Financial Navigation for People Newly Diagnosed With Cancer: Primary Outcomes From the Cancer Financial Experience Randomized Trial.

Abstract

Financial navigation could mitigate or prevent cancer-related financial hardship, but its effectiveness has not been established in real-world settings. We developed an intervention that provided proactive, personalized financial navigation to individuals newly diagnosed with cancer. We conducted a randomized controlled trial at two integrated health systems. Inclusion criteria were age 18+ years and receiving care for a new cancer diagnosis of any type or stage. Participants were randomly assigned 1:1:1 to either brief intervention (one proactive outreach +6 months of navigation), extended intervention (three proactive outreaches +6 months of navigation), or enhanced usual care. All arms received a list of available financial assistance resources. Primary outcomes were self-reported financial hardship (InCharge Financial Distress/Financial Well-Being Scale) and cancer-related quality of life (FACT-G7) at 12-month follow-up. We fit generalized linear models adjusting for site, cancer type, socioeconomic diversity, and demographics. We randomly assigned 371 participants (26.2% enrollment of those reached and eligible). The sample had a mean age of 61.6 years (standard deviation [SD], 13.3); 62.8% were female; 8.7% were Asian, 8.5% Black, 10.7% Hispanic, 8.2% other or multiple race, and 63.9% White. Cancer types were primarily breast (37.7%) and prostate (14.6%). At 12-month follow-up (n = 283), financial hardship and quality of life were similar between intervention groups (unadjusted mean [SD]: brief = 7.39 (2.66), extended = 6.84 (2.55), usual care = 6.69 (2.66), adjusted <i>P</i> value = .73; FACT-G7: brief = 19.1 (5.1), extended = 19.0 (5.2), usual care = 19.2 (5.2), <i>P</i> = .17). Financial navigation was not associated with improved financial hardship or cancer-related quality of life in patients newly diagnosed with cancer compared with enhanced usual care. Continued research on strategies to address the urgent problem of cancer-related financial hardship is needed.