Incorporating Routine Screening for Financial Toxicity Using a Two-Item Screening Tool in an Outpatient Oncology Clinic - a Student-Driven Interprofessional Initiative

Background: A new cancer diagnosis can be as financially and socially devastating as it can be medically. While addressing the medical aspects of chemotherapy toxicity is a major focus during cancer treatments, financial toxicity (psychological distress due to the cost of treatment) remains an underappreciated hardship among the oncology patient population. Receiving treatment can pose a significant financial burden to patients suffering from cancer and their families, especially for those on chemotherapy. Consequently, financial distress can similarly have a profound impact on a patient's lived reality of cancer and should be similarly addressed by oncology providers.

Aim: We set out to increase the rate of screening for financial toxicity using the 2-item CoST form at routine follow-up visits for patients actively receiving chemotherapy in a malignant hematology clinic from 0% to 70% from January 2022 to March 2022.

Methodology: The Comprehensive Score for Financial Toxicity (FACIT-CoST) is a 12-item validated screening tool that correlates with psychological distress in cancer patients receiving chemotherapy. We used an abbreviated 2-item version for ease of implementation (statements 1 and 3 of FACIT-CoST). At each appointment, patients were asked to indicate whether (yes or no) each of two statements applied to them. Screening was performed by an interprofessional team consisting of a medical student, a pharmacy student, and a nursing practitioner on Wednesday afternoons as a part of a two-year interprofessional program for health professional students. Only patients who were actively receiving chemotherapy were screened.

Results: 12 out of 16 eligible patients (75%) seen during the QI period were screened. 9 patients (75%) screened positive on at least one of the two items. 4 and 8 patients (33% and 67%) screened positive for financial toxicity on items 1 and 2, respectively.

Conclusion: Using the 2-item screening tool, we were able to efficiently screen patients. Even among patients who are currently able to afford treatment, a large majority still screen positive for financial toxicity and thus may benefit from psycho-oncology referrals or reassessment of needs.

Implications: Ongoing assessments of financial toxicity can identify patients who may benefit from referrals for mental health intervention or resource assistance. We recommend using this screening tool to facilitate initiating the conversation with patients about financial distress. Possible next steps include screening integration into EHR workflow and explicit discussion of the financial toxicity of cancer during new patient visits.