Financial Navigation in Cancer Care Delivery: State of the Evidence, Opportunities for Research, and Future Directions

Background Financial toxicity (FT) describes the significant economic burden imposed by cancer treatment on American households.1 In recent years, the incidence and severity of FT have regrettably escalated because of the high cost structure (direct and indirect) associated with cancer diagnosis, treatment, and survivorship. This reality has heightened attention, across the broad health care stakeholder community, to finding solutions to FT at the policy, payer, and health system levels. Financial navigation (FN) is increasingly recognized as a health system level intervention with the potential to significantly mitigate the onset, severity, and duration of FT.2 It denotes the provision of individualized assistance to patients, families, and caregivers to overcome the financial barriers to timely, high-quality care such as high copayments, difficulty in finding the optimal health plan, and high nonmedical costs associated with care such as transportation, lodging, and meals.3 In addition to the more traditional role of connecting patients to financial assistance resources, FN also involves helping patients understand the financial aspects of their care, budget appropriately, and manage their employment and disability benefits in the context of ongoing financial commitments as they navigate the cancer care continuum. Recent studies suggest that connecting patients and caregivers with FN services is feasible, leads to reductions in patients anxiety about costs, and provides concrete assistance with medical and nonmedical costs. In a recent pilot study, for example, patients with cancer and caregivers from low-income households received significant assistance with cost of living expenses (eg, food and rent) through communitybased FN organizations.4,5 In another study, hospitalhired trained oncology financial navigators saved patients and hospital systems 39,000,000 US dollars (USD) for approximately 11,000 patients through optimizing insurance coverage, copay assistance, and community assistance for nonmedical costs.6 Although these early results are encouraging, future efforts to optimize the delivery of FN and incorporate FN into routine oncology practice are needed. Such efforts are critical in not only mitigating FT but also decreasing the likelihood that patients will consider harmful trade-offs like forgoing needed care because of costs. In this article, we discuss the current state of oncology FN in the United States, highlight the various approaches to deliver these services, and discuss enduring research questions.