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Can the 4 Ps Devise Interventions to Reduce the Financial Toxicity of Cancer?
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Can the 4 Ps Devise Interventions to Reduce the Financial Toxicity of Cancer?

Surabhi Dangi-Garimella, PhD
A discussion at the 2017 American Society of Clinical Oncology Annual Meeting addressed the practical solutions to address the financial toxicity of cancer care and identified leads for future intervention studies aiming to prevent or reduce this burden.
“For me as an oncologist, my 1 solution is to know what the cost of the treatment,” said Saltz. “What we need is an informed discussion among stakeholders and for that we need everyone to have all the information."

He emphasized that he was talking about cost, not “value.” Saltz believes that cost and value are not the same. “They are related. They are inversely proportional,” he said.

However, we cannot put a number on value and we cannot provide an accurate qualitative context to it. Saltz drove home the point that while physicians consider it their duty to provide patients an accurate estimate of toxicities and the adverse effects, discussions on the impact on patient finances “is also a part of our job. We cannot be uncomfortable about this.”

“I’d also argue that as academicians, we could be considering costs in our trials. When we look at benefit (such as overall survival and disease-free survival) we could also include cost in the equation,” he said.

Nasso said that patients want to live their life well during and after treatment. They want to be functional and working and want to understand the impact on their families during treatment. “So, the burden of finances needs to be a part of the overall impact on the patient, in addition to the disease being treated,” she said.

Care planning, Nasso believes, should not be a checkbox, rather a conduit to initiate a discussion on the topic. This should include conversations around out-of-pocket costs as well as indirect costs of the treatment: hospital visits, work loss for self and family, and the like. “Affordability should not be on the map at all, but that’s where we currently are,” Nasso said.

She emphasized the importance of a cancer care plan for the patient to revisit after their conversation with the care provider and added that the healthcare system should reimburse this process through incentives. She also urged physicians to step up and be more proactive on this front.

“I’d like to see a system where we can help patients go through this process.”

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