Challenges and Opportunities for Addressing Financial Hardship as Part of Cancer Care Delivery

October 6, 2022
12:00 - 4:30 PM ET

Overview

In 2020, the National Cancer Institute (NCI) awarded administrative supplements to 11 NCI-Designated Cancer Centers to conduct research to develop or expand their capacity and infrastructure to deliver financial navigation services to cancer patients and their families. The goal of this meeting is to convene investigators from the 11 funded teams to share findings from their studies and to stimulate conversation about the challenges and opportunities for research to address cancer-related financial hardship.

This meeting is sponsored by the Healthcare Delivery Research Program (HDRP) in the Division of Cancer Control and Population Sciences (DCCPS), at the National Cancer Institute (NCI).

Please view the agenda and background materials for additional meeting resources.

Workshop Goals

The goal of this meeting is to convene investigators from the funded teams to share findings from their studies and to stimulate conversation about the challenges and opportunities for research to address cancer-related financial hardship.

Who should attend this workshop?

Clinicians, researchers, and individuals with expertise and interest in cancer-related financial hardship are encouraged to participate. This workshop is free and open to the public. The goal is to bring together a broad range of experiences and expertise in this scientific area. We highly encourage all interested individuals to register and participate in this workshop.

Agenda & Recordings

October 6th Agenda

Time (EDT) Session Presenters
12:00 - 12:20 pm

Overview and Introduction from the National Cancer Institute

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Henry Ciolino, PhD
Paul Jacobsen, PhD

Janet de Moor, PhD, MPH

12:20 - 12:55 pm

Introduction to Session 1
Identifying patients at risk for cancer-related financial hardship

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Hoda Badr, PhD
Dan L Duncan Comprehensive Cancer Center

Dorothy Rhoades, MD, MPH
Stephenson Cancer Center at The University of Oklahoma

Samilia Obeng-Gyasi, MD, MPH
The Ohio State University Comprehensive Cancer Center

Kristi Graves, PhD
Georgetown Lombardi Comprehensive Cancer Center

12:55 - 1:35 pm

Discussion

Objectives

  • Explore delivery system and clinician perspectives on systematic screening for financial hardship
  • Discuss the pros and cons of different screening approaches
  • Share lessons learned from the supplement projects that will inform future research on this topic

Moderator:
Ann M. Geiger, PhD, MPH
National Cancer Institute

1:35 - 1:50 pm

Break

1:50 - 2:25 pm

Introduction to Session 2
Integrating financial hardship screening and service delivery into cancer care

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Maria Pisu, PhD
University of Alabama, Birmingham Comprehensive Cancer Center

Melissa Beauchemin, PhD, MSN
Herbert Irving Comprehensive Cancer Center of Columbia University

Kathryn Glaser, PhD
Roswell Park Comprehensive Cancer Center

Wen You, PhD
University of Virginia Cancer Center

2:25 - 3:05 pm

Overview and Introduction from the National Cancer Institute

Objectives

  • Explore system-level changes implemented to conduct financial hardship screening and financial navigation
  • Discuss key challenges and how they were addressed
  • Share lessons learned from the supplement projects that will inform future research on this topic

Moderator:
Michael T. Halpern, MD, PhD, MPH
National Cancer Institute

3:05 - 3:20 pm

Break

3:20 - 3:45 pm

Introduction to Session 3
Implementing a sustainable model of financial navigation service delivery into cancer care

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Stephanie Wheeler, PhD, MPH
University of North Carolina, Lineberger Comprehensive Cancer Center

Ronny Bell, PhD
Wake Forest Baptist Medical Center Comprehensive Cancer Center

Jean Edward, PhD, RN
University of Kentucky, Markey Cancer Center

3:45 - 4:25 pm

Discussion

Objectives

  • Identify factors that influence the sustainability of financial navigation programs
  • Explore how different stakeholders think about the value of financial navigation and what data are needed to demonstrate return on investment
  • Share lessons learned from the supplement projects that will inform future research on this topic

