Dr Stephen Schleicher: We Need to Focus More on Financial Toxicity

Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology, addresses the “huge problem” of financial toxicity among patients with cancer, which can be attributed in part to both the high price of targeted treatments and even from ordering only necessary testing.

There is no easy fix to financial toxicity among patients who have cancer, and financial toxicity has not been investigated enough even though fixing it can save costs because patients are going to do better, noted Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology.


What are some optimal ways to help patients overcome financial toxicity so they will not delay cancer care?

Financial toxicity is a huge problem, and there's no easy answer. If a patient has new lung cancer and needs a PET scan, needs mutational testing, odds are they're going to need immunotherapy. They might have a target where they don't, but they very well could need immunotherapy. That's going to be expensive, but it's also a very effective treatment that's changing how lung cancer is thought of.

But even if you choose the right drugs, even if you only ordered the test absolutely necessary, which will include next-generation sequencing—and that's not the most expensive piece of the pie, but there's a lot of stuff you need full staging—it's going to be expensive. So, there's no easy solution to just fix financial toxicity. Definitely, you have to always do what's appropriate, because that at least limits any unnecessary financial toxicity.

At Tennessee Oncology we are blessed. We take everybody who walks in our door. I don't have to even think about if a patient's insured or not. If that patient needs an immunotherapy, I can order it and don't need permission from anybody and we will eat the costs if we need. We gave $100 million of free drug last year, but we're big so we can do that. But we really rely on great community partners. Community outreach is a huge focus at Tennessee Oncology, because we need to let these partners know how much we appreciate them.

There's a group in Lebanon called Sherry’s Run that helps with a lot of financial support for patients. There are other groups that help focus purely on utilities, transportation, and food.

A good thing about EOM [the Enhancing Oncology Model] is it does focus on social determinants of health. It doesn't fix it, but it's just an acknowledgement. People recognize, you can have all the best drugs in the world, but if a patient can't get to clinic, can't be healthy, doesn't have family support or a fringe support, it's going to be tough. How do we address those? And that's hard, because there's no businesses yet that know how to do that.

So, we rely on our amazing community partners. And it's our job to be great community partners to them and give back to the community. But I would love people to figure out how to make a model work to address those such important pieces of health care that are often forgotten. And not only is that the right thing to do, but if you can help fix those things, it's also going to save cost for the system, because patients are going to do better.

It's in an insurance plan’s, it's in an estate plan’s, it's in the government's plan, it's in their best interest to figure out how to do that and actually aligns what's best for the patient and what's best for the system and will lower costs and improve quality. But it's hard to fix and people haven't focused on it enough yet.

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