Completed Research: PRACTICE MANAGEMENT RESEARCH
Abstract #CR08

Perceptions of PGY2 Oncology Programs on Financial Toxicity Education and Preparedness

JHOP - March 2022 Vol 12 Special Feature - HOPA Abstracts

Presenter: Nicholas K. Chow, PharmD, BCOP, Clinical Pharmacy Supervisor, Clinical Trials, Miami Cancer Institute, Baptist Health South Florida

Co-Authors: Gaines Kyna Gania, PharmD, Ochsner Medical Center; Monica Tadros, PharmD, Miami Cancer Institute, Baptist Health South Florida; Benito Fernandez, PharmD, Nova Southeastern University College of Pharmacy; Aisha Shokoya, PharmD, Baptist Health South Florida; Nicholas Chow, PharmD, Miami Cancer Institute, Baptist Health South Florida

BACKGROUND: Patients with cancer face a rising financial burden resulting from increased direct and indirect costs associated with cancer treatment.1 This has an overall negative impact on the financial well-being of a patient,1-11 which is known as financial toxicity.5 There is a lack of literature about the implementation of financial toxicity education in postgraduate oncology residency training for pharmacists. In addition, the current American Society of Health-System Pharmacists (ASHP) resident standards for postgraduate year 1 (PGY1) and PGY2 residency programs do not address financial toxicity.

OBJECTIVE: To describe the perceptions of PGY2 oncology pharmacy residents and residency program directors about the incorporation of financial toxicity as an area of their training programs and the self-perceptions of their ability and experience in managing financial toxicity for patients.

METHOD: In December 2020, we e-mailed a qualitative, voluntary, and anonymous RedCap electronic survey to directors and residents of PGY2 oncology programs who were identified from a convenience sample using the ASHP residency program database. Separate surveys were used for directors and for residents.12,13 The questions aimed to assess the directors’ or residents’ familiarity with the concept of financial toxicity, potential training incorporated into the residency program, and the experience with managing financial toxicity. Descriptive statistics were used to analyze the survey data.

RESULTS: Overall, 64% of residency program directors were familiar and comfortable with the concept of financial toxicity, whereas 73% of pharmacy residents were less than familiar with the concept of financial toxicity within their program. Only 44% of residency program directors thought that their programs provided sufficient opportunities to master financial toxicity. Furthermore, only 40% of residency program directors were comfortable assisting patients with their financial toxicity, whereas a majority of residents were either uncomfortable or highly uncomfortable managing financial toxicity for patients. In addition, the most frequently used methods of incorporating the concept of financial toxicity in all programs were through specialty pharmacy and patient assistance programs; residents preferred these educational methods, along with guest speakers to provide such training.

CONCLUSION: These data indicate that there is a need to improve financial toxicity training in PGY2 oncology residency programs, and this training should be considered as an educational standard. We suggest introducing the concept through guest speakers, followed by practical applications integrated in specialty pharmacies and patient assistance programs. Further research should be considered to assess different pharmacists and/or pharmacy technicians’ roles and methods that may help to alleviate the financial toxicity of patients with cancer.

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  2. Soni A. Top 10 most costly conditions among men and women, 2008: estimates for the U.S. civilian noninstitutionalized adult population, age 18 and older. Medical Expenditure Panel Survey Statistical Brief #331. July 2011. Rockville, MD: Agency for Healthcare Research and Quality. http://meps.ahrq.gov/mepsweb/data_files/publications/st331/stat331.shtml. Accessed November 13, 2021.
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  6. Bestvina CM, Zullig LL, Zafar SY. The implications of out-of-pocket cost of cancer treatment in the USA: a critical appraisal of the literature. Future Oncol. 2014;10:2189-2199. Erratum in: Future Oncol. 2015;11:544.
  7. Yabroff KR, Dowling EC, Guy GP Jr, et al. Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol. 2016;34:259-267.
  8. Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood). 2013;32:1143-1152.
  9. Witte J, Mehlis K, Surmann B, et al. Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications. Ann Oncol. 2019;30:1061-1070.
  10. Meeker CR, Geynisman DM, Egleston BL, et al. Relationships among financial distress, emotional distress, and overall distress in insured patients with cancer. J Oncol Pract. 2016;12:e755-e764.
  11. Zafar SY, Newcomer LN, McCarthy J, et al. How should we intervene on the financial toxicity of cancer care? One shot, four perspectives. Am Soc Clin Oncol Educ Book. 2017;37:35-39.
  12. Jones TL, Baxter MAJ, Khanduja V. A quick guide to survey research. Ann R Coll Surg Engl. 2013;95:5-7.
  13. Choi BCK, Pak AWP. A catalog of biases in questionnaires. Prev Chronic Dis. Jan 2005;2:A13.
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