Moderator:
Kate Castro, MS, RN, AOCN®
National Cancer Institute

4:25 - 4:30 pm

Meeting Wrap up

Janet de Moor, PhD, MPH

Background Materials

The 11 projects discussed at the workshop were funded through administrative supplements to NCI-designated cancer centers. For background information about the cancer center supplement initiative, please visit the DCCPS Financial Hardship During Cancer Treatment webpageExternal Web Site Policy

Speakers

Planning Committee

Kate Castro

Kate Castro, M.S., R.N., AOCN®
Nurse Consultant, National Cancer Institute

Ms. Kate Castro is a Nurse Consultant in the Office of the Associate Director of the Healthcare Delivery Research Program. Ms. Castro is the Scientific Contact for the notice of special interest focused on addressing cancer-related financial hardship and program officer for a portfolio of grants testing interventions to mitigate financial hardship. Her additional programmatic areas of interest include management of patients receiving oral anticancer agents and care delivery for cancer survivors living with advanced and metastatic cancers. She has over 35 years of experience in oncology nursing and currently serves as the Cancer Care Delivery Operations lead for the NCI Community Oncology Research Program. She received a B.S. in nursing from the University of North Dakota and an M.S.N. from the University of Minnesota.

Ann M. Geiger

Ann M. Geiger, Ph.D., M.P.H.
Scientific Director, NCORP Cancer Care Delivery Research, National Cancer Institute

Dr. Ann Geiger is the Scientific Director of Cancer Care Delivery Research in the NCI Community Oncology Research Program (NCORP) within the Division of Cancer Control and Population Sciences. Her overarching responsibility is to engage scientific, clinical, and patient stakeholders in building a portfolio of impactful protocols that balance NCI priorities, methodological rigor, and feasibility. Dr. Geiger has participated in multiple NCI initiatives, including the President’s Cancer Panel, the NCI/AcademyHealth Healthcare Delivery Research Visiting Scholars Program, and the NCI COVID-19 in Cancer Patients Study. She has coauthored over 120 publications, the majority of which come from her time conducting cancer screening, survivorship, and disparities research in both academic and community-based clinical settings. Dr. Geiger has a long-standing interest in how research sponsored by NCI can characterize and address cancer patient, survivor, caregiver, and family financial hardship until the enactment of government, insurer, and institutional policies that address the issue systematically.

Michael T. Halpern

Michael T. Halpern, M.D., Ph.D., M.P.H.
Medical Officer, National Cancer Institute

Dr. Michael Halpern is a Medical Officer in the Healthcare Delivery Research Program of the Division of Cancer Control and Population Sciences, National Cancer Institute. Dr. Halpern’s expertise is in health services and health outcomes research, epidemiology, and data science, focused on access to care, quality of care, disparities, treatment patterns, health economics, and patient outcomes. At NCI, Dr. Halpern’s responsibilities include leading the NCI Patterns of Care study to evaluate dissemination of state-of-the-art cancer therapy and diagnostics into community oncology practice and examine patient-, provider-, and system-level factors associated with cancer care. He also coordinates the Medical Expenditure Panel Survey (MEPS) Experience with Cancer Supplement working group and serves as editor of the Cancer Treatment section of the NCI Cancer Trends Progress Report.

Dr. Halpern received his M.D. and Ph.D. through the University of Michigan’s Medical Scientist Training Program; he also received an M.P.H. in Epidemiology at the University of Michigan. Prior to join NCI, Dr. Halpern served as associate professor and Graduate Program Director at Temple University; associate professor and section chair at the University of Arizona; principal scientist at RTI International; and strategic director for Health Services Research of the American Cancer Society. He currently serves on the Commission on Cancer’s Quality Integration Committee; the editorial board of the American Journal of Public Health; and the leadership team of the American Public Health Association’s Cancer Forum.

Alina Majid

Alina Majid, M.P.H.
NCI Communications Fellow, Healthcare Delivery Research Program, National Cancer Institute

Ms. Alina Majid is an NCI Communications Fellow in the Office of the Associate Director of the Healthcare Delivery Research Program. She is working on cancer health economics projects related to financial hardship and employment disruption. She is also conducting portfolio analyses for the NIH Adherence Network. Ms. Majid contributes to a research project focused on analyzing the medical uncertainty experienced by people affected by dyskeratosis congenita. Before coming to NCI, Ms. Majid received her M.P.H., with a concentration in behavioral and community health, from the University of Maryland, College Park (UMD). During her M.P.H. program, she worked on science communications projects focused on translating scientific and health information into understandable materials for lay audiences. She collaborated with research teams and subject matter experts, as well as the UMD Herschel S. Horowitz Center for Health Literacy. Ms. Majid has a B.S. in chemistry from UMD.

