CHARLOTTE, N.C. – April 29, 2025 – The financial burden imposed by cancer treatments—commonly referred to as financial toxicity—has emerged as a critical yet often overlooked dimension affecting patient care and outcomes. This economic strain, which encompasses out-of-pocket costs, insurance gaps, and ancillary expenses tied to treatment, compromises not only the quality of life for patients but can also adversely influence treatment adherence and survival rates. In an unprecedented institutional response, the Atrium Health Levine Cancer Institute pioneered the establishment of a dedicated Financial Toxicity Tumor Board in 2019, a multidisciplinary initiative focusing exclusively on the financial challenges faced by cancer patients. This board’s innovative approach represents a paradigm shift in oncology care, emphasizing the integration of socio-economic factors into clinical decision-making and patient support.
The Financial Toxicity Tumor Board operates similarly to traditional tumor boards, which are typically centered on clinical and biological considerations of cancer management. However, its fundamental distinction lies in prioritizing financial distress as a core component of evaluation and intervention. This model convenes a diverse group of experts spanning clinical oncology, pharmacy, social work, administrative roles, and patient advocacy. Through coordinated collaboration, the board not only addresses individual cases but also identifies systemic barriers and opportunities for institutional reform. What makes this model particularly groundbreaking is its recognition that financial health is deeply intertwined with medical outcomes, and that multidisciplinary engagement is paramount for devising sustainable solutions.
The recent study published in the Journal of the National Comprehensive Cancer Network provides a comprehensive five-year analysis of the board’s operational impact and efficacy. The research methodically evaluates data from over 70 cases deliberated by the board, highlighting measurable benefits both at the patient-level and within broader systemic frameworks. Dr. Thomas G. Knight, chair of the Financial Toxicity Tumor Board and hematology-oncology specialist, who also holds an academic appointment at Wake Forest University School of Medicine, underscores the evidence linking financial hardship with diminished treatment efficacy and increased mortality risks. His clinical insights illuminate the intricate relationship between economic strain and biological disease progression, encouraging oncology centers worldwide to incorporate financial assessments as a standard component of care.
Central to the tumor board’s functioning is a two-tiered process. The first tier involves the identification and referral of patients facing financial difficulties. These referrals originate not only from patients themselves but also from caregivers, clinicians, social workers, pharmacists, and financial counselors. This screening ensures that no patient experiencing economic distress is overlooked, irrespective of the source of concern. The second tier focuses on the Patient Assistance Program (PAP), an innovative mechanism designed to systematically assess every newly proposed treatment plan against eligibility criteria for free medications or copayment support. Pharmacy technicians play a vital role here, facilitating timely access to these resources. This dual structure ensures proactive identification and remediation of financial barriers, significantly reducing delays and interruptions in cancer therapy.
The quantifiable outcomes of this model are particularly compelling. More than 90% of over 70 cases reviewed by the tumor board resulted in immediate, actionable solutions tailored to individual patient needs alongside recommendations for systemic improvements. Practically, this approach translated into substantial economic relief for thousands. The program assisted 9,321 patients with copay support, collectively saving them over $10 million in direct expenses. Moreover, an astounding 16,495 patients received free medications, representing nearly $393 million in pharmaceutical value. These figures not only reflect an impressive scale of assistance but also demonstrate the economic viability and scalability of the model within a complex healthcare ecosystem.
Integral to the board’s success is its facilitation of grant applications through partnerships with various foundations and nonprofit organizations. Financial navigators employed by the institute meticulously track available funding opportunities and actively assist patients throughout the application process. This aspect of the program addresses a critical pain point for many patients, who often struggle with navigating the bureaucracy inherent in the nonprofit assistance landscape. By streamlining access to these external resources, the board amplifies its impact, providing sustained and multifaceted financial relief that extends beyond pharmaceutical costs.
