Financial toxicity isn’t a side effect of cancer treatment. It’s a predictable outcome of a care model that was never built to handle the cost of staying alive.
We engineered oncology for precision – but not for economic survivability.
So, when patients begin treatment, the financial risk curve often rises faster than the disease itself. And every missed cost conversation or unflagged burden reinforces that design flaw.
Here’s the uncomfortable truth:
The system isn’t broken. It’s functioning exactly as designed.
- Clinicians are evaluated on outcomes, not affordability.
- Navigators are left to patch systemic gaps with grants and goodwill.
- Patients are forced to choose between adherence and solvency
We don’t ignore cost because we don’t care. We ignore it because the system made it hard to see – and harder to act on. But clinics that build cost-awareness into care are proving it’s both possible and powerful.
That’s why I’m sharing five models that community oncology programs are already using to reduce financial toxicity at the point of diagnosis. These aren’t just ideas. They’re systems – ready to implement, adapt, or scale.
1. Early Screening as Baseline Practice
A North Carolina pilot showed that newly diagnosed patients with high financial distress (COST <23) doubled their scores post-intervention—from 6.4 to 13.3 (p < 0.0001). None altered their treatment due to cost.
Apply it now:
- Add a 3-question COST screen at intake
- Refer any score <23 to a navigator or social worker
- Track COST scores like you do pain or fatigue
If we screen for neutropenia, we can screen for bankruptcy.
2. Financial Navigation as Core Infrastructure
Michigan: A half-time navigator saved patients $700K and prevented $265K in hospital losses in 5 months. By year four, the role drove $5M in annual savings.
Apply it now:
- Dedicate 0.5–1 FTE to navigation
- Equip navigators with an updated database of pharmaceutical assistance and foundation programs
- Report monthly: total aid secured, treatment cancellations avoided, change in COST (financial toxicity) scores
Navigators aren’t overhead. They’re operational infrastructure and directly reduce system losses while enhancing equitable patient access to care.
3. EMR-Based Referral Automation
Memorial Sloan Kettering embedded a “Financial Toxicity” order in their EMR. Result: 718 referrals, with > $850,000 USD in financial aid in 38 patients, zero added clinical burden.
Apply it now:
- Create an EMR order for “Financial Navigation Referral”
- Auto-trigger for high out-of-pocket projections or flagged distress
- Embed into treatment planning workflow
A missed referral is a missed opportunity to preserve adherence.
4. Proactive Cost Education (and Why Now Matters)
Cedars-Sinai’s Proactive Cost of Care (PCOC) program showed that a single cost education session – paired with written guides and planning tools – significantly improved COST scores and reduced anxiety at 6 months (p = 0.02).
Apply it now:
- Offer brief financial education sessions at diagnosis
- Include cost tracking tools, caregiver participation, and planning resources
- Deliver via group telehealth or printed packet
Open Enrollment Tip: A quick conversation about Medicare Advantage vs. Traditional Medicare + Medigap and Part D coverage can prevent care disruptions next year. Many patients don’t realize their coverage could limit access to oncology services, specialty pharmacies, or diagnostics. This is my favorite publication on the topic!
One five-minute conversation now may prevent treatment delays in January.
5. Financial Toxicity Tumor Boards
Levine Cancer Institute’s cross-functional Financial Tumor Board has resolved >90% of complex cases, securing:
- $10M+ in copay assistance
- $393M in free drugs via PAPs
- 9,000+ patients directly supported
Apply it now:
- Start a monthly 30-minute meeting: oncologist, navigator, billing, pharmacy
- Review top 2–3 high-risk cases
- Document learnings that trigger systemic fixes (e.g., insurance lapses, benefit denials)
Every difficult case reveals a design flaw. The best clinics act on it.
Dropped treatment is a signal the structure needs work.
We’ve mastered clinical precision. Now is the time to lead on economic survivability.
You can wait for system-wide change – or build workflows that work now.
You don’t need more studies.
You need systems.
And your leadership, to build them.
Warmly,
Shruti Agarwal
Founder, Together4Cancer
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The Compass is your practical briefing on what’s working in oncology care – strategy, science, and systems. No fluff. Just implementation.