Janet de Moor

Janet de Moor, Ph.D.
Deputy Associate Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute

Dr. Janet de Moor is the Deputy Associate Director of the Healthcare Delivery Research Program in the Division of Cancer Control and Population Sciences at the National Cancer Institute. In this role, she leads research and programmatic activities focused on cancer-related financial hardship, employment outcomes after cancer, and cancer survivorship. Dr. de Moor previously served as a Program Director in the Healthcare Delivery Research Program and prior to that the Office of Cancer Survivorship. Before coming to the National Cancer Institute in 2011, Dr. de Moor was on the faculty of The Ohio State University College of Public Health. She received her Master of Public Health degree and Doctorate in Behavioral Science from the University of Texas Health Science Center at Houston School of Public Health.

Annie Sampson

Annie Sampson, M.Sc.
Public Health Advisor, National Cancer Institute

Ms. Annie Sampson is a Public Health Advisor in the Office of the Associate Director in the Healthcare Delivery Research Program (HDRP). Ms. Sampson works closely with the associate and deputy directors of operations and planning and is on the HDRP Leadership Team. She manages the Program’s research budget and personnel, and provides research management for several large scientific initiatives. She also collaborates on scientific working groups in areas within cancer care delivery. Prior to joining HDRP, Ms. Sampson worked in the NIH Office of the Director, Office of Research on Women’s Health, where she served as staff lead of the trans-NIH Coordinating Committee for Research on Women’s Health and worked on a trans-HHS online course in collaboration with research and academic staff from NIH, the Food and Drug Administration, and Johns Hopkins University. She spent four years in the NCI Office of the Director’s Office of Advocacy Relations, where she was an advocacy relations manager representing the Institute’s mission in cancer control, and incorporating the patient perspective into research among patients, providers, and policy makers. She was a program analyst in the Applied Research Program in the Division of Cancer Control and Population Sciences previously, supporting research in methods and design, risk factor assessment, health disparities, international cancer screening networks, provider surveys, and health economics. Ms. Sampson received her B.S. in psychology with a minor in biology from Chestnut Hill College, and her M.Sc. in social psychology with concentrations in health and economics from the London School of Economics.

Virtual Conference Speakers

Hoda Badr

Hoda Badr, Ph.D.
Professor, Baylor College of Medicine

Dr. Hoda Badr is a Health Psychologist and tenured Professor in the Department of Medicine, Section of Epidemiology and Population Science at Baylor College of Medicine. She is also the leader of the Cancer Prevention and Population Sciences Program at the Dan Duncan Comprehensive Cancer Center. Dr. Badr’s research program focuses on developing and implementing psychosocial interventions that leverage family support to improve patient and caregiver health behaviors and well-being across the cancer control continuum. Dr. Badr has been continuously extramurally funded for the past 20 years, and her work has been supported by the National Cancer Institute, American Cancer Society, National Institute of Dental and Craniofacial Research, National Institute of Nursing Research, and U.S. Department of Defense.

Melissa P. Beauchemin

Melissa P. Beauchemin, Ph.D., M.S.N
Assistant Professor of Nursing, Columbia University Irving Medical Center

Dr. Melissa Beauchemin is an Assistant Professor of Nursing on the tenure track and the Cancer Care Delivery Co-Lead for the Columbia University Minority-Underserved NCI Community Oncology Research Program. As a nurse scientist and pediatric oncology nurse practitioner with over 15 years of clinical experience, her overarching career goal is to enhance delivery of high-quality cancer care for children, adolescents, and young adults while addressing inequities in care delivery. The premise of her research rests on the belief that delivery of care can be both evidence-based and implementable through acceptable and sustainable strategies as perceived by the health care team, patients, and their families.

