Financial navigation in gynecologic oncology: a qualitative study

Gynecologic oncology patients experience financial toxicity. Financial navigation, a program where individuals meet with a trained financial counselor to discuss estimated out-of-pocket costs, connect to assistance programs, and develop payment plans, may help reduce financial toxicity. Our objective was to examine the experiences of gynecologic oncology patients who received financial navigation services through qualitative data collection from patients and financial navigators.

Since May 2022, we have offered financial navigation to patients seen in gynecologic oncology practices at a large academic health system. Financial navigators completed questionnaires to characterize services provided to patients, and we reported descriptive statistics of those served. We then recruited patients who participated for semi-structured interviews. Two team members used a thematic approach to code and identify themes.

In the first year, 31 patients were referred for financial navigation, and 28 received services. After review of insurance benefits by financial navigators, half had no estimated out-of-pocket costs for cancer care. Of patients with non-zero out-of-pocket, 42% of patients were referred for co-pay assistance of whom 40% ultimately received financial assistance grants. Patients reported transportation, rent, and food as major concerns, alongside medical costs. Patients appreciated the financial navigators' compassion and assistance navigating bureaucracy. Patients identified delayed insurance billing, high treatment-related out-of-pocket, external grants not meeting needs, and treatment-related fatigue as contributing to financial distress.

Financial navigation was positively perceived by patients. Half of patients referred had low to no out-of-pocket costs after meeting with financial navigators, although patients identified significant non-medical financial stresses. Receipt of financial assistance was low among patients with high out-of-pocket, and patients identified gaps in coverage. Financial navigation addressed patients' medical costs, yet further work is needed to help patients survive broader financial toxicity of cancer treatment.