Some patients with lung cancer are delaying treatment or missing appointments due to the financial burden of their diagnosis, and health professionals feel hampered in their ability to help, a Victorian study suggests.

Melbourne researchers led by Peter MacCallum Cancer Centre say their findings highlight opportunities for interventions like financial consent, routine screening and discussion of financial toxicity to become commonplace across care pathways.

They conducted qualitative semi-structured interviews over the phone or on video with 23 patients with lung cancer attending two metropolitan hospitals and 11 health professionals involved in their care from July–August 2021.

Patients had a mean age of 67 and 57% were female.

Almost half (43%) reported English as their second language.

Health professionals and patients at both health services indicated there was a lack of routine discussion about financial concerns or treatment costs, according to findings published in Supportive Care in Cancer [link here].

“If they don’t get seen by social work, I don’t think anybody actually asks about the financial impacts of their treatment,” one health professional said.

Patients also didn’t recognise financial toxicity as a concern they could bring up with their clinical team, which hindered their awareness of available benefits.

Other barriers preventing patients from asking for financial assistance included lower health literacy, language barriers and financial insecurity prior to diagnosis.

Health professionals, which included five doctors and four nurses, recognised that ongoing expenses could heighten stress for patients and families, which could, in turn, result in a worsening of symptoms or a lack of treatment adherence.

However, health professionals felt limited in their ability to refer patients to outpatient support services, such as social work, and even when referrals were progressed, staffing constraints meant patients experienced lengthy delays.

One health professional pointed out the noticeable discrepancy in community supports specific to patients with lung cancer as opposed to other cancers.

“You sort of get a whole suite for other cancers. The first one that comes to mind really is breast cancer; so, there’s lots and lots of not-for-profit community support available for the breast cancer patients,” they said.

“But we find that with lung cancer patients we don’t have as many resources available to us in the community to refer onto.”

Previous experience with welfare services such as disability support or age pensions was an advantage for some patients, but the majority described access to government welfare services as slow, complex and confusing.

In some cases this led to patients choosing to delay treatment or missing appointments, with one health professional revealing that they had a patient who had to choose between receiving treatment or providing for his family.

“Our data lend support to evidence that financial toxicity is an avoidable consequence of cancer and its treatment that disproportionately affects those most disadvantaged,” said the authors, which included medical oncologists from Sunshine Hospital and Monash Health.

“Early discussion of financial stresses should be integrated as standard of care, along with timely access to services, supports, and financial counselling to mitigate toxicity, particularly for those experiencing financial stress at diagnosis.”

The authors called for clear referral pathways to support services that were sufficiently resourced to meet population need, as well as co-located social welfare experts or financial counsellors within the health services themselves.

They also suggested expansion of “closer to home” models of care, such as home-delivery of cancer therapies and investment in telehealth consultations to minimise the financial burden associated with travel for cancer treatment.