Ronny A. Bell

Ronny A. Bell, Ph.D., M.S.
Associate Director of Community Outreach and Engagement and Director of the Office of Cancer Health Equity, Atrium Health Wake Forest Baptist Comprehensive Cancer Center

Dr. Ronny Bell is a Professor of Social Sciences and Health Policy in the Division of Public Health Sciences at the Wake Forest School of Medicine. He is also associate director of community outreach and engagement and director of the Office of Cancer Health Equity at the Atrium Health Wake Forest Baptist Comprehensive Cancer Center. Dr. Bell received his undergraduate degree in public health nutrition from the University of North Carolina at Chapel Hill School of Public Health (1985) and his Master’s (1988) and doctorate (1993) in foods and nutrition from the University of North Carolina at Greensboro. He completed a postdoctoral fellowship in gerontology and a master’s in epidemiology (1996) from the Wake Forest School of Medicine.

Dr. Bell is a native of Pembroke, North Carolina, and is an enrolled member of the Lumbee tribe of eastern North Carolina. He currently serves as chair of the North Carolina American Indian Health Board. He is a member of the North Carolina Advisory Committee on Cancer Coordination and Control (NC ACCCC) and co-chairs the NC ACCCC Prevention Subcommittee. He co-leads the Southeastern American Indian Cancer Health Equity Partnership, a collaboration between the Community Outreach and Engagement programs at the three NCI-designated Comprehensive Cancer Centers in North Carolina. In 2019, he was appointed as scientific co-editor for the North Carolina Medical Journal. He previously served as co-chair of the Healthy North Carolina 2030 Task Force.

Henry Ciolino

Henry Ciolino, Ph.D.
Director, Office of Cancer Centers, National Cancer Institute

Dr. Henry Ciolino earned a Ph.D. in Anatomy and Cell Biology from the Louisiana State University Medical School in New Orleans, LA., and completed postdoctoral training in the laboratory of Dr. Rodney L. Levine in the Laboratory of Biochemistry of the National Heart, Lung, and Blood Institute. Moving to the National Cancer Institute, he became a Staff Scientist in the Laboratory of Metabolism before joining the faculty of the University of Texas at Austin Department of Nutritional Sciences. There, he ran an NCI-funded laboratory that studied the effect of dietary agents on the metabolic pathway mediated by the aryl hydrocarbon receptor. Dr. Ciolino returned to the NCI in 2010 in the Office of Cancer Centers and became Director of the OCC in 2015.

Jean S. Edward

Jean S. Edward, Ph.D., R.N., CHPE
Associate Professor and Assistant Dean for Diversity, Equity, and Inclusion, University of Kentucky

Dr. Jean Edward is an Associate Professor and Assistant Dean for Diversity, Equity, and Inclusion at the College of Nursing, and a nurse scientist for UK HealthCare’s Markey Cancer Center.

Dr. Edward’s program of research is focused on promoting equity in health care access, affordability, and health outcomes for underserved communities by intervening on the social determinants of health. She utilizes mixed methods and implementation science approaches to design and implement sustainable multi-level (patient-, provider- systems-, and community-level) interventions that promote equity in access to and affordability of care.

Her prior work has focused on establishing the impact of social determinants of health, such as health insurance literacy and socioeconomic factors, on access to care for underserved Hispanic/Latino and rural, Appalachian communities. Her current program of research is focused on improving health and financial outcomes of cancer survivors and caregivers by focusing on implementing sustainable financial and legal navigation/assistance programs within health systems to help alleviate financial toxicity and hardship. Dr. Edward has been funded by the National Cancer Institute, Robert Wood Johnson Foundation, American Cancer Society, Kentucky Nurses Association, and Sigma Theta Tau International. Her work has been published in over 40 peer-reviewed publications and presented at over 60 national, regional, and local conferences.