The tumor board also tackles the frequent issue of denied health insurance claims, a significant contributor to financial distress in oncology care. By investigating and identifying the root causes of claims denial, the team advocates vigorously on behalf of patients, often reversing denials and securing necessary coverage. This persistent review and advocacy ensure that patients receive timely authorization for treatments and supportive care services, significantly reducing out-of-pocket expenditures and the associated emotional burden. It exemplifies the board’s commitment to comprehensive patient advocacy, bridging gaps between clinical requirements and payor systems.
The multifactorial nature of financial toxicity is exemplified by complex patient scenarios encountered by the board. One illustrative case involves a patient who loses employer-based health insurance due to disability-induced unemployment. This event precipitates cascading challenges—including inability to afford treatments, transportation difficulties, and unmet basic living needs. In response, the tumor board coordinates access to COBRA insurance continuation, provides grants for transportation and food, and secures emergency financial assistance. This holistic approach addresses both direct medical expenses and ancillary costs that are crucial for sustaining patient compliance and quality of life.
A key strategic insight emerging from the tumor board’s operation is the realization that individual patient interventions generate broader systemic benefits. By convening all relevant stakeholders—clinicians, navigators, pharmacists, social workers, and administrators—in a single forum, the board identifies patterns and common risk factors predisposing patients to financial crises. Subsequently, it establishes workgroups tasked with proactively identifying and supporting at-risk populations. This anticipatory strategy transforms reactive case management into preventive care coordination, thereby reducing the incidence of financial distress crises and improving overall system efficiency.
Dr. Knight advocates for wider adoption of this model across cancer centers, positioning it as an essential evolution in oncology care delivery. The demonstrated out-of-pocket cost savings and enhanced patient support justify the investment in such dedicated multidisciplinary boards. By institutionalizing financial toxicity evaluation and intervention, oncology programs can not only improve outcomes but also foster equity in access to care. The paradigm underscores the intricate linkage between socioeconomic factors and health, urging a recalibration of clinical priorities to encompass financial well-being as a core domain.
The published analysis concludes that focused systemic interventions addressing financial toxicity yield substantial improvements not only in patient quality of life but also in treatment adherence and survival metrics. This evidence challenges cancer centers to reevaluate traditional tumor board structures, expanding their scope to integrate economic hardship as a standard consideration. Adopting this integrated model promises to establish a new standard of comprehensive care—one that recognizes the multifaceted challenges faced by patients and delivers holistic, effective solutions.
As financial burden increasingly comes to the forefront of oncologic discourse, the Atrium Health Levine Cancer Institute’s Financial Toxicity Tumor Board serves as a beacon of innovation and hope. Its success story is a clarion call for healthcare systems globally to acknowledge and address the invisible yet profound impact of financial toxicity. Through collaborative, multidisciplinary frameworks, patient-centered advocacy, and systemic reforms, the future of cancer care can be reimagined to support not only biological cure but also the economic sustainability of patients and families battling cancer.
Subject of Research: Financial toxicity related to cancer treatment and its intervention through a multidisciplinary tumor board.
Article Title: The Financial Toxicity Tumor Board: 5-Year Update on Practice and a Guide to Implementation
News Publication Date: April 29, 2025
Web References:
– Journal Article: https://jnccn.org/view/journals/jnccn/aop/article-10.6004-jnccn.2025.7010/article-10.6004-jnccn.2025.7010.xml
– DOI: http://dx.doi.org/10.6004/jnccn.2025.7010
Keywords: Cancer, Cancer treatments, Health care costs, Financial toxicity, Oncology, Multidisciplinary tumor board, Patient assistance program, Insurance claims advocacy, Financial navigation
Tags: cancer care socio-economic factorscost management in oncologyeconomic strain cancer treatmentfinancial distress and patient outcomesfinancial toxicity in cancer treatmentimproving treatment adherence cancerinnovative cancer care solutionsinsurance gaps cancer patientsmultidisciplinary tumor board approachpatient financial burden cancerpatient support initiatives oncologysystemic barriers in healthcare