At the recent Oncology Nursing Society (ONS) Congress in Anaheim, California, Dr. Mateo Banegas of the University of California, San Diego (UCSD) gave a presentation about the financial toxicity of cancer care, particularly during the COVID-19 pandemic. In this interview with Oncology Data Advisor, Dr. Banegas shares additional advice for members of the cancer care team on how to engage in conversations about financial costs and well-being with their patients.
Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, I'm here with Dr. Mateo Banegas.
Mateo Banegas, PhD, MPH: Hello, everybody.
Oncology Data Advisor: Would you like to tell us a little bit about what you do at UCSD?
Dr. Banegas: At the University of California, San Diego, I'm an Associate Professor in the Department of Radiation Medicine and Applied Sciences. I'm also the Co-Director of a center we have here called the Center for Health Equity, Education, and Research. My role here is as a researcher, focusing mainly on the social and economic factors of individuals who are diagnosed with cancer and trying to understand how those issues affect their care and their health outcomes.
Oncology Data Advisor: You mentioned in your session at ONS Congress that the cost of cancer care is rising faster than in other diseases. Why do you think this is?
Dr. Banegas: Sure. I don't think that the issue is necessarily that the cost of cancer care is rising faster than other diseases; it's more about the magnitude and the drivers of the costs that are increasing within the cancer arena. For instance, we know that nationally, the costs for cancer care are projected to be almost $250 billion by 2030. Then, the US population is aging, which is the major contributor to the rising cost of care.
Other factors, like the development of newer cancer therapies, which are often extremely expensive, are also driving these expenditures. For example, while new treatments have greatly improved the survivorship of these cancers—it's a great thing, people are living longer—this could also mean that some of these individuals have late and long-term effects that are associated with the treatments and require additional care, medications, and, of course, the costs. All of these together are some of the factors that are driving up the costs for cancer care in the US.
Oncology Data Advisor: What are some of the ways that nurses can help prepare their patients, as well as their families, for the financial costs that they might encounter?
Dr. Banegas: First, I would say, just simply asking the patients and their families if they have any questions about the cost of their care is important. Many patients may be reluctant to ask their care team for several reasons, but one of which could be a fear that somehow asking these questions could impact their care. The fact that someone on the health care team, whether it's the nurse or someone else, is acknowledging and recognizing that this is an important issue and something that they want to check in about would be a huge step for the health care team.
Second, I would say, trying to identify and get to know both the information and the information sources for the costs of care in each of our health systems would be huge—some kind of resource in the system that the nurse or other health care team member can leverage, should a patient and their family want to know more information about the costs. A third, I would say, would be working with the broader health care team, whether it's the social workers or the case managers, to identify and create a list of resources that they could provide to the patients and their families—a resource sheet or resource list that they could have on hand and refer to a patient. Those are some of the things I would say that would help prepare both the patients and their families for the costs.
Oncology Data Advisor: Great, thank you. What are some of the specific points, between diagnosis and survivorship, where nurses can help to evaluate financial well-being, and what are some ways that they can do so?
Dr. Banegas: Really, really good question. Several studies have asked this question of patients and other stakeholders, and the answers are mixed. On the one hand, some patients note that the time period around diagnosis can be daunting, as it's physically, emotionally, and mentally draining. You're going through a lot between having that diagnosis and then everything else that comes with that. Because of this, those patients may not feel as ready for such a conversation at that time. On the other hand, we have some patients who, while they agree with those challenges during that time period, note that waiting too long may prevent them from getting help early and truly prevent any late or downstream financial hardship. In general, the consensus is that the sooner we can identify patients' financial well-being and, of course, the risk of financial hardship, the better.
Again, simply asking, "Would you like to discuss the finance related to your cancer care?" would be helpful. If they're not ready, ask at the next appointment and the next one until they are. Maybe they don't have any, and that's a great acknowledgement too; just knowing that they don't have any questions at this time is perfect. Then, thereafter, the frequency that enables the health care team to know their patients' financial circumstances over time, throughout that care trajectory, is critical, and it's sufficient—just the frequency at which the health care team knows this patient's okay, or if they do have some questions, seeing what they can do to help them.
Oncology Data Advisor: When nurses are having these conversations, are there any specific resources they can provide to their patients about financial toxicity?
Dr. Banegas: There definitely are resources at each level, whether it's national, state, or local. While I won't know a lot of the local resources depending on where they are, there are national foundations like the Patient Access Network Foundation. There's the National Patient Advocate Foundation. Then Cancer and Careers is another great one that focuses on both the employment piece, as the name says, but also the financial aspects of that. All of those are national organizations that have tons of resources and/or information about resources at different levels, and these are organizations that also working with the state and local levels in particular areas.
Another key resource for training related to this—which is incredible, and some of my research teams have leveraged it—is the Association of Community Cancer Centers. They have a financial advocacy boot camp, which is just an incredible resource of information and training, that individuals can go online and take to enhance their toolbox, if you will, with information on how they might go about working with patients around this issue. There are also resources at the Academy of Oncology Nurse and Patient Navigators. They also have some incredible resources. When we were preparing for the financial navigation trial that we have ongoing right now, we went to their website. They have some really great videos of nurses and other experts discussing their examples or their recommendations. All that was just super helpful, just to give you a sense of not the importance of this issue, but how to go about having a conversation like this with a patient or their family.
Oncology Data Advisor: Thank you. These all sound like really valuable resources. Thank you so much for sharing them all with us.
Dr. Banegas: My pleasure.
About Dr. Banegas
Mateo Banegas, PhD, MPH, is an Associate Professor of Radiation Medicine and Applied Science at the University of California, San Diego, where he also serves as Co-Director of the Center for Health Equity, Education, and Research. Dr. Banegas' research focuses on impact of social and economic factors on cancer care and outcomes, as well as understanding financial and employment-related challenges faced by patients with cancer.
For More Information
American Cancer Society (2020). The costs of cancer: 2020 edition. Available at: https://www.fightcancer.org/sites/default/files/National%20Documents/Costs-of-Cancer-2020-10222020.pdf
Patient Access Network Foundation (2022). Available at: https://www.panfoundation.org/
National Patient Advocate Foundation (2022). Available at: https://www.npaf.org/
Cancer and Careers (2022). Available at: https://www.cancerandcareers.org/en
Association of Community Cancer Centers (2022). Available at: https://www.accc-cancer.org/
Academy of Oncology Nursing and Patient Navigators (2022). Available at: https://aonnonline.org/
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.