Kathryn Glaser

Kathryn Glaser, Ph.D.
Assistant Professor, Roswell Park Comprehensive Cancer Center

Dr. Kathryn Glaser is an Assistant Professor of Oncology in the Department of Cancer Prevention and Control at Roswell Park Comprehensive Cancer Center in Buffalo, New York. She is a medical anthropologist and health disparities researcher serving as co-leader of the Roswell Cancer Screening and Survivorship Program and a member of the Community Outreach and Engagement team, with a research focus on early detection/screening and survivorship care. Her primary research interests include reducing the cancer burden and disparities in Roswell’s catchment area using implementation science approaches to implement evidence-based cancer screening guidelines into practice at Federally Qualified Health Centers, reaching diverse underserved populations through a combined model of practice facilitation and patient navigation to increase cancer screening rates and early detection. With a background in health services administration combined with expertise in quality improvement and implementation methods, Dr. Glaser focuses on designing and implementing high-impact interventions that are practical, sustainable, and scalable in varied clinical contexts across the cancer care continuum. Using these implementation strategies and practice facilitation, this work includes a recent initiative to explore system-level changes and develop standardized pathways/workflows to enhance proactive financial hardship identification and financial navigation services at her cancer center.

Kristi D. Graves

Kristi D. Graves, Ph.D.
Associate Professor of Oncology and Associate Dean of Faculty Development, Georgetown University Medical Center

Dr. Kristi Graves received her Ph.D. in Clinical Psychology from Virginia Polytechnic Institute and State University and completed postdoctoral training at the University of Kentucky. She is a tenured associate professor of oncology and in the Cancer Prevention and Control Program. In January 2021, Dr. Graves began serving as the associate dean for faculty development at Georgetown University Medical Center. Her research focuses on cancer survivorship and translational genomics, with a particular emphasis on community engagement and addressing health disparities. Dr. Graves is co-leading an R01-funded project to explore symptoms experienced by patients diagnosed with thyroid cancer who received radioactive iodine treatment. She is a site principal investigator on an R01 to evaluate an expressive writing intervention to reduce symptoms among patients treated with stem cell transplants. Another area in which Dr. Graves conducts work is raising awareness about genetic counseling and testing in underserved communities. She is a multiple principal investigator on an NCI-R25 award to train community health educators, patient navigators, and promotoras about hereditary breast and ovarian cancer in Latinos. This training project is called ARBOLES Familiares (Family Tree).

Paul Jacobsen

Paul Jacobsen, Ph.D.
Associate Director, Cancer Control and Population Sciences, National Cancer Institute

Dr. Paul Jacobsen leads a team whose mission is to advance innovative research to improve the delivery of cancer-related care to patients, families, and communities. Before entering government service, Dr. Jacobsen served as Associate Center Director for Population Science at the Moffitt Cancer Center. Over the past 30 years, his research has focused on using knowledge from the behavioral and social sciences to understand and address quality of life and quality of care issues in oncology. Dr. Jacobsen is a past recipient of the of the Trish Green Award for Excellence in Quality-of-Life Research from the American Cancer Society and the Jimmie Holland Distinguished Leadership Award from the American Psychosocial Oncology Society.

Samilia Obeng-Gyasi

Samilia Obeng-Gyasi, M.D., M.P.H.
Associate Professor of Surgery, The Ohio State University

Dr. Samilia Obeng-Gyasi is a Breast Surgical Oncologist and Associate Professor of Surgery at The Ohio State University. Her practice focuses on surgery for breast cancer and benign breast diseases. She obtained her B.S. in biology (with highest distinction and departmental honors) from Indiana University-Bloomington and her M.D. from the University of Michigan. She completed her general surgery residency at the Cleveland Clinic and a Society of Surgical Oncology accredited breast surgical oncology fellowship at Duke University. Due to her interest in health services research, after finishing her residency, she completed an M.P.H. at the Harvard T.H. Chan School of Public Health with a focus on quantitative research methods. As a health services researcher with an emphasis on health equity, the overarching goal of her work is to understand how ancestry, race, social determinants of health, and stress interact to influence cancer initiation, progression, and mortality.

Maria Pisu

Maria Pisu, Ph.D.
Professor, University of Alabama at Birmingham

Dr. Maria Pisu is a Professor in the Division of Preventive Medicine of the University of Alabama at Birmingham. She received a Ph.D. in economics from the Pennsylvania State University and postdoctoral training at the Centers for Disease Control and Prevention. Dr. Pisu is a health economist whose research focuses on cancer outcomes and health services research across diverse and older populations. Her studies address financial hardship of cancer and its treatment, disparities in access and utilization of recommended health care services, and disparities in recruitment to cancer studies. In addition, Dr. Pisu has expertise in economic evaluation of interventions beneficial to the health of survivors, such as behavioral and supportive care interventions. Her work is currently funded by the National Cancer Institute, National Institute on Minority Health and Health Disparities, and National Center for Complementary and Integrative Health.

