Effectiveness of a Multisite Oncology Financial Navigation Intervention: The Lessening the Impact of Financial Toxicity Clinical Trial

Purpose Financial toxicity (FT) among cancer survivors is prevalent and associated with excess morbidity and mortality. Although financial navigation (FN) has reduced FT in limited academic and urban settings, evaluation of FN within broader practice settings is needed. Methods We conducted a pragmatic hybrid II implementation-effectiveness clinical trial (Lessening the Impact of Financial Toxicity [LIFT]) in eight oncology practice sites, tailoring FN for four rural sites and four nonrural sites. All patients with cancer within 5 years of diagnosis, or those living with advanced disease, with a Comprehensive Score for financial Toxicity (FACIT-COST) score of ≤22 (indicating moderate-to-severe FT) who understood English were eligible. The primary effectiveness outcome was change in FACIT-COST score, pre- versus post-LIFT implementation. Patient-level secondary outcomes included the following: uptake (number served by FN/number screened positive for FT), acceptability, responsiveness, alignment with needs, patient-centeredness, and timeliness. Results Of 258 patients consented, 233 screened FT-positive, 179 received FN, 134 completed post-intervention measures, and 21 died before study completion. Participants were, on average, 53.0 years (standard deviation [SD], 13.0), mostly female (65.7%), and non-Hispanic White (56.0%) or Black (33.6%), with 9.0% identifying as Hispanic and 39.6% from a rural ZIP code. After LIFT, FACIT-COST scores significantly improved by an average 8.1 (SD, 10.0) points ( P < .0001), Pre: 6.6 (SD, 5.1), Post: 14.7 (SD, 10.2), with significant increases at both rural (6.3 [SD, 9.2], P < .0001) and nonrural sites (9.3 [SD, 10.4], P < .0001). Intervention uptake was high, with nearly three quarters of those who screened positive for FT receiving FN. LIFT was broadly perceived as acceptable, responsive, aligned with patient needs, and timely. Conclusion Patient-centered interventions like FN can clearly reduce FT in diverse patient populations across clinical settings and should be considered best practice.