Financial counseling is associated with reduced financial difficulty scores in head and neck cancer patients treated with radiation therapy

Mark Farrugia, Han Yu, Sung Jun Ma, Austin J. Iovoli, Kayleigh Erickson, Elizabeth Wendel, Kristopher Attwood, Kimberly E. Wooten, Vishal Gupta, Ryan P. McSpadden, Moni A. Kuriakose, Michael R. Markiewicz, Jon M. Chan, Wesley L. Hicks, Mary E. Platek, Andrew D. Ray, Elizabeth A. Repasky, Anurag K. Singh

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Financial toxicity (FT) can be devastating to cancer patients, and solutions are urgently needed. We investigated the impact of financial counseling (FC) on FT in head and neck cancer (HNC) patients. Methods: Via a single-institution database, we reviewed the charts of HNC patients who underwent definitive or post-operative radiotherapy, from October 2013 to December 2020. Of these patients, 387 had provided baseline and post-treatment information regarding financial difficulty. In July 2018, a dedicated financial counselor was provided for radiation therapy patients and we subsequently examined the impact of FC on financial difficulty scores. Results: Following the hiring of a dedicated financial counselor, there was a significant increase in the proportion of patients receiving FC (5.3% vs. 62.7%, p < 0.0001). Compared with baseline scores, patients who did not undergo FC had a significant increase in reported financial difficulty at the end of treatment (p = 0.002). On the other hand, there was no difference in pre-and post-treatment scores in patients who had received FC (p = 0.588). After adjusting for gender and nodal status with a multiple linear regression model, FC was significantly associated with change in financial difficulty (β = −0.204 ± 0.096, p = 0.035). On average, patients who received FC had a 0.2 units lower change in financial difficulty score as compared with those with the same gender and nodal stage but without FC. Conclusions: Providing a dedicated financial counselor significantly increased the proportion of HNC receiving FC, resulting in the stabilization of financial difficulty scores post-treatment. Based on a multiple linear regression model, FC was independently associated with reduced financial difficulty. The employment of a financial counselor may be a viable, hospital-based approach to begin to address FT in HNC.

Original languageEnglish
Article number2516
Issue number11
StatePublished - 1 Jun 2021
Externally publishedYes


  • Financial counseling
  • Financial toxicity
  • Head and neck cancer


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