Dorothy A. Rhoades

Dorothy A. Rhoades, M.D., M.P.H.
Clinical Professor, University of Oklahoma Health Sciences Center; and Director of American Indian Cancer Research Initiatives, OU Health-Stephenson Cancer Center

Dr. Dorothy Rhoades is a Clinical Professor in the Department of Medicine at the University of Oklahoma Health Sciences Center and is the director of American Indian Cancer Research Initiatives for the Stephenson Cancer Center’s Community Outreach and Engagement Core. Dr. Rhoades has studied chronic disease health disparities among Native American populations for decades, focusing in the past 10 years on cancer-related studies ranging from tobacco and nicotine product use to the implementation of cancer screening programs. She is the project lead for the National Cancer Institute-funded pilot project “Financial Hardship Screening among Native American Cancer Patients.”

Stephanie Wheeler

Stephanie Wheeler, Ph.D., M.P.H.
Professor of Health Policy and Management, University of North Carolina Gillings School of Public Health

Dr. Stephanie Wheeler is a Professor of Health Policy and Management at the University of North Carolina Gillings School of Public Health. As a health services researcher and decision scientist, her research is focused on understanding cancer care quality, access, equity, and value. Strong and noteworthy aspects of her research portfolio are: leading studies focused on comparative and cost-effectiveness of breast cancer care; exploring patient preferences and values in medical decision making; studying breast cancer health disparities and solutions; compiling and linking big data from various sources to enable a more complete understanding of complex health care issues; and employing simulation tools to study important questions that traditional experimental or observational methods cannot feasibly address. Her work has been funded by more than $20 million in research grants, including multiple investigator-initiated awards for which she serves as principal investigator (PI)/multiple principal investigator. Many of these grants have focused on understanding patterns of breast cancer care (American Cancer Society, PI: Stephanie Wheeler), understanding financial impact of breast cancer among survivors (National Comprehensive Cancer Network/Pfizer, PI: Dr. Wheeler and Dr. Donald Rosenstein), and describing the cost and cost-effectiveness of various cancer interventions (Centers for Disease Control and Prevention [CDC], PI: Dr. Wheeler). Dr. Wheeler currently leads the Coordinating Center of the CDC- and NCI-funded Cancer Prevention funded Special Interest Project Cancer Prevention and Control Research Network, a hallmark thematic research network of CDC’s Prevention Research Centers Program.

Wen You

Wen You, Ph.D.
Professor, University of Virginia and Director of Population Health and Cancer Outcomes Core, University of Virginia Comprehensive Cancer Center

Dr. Wen You is an applied Health Economist and Econometrician. She is a Professor of Public Health Science at the University of Virginia (UVA) and the director of the Population Health and Cancer Outcomes Core at UVA Comprehensive Cancer Center. Her research program focuses on understanding and addressing the causes of health disparities through creative integration of economics with other disciplines. It revolves around two interconnected research areas that are crucial for improving population health: 1) understanding how individuals make lifestyle behavioral choices and health care decisions; and 2) evaluating whether or not certain health policies/interventions achieve their goals and investigating how to improve their effectiveness. Dr. You has extensive experience in randomized control trials, economic evaluation, and the associated appropriate statistical analysis including mixed effect models, cluster and panel robust statistical inferences, discrete choice experiments, cost effectiveness, and policy simulations. Dr. You has been engaged as PI or co-I in several successfully completed, ongoing, or forthcoming interdisciplinary projects (including nine NIH R01, one NIH R18, one NIH R34, one NIH R37, three NIH R21, two American Cancer Society grants, and one Patient-Centered Outcomes Research Institute grant). Dr. You has published over 80 peer-reviewed publications ranging from economic journals to interdisciplinary journals.

Last Updated: 27 Nov, 2023