October 24, 2019

Dr. Stephanie Wheeler

Dr. Stephanie Wheeler

Professor of Health Policy and Management Stephanie Wheeler, PhD, is part of a research team that has received a 4-year, more than $1.87 million grant from the National Cancer Institute (NCI) to study the impact of establishing financial navigation services at five rural cancer centers in North Carolina. These services will guide patients in managing the financial burdens associated with cancer treatment.

Wheeler’s team at the UNC Lineberger Comprehensive Cancer Center, where she serves as the associate director of community outreach and engagement, includes assistant professors Sarah Birken, PhD, and Cleo Samuel, PhD, from the Gillings School of Global Public Health as well as Professor Don Rosenstein, MD, and Assistant Professor Katherine Reeder-Hayes, MD, from the UNC School of Medicine.

The researchers will work with existing financial support resources in five rural North Carolina counties – Carteret, Dare, Jackson, Lenoir and Nash – to connect with patients seeking strategies to mitigate the complicated and oftentimes overwhelming costs they may face. Such costs have collectively been termed “financial toxicity” by researchers because they are not simply associated with payment for cancer treatment; they can also come from lost wages, the psychological burden associated with high-cost care, insurance complexities and potentially harmful behavioral strategies that patients sometimes use to cope with costs, such as delaying treatment or even skipping it altogether.

The process of applying for financial assistance can also compound financial toxicity. As Wheeler and her team discovered, trained financial navigators often are essential in helping patients identify available assistance programs, especially if a patient is uninsured or underinsured.

“Our intervention addresses the financial difficulties that so many cancer patients face: How do you afford cancer treatment? How do you make sense of your insurance and understand your out-of-pocket cost responsibility?” says Wheeler. “What government programs might you be eligible for, how do you get insurance if you’re uninsured and what other assistance programs are there that you can tap into while going through cancer treatment?”

During a presentation at the 2018 American Society of Clinical Oncology’s Quality Care Symposium, Wheeler noted the results of a survey of more than 1,000 breast cancer patients indicated that nearly 70% of respondents were concerned about the financial burden posed by cancer treatment. Wheeler and a team also surveyed a network of oncology navigators in 2018 and found that not only did these navigators report a high percentage of patients who experienced financial toxicity – an average of 75% – but that the most common barriers for obtaining assistance included both lack of resources and lack of knowledge about resources available to patients.

Wheeler is part of a team that received an Innovation Pilot Award from the UNC Center for Health Innovation. The team piloted a program establishing a financial navigation clinic for uninsured and underinsured patients who were undergoing treatment at the North Carolina Cancer Hospital. Using data collected from participants, the team then developed a screening strategy to identify patients with high financial burden and connected those patients with a trained financial navigator staffed from the UNC School of Social Work.

“Our long-term hope,” Wheeler says, “is that patients will be more adherent to cancer treatment and have better outcomes than if they had discontinued or skipped treatment altogether because of cost.”

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