Enhanced financial assistance intervention for unmet essential needs: A prospective pilot study to improve timely cancer treatment completion.

Abstract

11078 Background: Unmet essential needs, such as food, transportation, and housing insecurity, can create barriers to timely cancer treatment. Delayed or prolonged courses of definitive radiotherapy (RT) can compromise cancer outcomes like recurrence and survival. There are limited prospective data testing interventions to improve timely cancer treatment completion by meeting essential needs. Methods: We conducted a pragmatic single-arm pilot study testing an enhanced financial assistance intervention for unmet needs during RT. Eligibility criteria included adults with a cancer diagnosis and unmet social needs (via social risk screening and/or social worker evaluation) who were prescribed or undergoing a course of RT with > 10 fractions remaining. Participants received standard institutional assistance (e.g., limited support for travel/lodging with strict eligibility criteria) plus the enhanced assistance intervention, including needs assessments prior to and during RT and up to $2000/patient of tailored unconditional monetary transfer via gift cards for all essential needs identified. The primary outcome was delay-free completion of RT (DFC: completing all prescribed RT fractions and delaying < 5 fractions). The study was powered (power = 80%, 1-sided alpha = 0.2 for this pilot study) to detect a 10-percentage point increase in % DFC relative to a historic benchmark of 83% (based on similar patients from our institution), with required sample size of N = 33. Due to delays in gift card administration (on average ~2 weeks after consent), we also present per protocol analysis, limited to patients who had > 10 fractions remaining after first receiving financial assistance. Post-hoc analyses using generalized linear mixed models evaluated percentages of delayed fractions prior to and after an individual’s receipt of financial assistance. Results: 35 met inclusion criteria and were approached, 33/35 enrolled. Participants received median assistance of $1800 ($700-2000) and had a median of 27 RT fractions after consent (range: 12-35) and 17 (3-34) after receiving assistance. In the overall cohort, 1 patient did not complete RT and 2 patients had ≥5 delayed fractions, leading to 30/33 achieving DFC (90.9%, 80% CI = 83.9 – 100), significantly higher than the 83% benchmark. In the per protocol analysis, 27/28 achieved DFC (96.4%, 80% CI = 89.7–100, P = .037). Among the 27 patients who started RT prior to receiving assistance, mixed model analysis showed more delayed fractions prior to (7.1%) vs. after (3.0%) receiving assistance (OR 2.84, 95% CI = 1.43-5.80, P = .003). Conclusions: In this prospective pilot study, a tailored enhanced financial assistance intervention for unmet essential needs led to improved delay-free completion of RT over a historic benchmark. Further analysis on patient-reported quality of life and financial toxicity will be reported in the future. Clinical trial information: NCT06582849 .