Financial-legal navigation reduces financial toxicity of pediatric, adolescent, and young adult cancers

Author:

Edward Jean1ORCID,Northrip Kimberly D2,Rayens Mary Kay1,Welker Andrea2,O’Farrell Rachel3,Knuf Jennifer3,Fariduddin Haafsah4,Costich Julia5,D’Orazio John23

Affiliation:

1. College of Nursing, University of Kentucky , Lexington, Kentucky, USA

2. Department of Pediatrics, College of Medicine, University of Kentucky, Lexington , Kentucky, USA

3. Danceblue Pediatric Hematology Oncology Clinic, Kentucky Children’s Hospital, University of Kentucky HealthCare, Lexington , Kentucky, USA

4. Markey STRONG, Markey Cancer Center, University of Kentucky HealthCare, Lexington , Kentucky, USA

5. Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington , Kentucky, USA

Abstract

Abstract Background Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers. Methods We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness. Results In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness. Conclusions Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity. ClinicalTrials.gov registration NCT05876325

Funder

Robert Wood Johnson Foundation

Publisher

Oxford University Press (OUP)

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