Development of comprehensive intervention to address financial toxicity among cancer survivors and caregivers

About This Grant

PROJECT SUMMARY More than half of cancer survivors and caregivers experience financial toxicity (FT),a multidimensional construct encompassing not only material burden resulting from cancer treatment but also psychosocial distress and coping behaviors driven by real, perceived, or anticipated financial strain. FT adversely impacts survivors’ and caregivers’ well-being and contributes to poor survivorship outcomes. Existing FT interventions have limited translational potential because they primarily target survivors with demonstrated material burden, focus narrowly on financial or insurance education, and are typically available only during active treatment. To reduce overall hardship and improve survivorship outcomes, future FT interventions must (i) address all domains of FT (i.e., material, psychosocial, and behavioral), (ii) reach participants with varying degrees of FT and beyond just material burden, and (iii) adapt to the dynamic trajectories of cancer treatment and recovery needs of survivors and caregivers across the cancer journey. Thus, this R21 application seeks to inform a comprehensive, adaptive, and feasible FT intervention for survivors and caregivers. In Aim 1 [Landscape confirmation], we will engage a 24-member Stakeholder Advisory Team (SAT, 8 survivors, 8 caregivers, 8 supportive care professionals) in Step 2 of Putting Public Health Evidence into Action (PPHEA) over the course of one round of individual interviews and three group meetings with follow-up surveys. Findings from this mixed methods process will confirm survivor and caregiver needs to be addressed by the intervention and explore the strengths, weaknesses, threats, and opportunities among existing systems to identify structural considerations. In Aim 2 [Component prioritization and selection], we will complete Step 3 of the PPHEA. In Aim 2a, we will conduct a Discrete Choice Experiment (DCE) with a national sample of cancer survivors within five years of initial diagnosis (n=100) and caregivers of cancer survivors within five years of initial diagnosis (n=100). Through Aim 2b, the SAT will identify valued evidence-based interventions (EBIs) or EBI components and components missing from existing EBIs. Aim 2b will occur over two rounds of meetings with follow-up surveys and will be informed by the literature and emerging findings from the DCE. In Aim 3 [Co-development], the SAT will execute Step 4 of the PPHEA to create prototypes of adapted (components of) FT interventions, new components to address gaps in existing interventions, and protocols to support recruitment, implementation, and evaluation. Data across Aims 1, 2b, and 3 will be mapped to the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and Bowen’s feasibility framework. Findings will provide a stakeholder- and evidence-informed intervention prototype to be tested in a fully-powered hybrid type 1 effectiveness- implementation trial. This research has the long-term potential to transform supportive care services, reduce FT, enhance survivor and caregiver quality of life, and improve survivorship outcomes.