Approximately one-half of individuals with cancer face personal economic burdens associated with the disease and its treatment, a problem known as financial toxicity (FT). FT more frequently affects socioeconomically vulnerable individuals and leads to subsequent adverse economic and health outcomes. Whereas multilevel systemic factors at the policy, payer, and provider levels drive FT, there are also accompanying intervenable patient-level factors that exacerbate FT in the setting of clinical care delivery. The primary strategy to intervene on FT at the patient level is financial navigation. Financial navigation uses comprehensive assessment of patients’ risk factors for FT, guidance toward support resources, and referrals to assist patient financial needs during cancer care. Social workers or nurse navigators most frequently lead financial navigation. Oncologists and clinical provider teams are multidisciplinary partners who can support optimal FT management in the context of their clinical roles. Oncologists and clinical provider teams can proactively assess patient concerns about the financial hardship and employment effects of disease and treatment. They can respond by streamlining clinical treatment and care delivery planning and incorporating FT concerns into comprehensive goals of care discussions and coordinated symptom and psychosocial care. By understanding how age and life stage, socioeconomic, and cultural factors modify FT trajectory, oncologists and multidisciplinary health care teams can be engaged and informative in patient-centered, tailored FT management. The case presentations in this report provide a practical context to summarize authors’ recommendations for patient-level FT management, supported by a review of key supporting evidence and a discussion of challenges to mitigating FT in oncology care. CA Cancer J Clin. 2022;72:437-453.

中文翻译：

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应对癌症患者的财务毒性：多学科管理方法

大约一半的癌症患者面临与疾病及其治疗相关的个人经济负担，这一问题被称为经济毒性(FT)。FT 更频繁地影响社会经济弱势群体，并导致随后的不利经济和健康结果。虽然政策、付款人和提供者层面的多层次系统性因素推动了 FT，但在临床护理提供环境中，伴随可干预的患者层面因素也加剧了 FT。在患者层面干预 FT 的主要策略是财务导航. 财务导航使用对患者 FT 风险因素的综合评估、对支持资源的指导以及转介以协助患者在癌症治疗期间的财务需求。社会工作者或护士导航员最常领导财务导航。肿瘤学家和临床提供者团队是多学科合作伙伴，可以在其临床角色的背景下支持最佳 FT 管理。肿瘤学家和临床提供者团队可以主动评估患者对疾病和治疗的经济困难和就业影响的担忧。他们可以通过简化临床治疗和护理提供计划并将 FT 问题纳入护理讨论和协调症状和社会心理护理的综合目标中来应对。通过了解年龄和人生阶段、社会经济、和文化因素改变 FT 轨迹，肿瘤学家和多学科医疗团队可以参与以患者为中心的定制 FT 管理并提供信息。本报告中的案例介绍提供了一个实用的背景来总结作者对患者级 FT 管理的建议，并辅以对关键支持证据的审查和对减轻肿瘤护理中 FT 的挑战的讨论。CA 癌症临床杂志。2022；72：437-453。