OnCo
ideasIdea

Screen every cancer patient for financial toxicity as a vital sign, with navigation

Cancer costs push patients into debt and make them skip treatment. Asking about money at every visit, and having someone to help, catches this before it does harm.

Financial toxicity affects a large share of patients even in insured and universal systems and is associated with non-adherence and worse survival. Validated instruments (COST-FACIT) exist, and financial navigation programmes have shown reductions in patient debt and distress in US trials. The proposal is to embed a short financial toxicity screen in routine patient-reported outcome collection at each cycle, with an automatic referral to a financial navigator and a data feed to payers documenting the burden by drug and regimen.

Hypothesis
Routine screening with navigation reduces the proportion of patients reporting severe financial toxicity by a third, reduces treatment non-adherence for oral oncolytics, and generates drug-level financial burden data that payers use in negotiations.
Rationale
Financial toxicity is a recognised adverse effect that is not measured, so it is not managed; the same logic that made pain a vital sign applies, and navigation interventions have randomised evidence of benefit.
What would test it
Cluster-randomised trial across 20 cancer centres of routine screening plus navigation versus usual care with financial toxicity score, adherence and out-of-pocket cost at 12 months.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
  • Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.

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