# Screen every patient for financial toxicity at diagnosis and refer like any other symptom

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

## TL;DR

Ask about money problems with a short validated questionnaire when treatment starts, and route those at risk to financial navigators before bills cause missed doses.

## Summary

Financial toxicity is associated with non-adherence, bankruptcy and worse survival, and is invisible unless asked about. The COST-FACIT instrument is validated and short. The proposal is universal screening at diagnosis and at each treatment change, with automatic referral to financial navigation (benefits, assistance programmes, employment rights, billing review), and inclusion of the score as a routinely collected outcome in registries and trials.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Screening plus navigation reduces treatment non-adherence for financial reasons and self-reported financial distress at six months, and cuts uncollectable debt for hospitals.
- Rationale: Financial navigation programmes recover assistance funding worth many times their cost; the barrier is identification, not solutions.
- Proposed test: Randomised trial of screening-plus-navigation versus usual care in two health systems; primary endpoint COST score at six months, secondary adherence, out-of-pocket spend and debt.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Patients lack understanding, navigation and agency): Basch et al., Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment (JAMA 2017): https://doi.org/10.1001/jama.2017.7156

## Connected records

- bottlenecks: [Patients lack understanding, navigation and agency](https://onco.cc/bottlenecks/b-patient-voice/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- technologies: [Money after treatment: what the cost of cancer does once the treatment has finished](https://onco.cc/technologies/rejuv-life-money-after-treatment/)

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