The purpose of this research is to see how personal financial burden (financial toxicity) related to cancer affects the overall health and quality of life by evaluating the impact of systematic financial navigation in addition to standard financial distress interventions during cancer treatment.
Financial navigation (FN) has been increasingly recognized as an important interventional tool with the potential to significantly mitigate the onset, severity, and duration of financial toxicity (FT). There have been several recent pilot studies in this area demonstrating the feasibility and effectiveness of this approach. With the suddenness of onset and high healthcare utilization of an acute leukemia diagnosis, financial navigation early in the disease course may represent an opportunity to reduce the financial distress burden of this disease and improve outcomes. The investigators have chosen to conduct this as a randomized, controlled trial (RCT) evaluating the effect of financial navigation (FN) on the patient reported objective measurement of financial toxicity (FT) using the Comprehensive Score for Financial Toxicity (COST) measure. This 12-question measure has become the standard for financial toxicity (FT) quantification in the research setting and will allow for direct comparison between the two groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
120
The intervention will consist of systematic financial navigation with consistent screening and intervention on any financial related issues. All patients randomized to the financial navigational group will be contacted by clinical trial staff assigned to the study to screen for financial needs. Based on the results of this assessment, the clinical trials staff will refer to the appropriate services for personalized recommendations and assistance provided by Atrium Health personnel including financial navigators, nurse navigators. All the resources provided to the patient, including counseling, will be free of charge. Assessment will be performed once per month for 6 months.
All patients randomized to the Standard of Care arm will have access to the financial distress resources (Financial Navigation and Nurse Navigation) as per current clinical policy which is per patient or clinician request. Utilization of these resources will be tracked to assess and describe the per-protocol population. All the resources provided to the patient, including counseling, will be free of charge as per institutional policy.
Levine Cancer Insitute
Charlotte, North Carolina, United States
RECRUITINGSelf-reported financial toxicity as assessed by the total score of the COmprehensive Score Financial Toxicity (COST) assessment tool at 6 months after enrollment.
For each participant, the total score of the COST at the 6-month assessment will be calculated. The total score is informed by 11 questions, each assessed on a 5-point scale of numerical values ranging 0 to 4, and the total score may range from 0 to 44 (where the lower score, the worse the financial well-being of the participant). Data of COST assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until six months
Self-reported financial toxicity as assessed by the total score of the COmprehensive Score Financial Toxicity (COST) assessment tool at 3 months after enrollment.
For each participant, the total score of the COST at the 3-month assessment will be calculated. The total score is informed by 11 questions, each assessed on a 5-point scale of numerical values ranging 0 to 4, and the total score may range from 0 to 44 (where the lower score, the worse the financial well-being of the participant). Data of COST assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until three months
Self-reported financial toxicity as assessed by the total score of the COmprehensive Score Financial Toxicity (COST) assessment tool at 12 months after enrollment.
For each participant, the total score of the COST at the 12-month assessment will be calculated. The total score is informed by 11 questions, each assessed on a 5-point scale of numerical values ranging 0 to 4, and the total score may range from 0 to 44 (where the lower score, the worse the financial well-being of the participant). Data of COST assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until twelve months
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Self-reported physical health as assessed by the total score of the Global Physical Health (GPH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 3 months after enrollment
For each participant, the total score of the GPH measure at the 3-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 16.2 to 67.7. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until three months
Self-reported physical health as assessed by the total score of the Global Physical Health (GPH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 6 months after enrollment
For each participant, the total score of the GPH measure at the 6-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 16.2 to 67.7. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until six months
Self-reported physical health as assessed by the total score of the Global Physical Health (GPH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 12 months after enrollment
For each participant, the total score of the GPH measure at the 12-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 16.2 to 67.7. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until twelve months
Self-reported physical health as assessed by the total score of the Global Mental Health (GMH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 3 months after enrollment
For each participant, the total score of the GMH measure at the 3-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 21.2 to 67.6. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until three months
Self-reported physical health as assessed by the total score of the Global Mental Health (GMH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 6 months after enrollment
For each participant, the total score of the GMH measure at the 6-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 21.2 to 67.6. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until six months
Self-reported physical health as assessed by the total score of the Global Mental Health (GMH) as part of the Patient-Reported Outcomes Measurement Information System (PROMIS) at 12 months after enrollment
For each participant, the total score of the GMH measure at the 12-month assessment will be calculated. The total raw score is informed by four items and the total raw score may range from 4 to 20 (where the higher score represents more physical health). The total raw score will be standardized to the general population using the scale's published T-scores. The transformed T scores will be used in analyses and range from 21.2 to 67.6. Data of GPH assessments from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until twelve months
Self-reported gaps in care as assessed by the number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at 3 months after enrollment
For each participant, the total number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at the 3-month assessment will be calculated. The total score is informed by 9 questions, each assessed as a binary response "Yes/No", where each response of "Yes" will be mapped to a numerical value of 1 and each "No" will be mapped to a numerical value of 0. The total sum will be calculated as the total score and the total score may range from 0 to 9 (where the higher score represents the most severe gaps in care assessed by the survey). Data from the Financial Navigation Intervention Compliance/Coping Survey from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until three months
Self-reported gaps in care as assessed by the number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at 6 months after enrollment
For each participant, the total number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at the 6-month assessment will be calculated. The total score is informed by 9 questions, each assessed as a binary response "Yes/No", where each response of "Yes" will be mapped to a numerical value of 1 and each "No" will be mapped to a numerical value of 0. The total sum will be calculated as the total score and the total score may range from 0 to 9 (where the higher score represents the most severe gaps in care assessed by the survey). Data from the Financial Navigation Intervention Compliance/Coping Survey from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until six months
Self-reported gaps in care as assessed by the number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at 12 months after enrollment
For each participant, the total number of gaps of care reported in the Financial Navigation Intervention Compliance/Coping Survey at the 12-month assessment will be calculated. The total score is informed by 9 questions, each assessed as a binary response "Yes/No", where each response of "Yes" will be mapped to a numerical value of 1 and each "No" will be mapped to a numerical value of 0. The total sum will be calculated as the total score and the total score may range from 0 to 9 (where the higher score represents the most severe gaps in care assessed by the survey). Data from the Financial Navigation Intervention Compliance/Coping Survey from all randomized participants will inform this intent-to-treat analysis comparing scores between the arms.
Time frame: From the date of randomization up until twelve months
Overall survival
Overall survival is defined as the time interval from the date of diagnosis to the date of death from any cause, or the date of last known follow-up while on study. All randomized participants will inform this analysis.
Time frame: From the date of randomization up until date of death or last known follow-up, assessed over 3 years.
Comparison of relapse-free survival All randomized participants will inform this analysis.
Relapse-free survival is defined as the time interval from the completion of initial treatment (which may include induction and consolidation therapy) to the date of the first documented relapse of AML or death from any cause, whichever occurs first. A relapse is characterized by the re-emergence of leukemia cells in the bone marrow or peripheral blood; in absence of disease relapse, participants will be censored at the last follow-up visit where they were confirmed to be in complete remission without evidence of relapse. Relapse-free survival will be calculated for participants achieving complete response after initial treatment only.
Time frame: From the date of randomization up until date of relapse, death or last known follow-up, assessed over 3 years.
Annualized count of acute care visits
The annualized count of acute care visits, where acute care visits include all unplanned hospital admissions and unplanned emergency department visits was calculated for each participant as the total number of acute care visits normalized to an annual basis. Data of randomized will inform this intent-to-treat analysis comparing counts between the arms. All randomized participants will inform this analysis.
Time frame: From the date of randomization up until twelve months