Coordinated Navigation to Reduce Financial Toxicity in Multiple Myeloma
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 aims 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. Patients randomized to the coordinated navigation program will benefit 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 will assess 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 will develop concrete action plans tailored to patients’ individual needs to address barriers and connect them with appropriate resources.
This study will take 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. The study will assess the program’s effectiveness at reducing financial toxicity, improving patient quality of life, and improving patient satisfaction compared to usual care.
Mia Djulbegovic, MD, MHS; Edward A. Stadtmauer, MD; Karen Glanz, PhD, MPH; Meredith Doherty, PhD, LCSW; Katie Fanslau, DNP, RN; Zachary Frosch, MD, MSHP; Pearl Joslyn; Sarah Girgis; Shawn Carney, BS; Joyce Mitchell, MSW, LSW; Lyndsay James, MPS
Abramson Cancer Center Hematologic Malignancy Disease Team Incentive Fund
Payment Models and Affordability; Clinical Transformation; Health Equity