# Screen every patient for financial hardship at diagnosis and connect them to help

Source: https://onco.cc/ideas/idea-acc-financial-toxicity-screening-at-diagnosis/  
OnCo record `idea-acc-financial-toxicity-screening-at-diagnosis` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer often ruins families financially, and money worries make people skip treatment. Ask about finances at the first visit, as routinely as asking about allergies, and route people to assistance.

## Summary

Financial toxicity is common, predicts non-adherence and worse outcomes, and is rarely assessed. Validated brief instruments (such as the COST measure) can be added to intake, with positive screens triggering referral to financial navigators, charity programmes, and benefit advice. This is cheap and addresses a cause of care fragmentation and abandonment in every health system, insured or not.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Routine financial screening with navigation will reduce treatment non-adherence attributable to cost by at least a third and improve financial-toxicity scores at six months.
- Rationale: Screening for distress became standard once it was embedded in intake; financial hardship is more prevalent than clinical distress and has a clearer remedy.
- Proposed test: A randomised implementation across ten clinics with adherence, financial-toxicity scores, and use of assistance as endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Fragmented care and guideline gaps): Hanna et al., Mortality due to cancer treatment delay: systematic review and meta-analysis (BMJ 2020): https://doi.org/10.1136/bmj.m4087

## Connected records

- ideas: [A paid patient navigator for every new cancer diagnosis, reimbursed as a service](https://onco.cc/ideas/idea-acc-funded-navigator-per-diagnosis/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- key papers: [Mortality due to cancer treatment delay: systematic review and meta-analysis](https://onco.cc/key-papers/paper-hanna-bmj/)
- technologies: [Money after treatment: what the cost of cancer does once the treatment has finished](https://onco.cc/technologies/rejuv-life-money-after-treatment/), [Screening for distress: what the thermometer can and cannot do](https://onco.cc/technologies/rejuv-mind-distress-screening/)

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