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Evidence-Based Oncology February 2017
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Shawn M. Regis, PhD
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Produced by Nicole Beagin and Laura Joszt

Patient Navigation in Immuno-Oncology

Shawn M. Regis, PhD
Patient navigation is immensely helpful in relieving some of the burden placed on cancer patients, and there are some particularly unique aspects of navigation as it pertains to immuno-oncology.
Helping With the Cost of Treatment
There are many options available to assist patients with the expenses associated with their oncology care. In addition to standard health insurance, these can include government programs, co-pay relief and patient assistance programs, assistance from volunteer organizations, and fundraising. However, it is not enough to simply notify a patient about these options; they also need guidance on whether they are eligible for this funding, and need to be informed of how to apply and obtain it. Patient navigators can connect with these different networks and help identify options that will generate the most benefit for the patient, and assist with the application process. 
 
Because the cost of I-O therapies is high, and insurance companies often struggle to stay abreast and provide coverage for these rapidly emerging treatments,3 many pharmaceutical companies offer assistance programs that can help patients with the cost of treatments, both beyond what their insurance will cover as well as for potential off-label use that most insurers will not cover. To apply, patients typically need to supply personal financial documents, including the previous year’s tax returns, and/or a financial hardship statement attesting that even if they could “afford” the treatment, the burden of co-pays and other cost sharing would create a financial hardship. It is also important to note that while enrolling in such programs can lead to getting the treatment drug for free, the costs of the actual infusion (such as charges for supplies and intravenous catheter insertion) are still not covered. Navigators who are well educated in the field of I-O can be enormously beneficial when it comes to finding assistance programs like these.
 
Navigation Doesn’t End When Treatment Does
As with all oncology care, the primary objective of coordinating care for patients receiving I-O therapy is to provide assistance throughout the care continuum. This includes survivorship, palliative, and hospice care, as applicable after treatment. Patients will continue to have follow-up visits, imaging, lab work, etc, and continue to require assistance in coordinating the care and costs. The benefits of survivorship programs have been well established, and there are often many questions and challenges associated with the transition to palliative and hospice care. Patient navigation should exist over this entire spectrum for oncology patients. Additionally, there are specific challenges associated with the rapidly evolving field of I-O that make having a patient navigator with extensive knowledge of the field a very valuable resource. 



Shawn M. Regis, PhD, is a patient navigator, Lung Cancer Screening Program, Lahey Hospital & Medical Center. 

ADDRESS FOR CORRESPONDENCE
 
Shawn M. Regis, PhD
Department of Radiation Oncology
Lahey Hospital & Medical Center
41 Mall Road
Burlington MA 01805
 
E-mail: Shawn.M.Regis@Lahey.org
REFERENCES
 
  1. Gorman LM, Boyle DA. The psychosocial impact of cancer on the individual, family, and society. In: Psychosocial Nursing Care Along the Cancer Continuum. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2010:1-23.
  2. Hutchison SD, Steginga SK, Dunn J. The tiered model of psychosocial intervention in cancer: a community based approach. Psychooncology. 2006;15(6):541-546. doi: 10.1002/pon.973.
  3. Advancing immuno-oncology in the community setting. Institute for Clinical Immuno-Oncology website. http://accc-iclio.org/wp-content/uploads/2016/01/ICLIO-White-Paper-Final.pdf. Accessed December 12, 2016.
  4. Seiden MV. Immuno-oncology 2016 and beyond: the opportunities, challenges, and risks. Am J Manag Care. 2016;22(SP1):SP67-SP71.
  5. Cancer prevalence and cost of care projections. National Cancer Institute website. http://costprojections.cancer.gov/. Accessed December 12, 2016.
  6. Marks A, Chapman MA. Improving patient access to immuno-oncology therapies. The Physician’s Perspective: A Health Policy Brief from the Institute for Patient Access. Institute for Patient Access website. http://1yh21u3cjptv3xjder1dco9mx5s.wpengine.netdna-cdn.com/wp-content/uploads/2015/10/Improving-Patient-Access-to-Immuno-Oncology-Therapies_Oct-20151.pdf. Published October 2015. Accessed December 12, 2016.
  7. Bankruptcy may portend greater mortality risk in patients with cancer. ASCO Annual Meeting website. https://am.asco.org/bankruptcy-may-portend-greater-mortality-risk-patients-cancer. Published May 31, 2015. Accessed December 12, 2016.
  8. Cost of cancer drugs should be part of treatment decisions. ASCO Annual Meeting website. https://am.asco.org/cost-cancer-drugs-should-be-part-treatment-decisions. Published May 31, 2015. Accessed December 12, 2016.
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