“When we’re talking about the role of nurses in addressing these challenges, they play a critical role because of when they actually get to see patients. And so, if we can help with early identification and assessment, really finding out, using financial screening tools to identify any patients that might be at risk, early on, of financial toxicity, that can really allow for timely interventions,” Sarah Paul, LCSW, OSW-C, senior director of social work at CancerCare in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about financial toxicity in adolescent and young adult (AYA) cancer survivors.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to financial toxicity in the adolescent and young adult population.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 300: AYAs With Cancer: End-of-Life Care Planning
  • Episode 294: AYAs With Cancer: Clinical Trial Enrollment Barriers and Facilitators
  • Episode 287: Tools, Techniques, and Real-World Examples for Difficult Conversations in Cancer Care
  • Episode 276: Support Young Families During a Parent’s Cancer Journey
  • Episode 62: Financial Toxicity Legislation
• ONS Voice articles:
  • AYA Cancer Survivorship: Younger Survivors Face Different Challenges and Prefer More Casual Support Programs
  • Nursing Considerations for Adolescent and Young Adult Cancer Survivorship Care
  • How to Support Adolescents and Young Adults With Cancer at the End of Life
  • LGB AYA Patients With Cancer Have High Burden of Chronic Conditions in Survivorship
  • AYA Champions Clinic Fills Gaps in Care and Addresses Unmet Needs
• ONS book: Oncology Nurse Navigation: Delivering Patient-Centered Care Across the Continuum (second edition)
• Clinical Journal of Oncology Nursing articles:
  • Two Case Reports on Financial Toxicity and Healthcare Transitions in Adolescent and Young Adult Cancer Survivors
  • Crucial Conversations: Addressing Informational Needs of Adolescents and Young Adults Diagnosed With Cancer
  • A Nurse-Pharmacist Collaborative Approach to Reducing Financial Toxicity in Cancer Care
• Oncology Nursing Forum article: A Brief Screening Tool for Assessment of Financial Toxicity
• ONS Financial Toxicity Huddle Card
• ONS Nurse Navigation Learning Library
• Adolescent and Young Adult Cancer Awareness Week
• American Society of Clinical Oncology
• CancerCare
• Got Transition
• National Comprehensive Cancer Network
• Patient Advocate Foundation
• Triage Cancer

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“For nurses that are caring for AYA patients, it’s really important to not only be aware of financial toxicity but know how to assess for financial toxicity because of the pivotal stage that these patients are at in their life. They often don’t have the financial stability or insurance coverage that adults who are maybe middle age or even in the older adult population might have.” TS 2:11

“The idea of [AYAs] not really understanding insurance coverage—I think it’s really important that as a team, we simplify some of this complex information, breaking it down into more manageable steps and providing that guidance on the documents and all the information that’s needed to apply [for financial assistance].” TS 8:59

“We see significant impacts in the AYA community, especially those that are in school or at the early stages of their career, because putting a job or school on hold to focus on treatment can have long-term effects. So, we see a couple of things. In education, we see academic delays; interrupting education can delay graduation or achievement of certain educational milestones, which would affect their ability to pursue higher education or even specialized training for their career. We also see, which is very difficult, loss of scholarships or financial aid. Some AYAs are starting school. It’s based on a scholarship or a grant or financial aid, and they can’t meet those full-time enrollment requirements or be able to maintain the GPA that they need to stay in the program. We see people losing their scholarships, and this is not their fault.” TS 10:11

“Down the road, you have this stress leading to chronic stress. We know that constant worry about finances can create a chronic stress environment. That is going to impact mental health across the board, which can lead to increased irritability, feelings of sadness, or even conflict among family members. So when we talk about managing these dynamics, we really want to focus on the importance of open communication because a lot of times we see families avoid discussing financial issues to shield each other from that additional stress.” TS 18:06

“One of the challenges that we face with this population is that we might assume that if they’re not talking about it, if an AYA is not bringing up finances, that it’s not an issue. And so sometimes even our own assumptions or assumptions of healthcare professionals that they don’t even need to ask, ‘How are finances going? Are you working currently? Do you feel financially stable? Are you insured?’ Often, maybe there’s not room for those questions. Maybe the appointments are too rushed. … Healthcare professionals could maybe take a pause to evaluate their own hidden or implicit bias, reflecting on their own experience, really trying to become aware of the assumptions they might have about this population.” TS 32:46