Targeting Cancer-Related Financial Hardship through Financial Navigation and Guaranteed Income
Financial hardships impact one in three patients during the course of their cancer treatment, and are experienced more severely by women, people of color, and low-income families. Breakthrough cancer treatments are more expensive than ever, and rising out of pocket costs paired with deficient insurance coverage are further exacerbated by patients missing work in order to receive treatment, resulting in possible job loss. All of this affects health outcomes, particularly when patients may need to delay or even forego treatment due to cost. While cancer-related financial hardship has been well-documented, there remains a critical need for a systemic approach to address and lessen its impact, particularly on more vulnerable patients who are low-income and underserved. Financial navigation is a recently employed intervention through which patients are provided with assistance in preparing for out-of-pocket medical costs, accessing resources, and applying for financial assistance grants.
The Guaranteed Income and Financial Treatment Trial (G.I.F.T.T.) will deliver oncology financial navigation alongside guaranteed income: unconditional monthly cash assistance. Guaranteed income has produced positive health effects in other populations but has not yet been evaluated in the oncology space. The trial aims to produce evidence regarding the effectiveness of financial navigation and guaranteed income in reducing the impact of financial hardship on treatment adherence and quality of life for low-income cancer patients.
The first phase of the trial evaluates Family Reach’s Financial Treatment Program (FTP), which is an individualized financial navigation intervention. Through FTP, a social worker completes an online program application on behalf of each patient in order to determine eligibility and a financial needs assistance to inform services needed. A financial navigator works with eligible patients to access these services, which can include financial education, resource navigation, financial planning, or a one-time assistance grant that can be used for daily household expenses like rent/mortgage or food. In the second phase, a randomized control trial will test the effectiveness of a guaranteed income intervention on reducing financial hardship and treatment nonadherence when delivered alongside FTP, relative to a traditional financial assistance grant. Patients in the treatment condition will receive $500 to $1000 a month for 12 months and can utilize these funds as wanted and needed, while patients in the control condition will receive a one-time grant that can only be used towards necessities such as rent/mortgage or food. This program has the potential to improve patients’ overall quality of life, reduce stress, and increase rates of treatment adherence and completion, all of which may lead to better survival outcomes.
Findings from this study will have implications for health policy and practice; the Social Security Administration will use findings from this study to inform decisions on increasing monthly payments and reducing barriers to program access for patients with cancer.
Meredith Doherty, PhD, LCSW; Jessica Jacoby, MS; Jennifer Kellet, MSW; Jesica Broadnax, LMSW; Devin Traxler, LMSW; Sruti Erikkala, BS; Yingyue Jiang, BS
Center for Guaranteed Income Research (GGIR) at the University of Pennsylvania’s School of Social Policy and Practice (SP2); Sidney Kimmel Cancer Center at Jefferson Health; Children’s Hospital of Philadelphia
Payment Models and Affordability; Clinical Transformation; Health Equity