-care arm had access to financial counselors on request, but they were not automatically assigned counseling.

Of the 95 patients randomized, 65 completed both the baseline and follow-up assessments. The investigators noted that participants tended to have more advanced disease; six patients in the standard-of-care arm and five in financial-counseling arm died before they could complete the follow-up assessment.

Of the 43 participants randomized to counseling, 42 (98%) completed the phone call, 20 (47%) completed the in-person visit, and 13 (30%) completed the entire intervention.

At the second, follow-up assessment, 83% of participants in the counseling arm said they were comfortable with answering questions about how the costs of treatment affected their pocketbooks, and 76% reported that they did not have difficulty understanding the estimation tool, and 88% said that the financial counselor helped them to understand their out-of-pocket costs “somewhat” or “a lot.”

However, when they were asked how they felt about paying for their care after completing the intervention, 76% said they felt about the same, 18% said they felt “a little better,” and only 6% said they felt “much better.”

In addition there were no statistically significant differences in any of the financial distress measures between the intervention and standard-of-care groups.

The investigators speculated that the study was underpowered to detect differences in COST (financial toxicity) scores.

High financial distress was significantly associated with worse emotional functioning (P = .0189), whereas being married or in a cohabiting relationship was associated with less financial distress (P = .0092).

“Future studies should aim to better understand patient perspectives and preferences around discussing transparent cost data and design system-level interventions to identify and assist patients efficiently with their specific financial concerns,” Dr. Kircher and her colleagues concluded.

The study was supported by the Robert H. Lurie Comprehensive Cancer Center and the Cancer Survivorship Institute of Northwestern University. Dr. Kircher disclosed stock or ownership interest in Penrose TherapeuTx. Five coauthors reported research funding, travel expenses, and/or honoraria from multiple other companies, as well as consulting/roles.

SOURCE: Kircher SM et al. J Oncol Pract. 2019 Jan 9. doi: 10.1200/JOP.18.00270.

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