Findings from the PRO-TECT trial suggest that patients and nurses are generally in favor of implementing financial toxicity screening into routine care for cancer.
Screening for financial toxicity as part of routine digital monitoring with patient-reported outcomes (PROs) lowered the likelihood of patients having new or worsening financial difficulties while receiving systemic care for metastatic cancer, according to secondary findings from the cluster-randomized PRO-TECT (AFT-39) trial (NCT03249090).
Of those who received the financial toxicity screening intervention (n = 1191), 30.2% experienced worsening financial difficulties compared with 39.0% of patients treated at control practices (P = .004). In total, 31.1% and 40.1% of patients treated at a PRO practice and control practice who were active in the study following March 2019, respectively, experienced worsening financial difficulties (P = .014).
Overall, 8.5% (n = 252/2969) of respondents to PRO surveys triggered a financial toxicity alert, and 3.5% (n = 103) triggered an alert for financial toxicity only. Of 246 documented nurse responses to these alerts, 53.3% (n = 131) involved a telephone call to the patient, 28.5% (n = 70) demonstrated an awareness of the alert with no need to call and 16.7% (n = 41) made plans to speak about the issues with the patient at the next visit.
Across 10 PRO practices, 19 of 22 interviewed patients stated that they were in favor of having the financial toxicity screening question as part of the PRO survey. Some patients suggested that additional context about why the question was being asked should accompany that portion of the survey. One patient stated that a question about financial toxicity was inappropriate to include.
Interviews with 10 nurses at 4 PRO practices indicated that most responded positively to the implementation of financial toxicity screening and felt that it initiated important conversations with patients. Additionally, repeated financial toxicity screening was reported as being helpful for identifying patients who may have been missed if they only underwent screening at the beginning of treatment. One response from a nurse suggested that patients were appreciative of ongoing discussions brought about by financial toxicity screening.
“In this multicenter, cluster-randomized trial of approximately 1200 patients, remote symptom monitoring, including [financial toxicity] screening, protected patients undergoing systemic therapy from experiencing worsening financial difficulties,” the study authors wrote. “The finding, in exploratory analyses, that [financial toxicity] screening may not have been effective among Black patients raises concerns that the intervention as implemented may not address [financial toxicity] equitably…. Additional research is needed to understand why [financial toxicity] screening may not decrease the development of new or worsening financial difficulties in Black patients.”
Investigators of the PRO-TECT trial assessed the impact of digital patient monitoring via PRO surveys compared with usual care. Institutions randomly assigned to the experimental arm had access to a digital patient monitoring intervention including questions regarding symptoms, oral intake, performance status, falls, and screening for financial toxicity for up to 1 year. As part of the intervention, practice nurses received email alerts when patients reported a financial toxicity screening score of higher than 2; care teams were not required to take specific actions in response to an alert.
Investigators’ primary outcome in this secondary analysis was the development or worsening of financial difficulties via responses to the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire.
Adult patients receiving systematic chemotherapy, targeted oral therapy, or immunotherapy for metastatic cancer were eligible for inclusion in the study. Those with indolent lymphoma or acute leukemia were not able to enroll, as were those treated with hormonal monotherapy.
A total of 1444 patients were initially approached for the study, of whom 1191 were enrolled. This included 593 patients who were treated at 26 PRO practices and 598 at 26 control practices. The median patient age was 63 years. Additionally, 58.3% of patients were female, 79.5% were White, and 39.4% received a high school education at most.
Blinder VS, Deal AM, Ginos B, et al. Financial toxicity monitoring in a randomized controlled trial of patient-reported outcomes during cancer treatment (Alliance AFT-39). J Clin Oncol. Published online August 25, 2023. doi:10.1200/JCO.22.02834