Financial Navigation Program for Patients with Multiple Myeloma
- Health Equity,
- Payment Models & Affordability
This project sought to reduce the financial impact of multiple myeloma on patients and their families by providing coordinated financial navigation. Findings showed that the financial navigation program helped reduce stress and improve patients’ understanding of financial support services.
Multiple myeloma is a cancer of the plasma cells which is currently incurable and often requires systemic therapy for the duration of a patient’s life–which for one quarter of patients is over 10 years post-diagnosis. The usual frontline therapies for multiple myeloma can cost over $200,000 each year, a lifelong expense for patients on maintenance therapy. A survey study showed that patients have to reduce spending on essentials, tap into their savings, or borrow money to afford treatment–and that some have even deferred treatment due to the excessive costs.
Patients experiencing financial hardship can work with social workers or financial advocates, who provide benefit education, evaluate for financial support eligibility, and identify resources and community support services to reduce financial hardship. However, referrals to these programs do not occur systematically, and patients may fall through the cracks or receive referrals too late, after they are already experiencing hardship. Evaluating pathways that systematically connect patients with multiple myeloma who are at risk of financial hardship with interventions and resources can help to reduce the financial burdens associated with treatment.
This study aimed to develop a coordinated financial navigation program for patients with multiple myeloma receiving care at the Abramson Cancer Center and test it against usual care in a randomized controlled trial. 193 patients were screened for financial toxicity risk using the Comprehensive Score for Financial Toxicity (COST) survey. Patients also completed a baseline survey to assess socioeconomic and demographic factors, cost-coping behaviors, quality of life, and satisfaction. Patients randomized to the coordinated navigation program benefitted from a proactive, coordinated, and systematic approach that includes outreach by a nurse navigator to at-risk patients, systematic referral to financial support services, creation of concrete action plans, and frequent and standardized follow-ups by a nurse navigator over a four-month period. During program intake, a nurse navigator assessed whether patients are interested in assistance with affording medications, copayments, or medical bills or support addressing food insecurity, housing insecurity, or transportation costs. The nurse navigator developed concrete action plans tailored to patients’ individual needs to address barriers and connect them with appropriate resources.
This study took place over the course of one year, enrolling patients receiving care for multiple myeloma at the Abramson Cancer Center while assessing scalability and incorporation into other existing ACC workflows. Findings showed that screening patients with the COST tool and proactively coordinating financial support services for those at a greater risk for financial toxicity can reduce financial hardship. Additionally, the financial navigation program helped improved patients’ understanding of financial support services and reduced stress.
Abramson Cancer Center Hematologic Malignancy Disease Team Incentive Fund
Project Leads
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Karen Glanz
PhD, MPH
George A. Weiss University Professor and Professor of Nursing, School of Nursing
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Mia Djulbegovich
MD, MHS
Assistant Professor of Clinical Medicine (Hematology-Oncology), Perelman School of Medicine
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Edward A. Stadtmauer
MD
Roseman, Tarte, Harrow, and Shaffer Families’ President’s Distinguished Professor, Perelman School of Medicine
Project Team
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Shawn Carney
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Kan Chen
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Adam Cohen
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Meredith Doherty
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Abbie Etzweiler
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Katie Fanslau
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Zachary Frosch
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Alfred Garfall
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Sarah Girgis
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Pearl Joslyn
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Qi Long
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Joyce Mitchell
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Sandra Susanibar-Adaniya
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Dan Vogl
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Adam Waxman
