Abstract A36: [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC
Authors: Strom Carla , Lanford Julie , Foley Kristie 
Published: March 2017

Abstract
Background: Cancer Services, Inc. is a non-profit, 501c3 providing a comprehensive range of services addressing financial, physical and emotional needs of cancer patients primarily in the Triad region of NC. One of the major challenges facing cancer patients is the costs associated with cancer care. This study evaluates the uptake, cost, and value of supplies and services provided to individuals seeking support from a community-based, non-profit cancer support agency over the past five years. Methods: Retrospective de-identified data were obtained from a database maintained by Cancer Services, Inc. between 2011 and 2015. We estimate the most common support provided, whether these supplies and services were provided directly by the agency (either donated or paid), and whether the agency facilitated the receipt of supplies and services from another source. Each supply/service was assigned a monetary value based on the cost the agency paid or estimated value of the procured support. Data are reported in the aggregate and time trends were also assessed. Results: There were 10,448 unduplicated clients served during the five years, including 70% female, 21% African American and 4% Hispanic, with 22% below the 200% federal poverty level. The majority of clients were diagnosed with breast cancer (40), followed by gastrointestinal (11%), hematologic (10%) and thoracic (10%) malignancies. There were 187,485 services/supplies provided during this period. Agency personnel secured more than $44M in medications from external sources by providing technical support, such as determining eligibility for the medication and completing necessary paperwork on behalf of their clients. The agency provided an additional $1.38M in donated supplies/services to their clients, including equipment and home health supplies (59%), wigs (16%), mastectomy supplies (13%), ostomy supplies (3%), and nutritional supplements (3%). The organization incurred $911K in expenses to provide direct support to their clients, with most of these funds going towards medication (60%) and emergency financial assistance (31%). This does not include the cost of staff time required to secure the assistance. The value of the medications accessed through outside agencies has markedly increased from $4.2M in 2011 to $14.5M in 2015, while the amount paid for medications directly from the agency has declined from $132K in 2011 to $81K in 2015. A similar pattern emerged for emergency financial assistance, with a more than doubling in value of medications accessed from outside sources in the past 5 years ($23K to $51K) to a decrease in funds provided directly by the agency to their clients ($75K to $31K). Conclusions: Patients and their families face considerable expenses associated with cancer care that are often not covered by insurance. While programs exist to help support low-resource patients (e.g., Prescription Assistance Programs), they often do not know how or have limited capacity to access these resources. Moreover, some services/supplies (e.g., wigs, nutritional supplements, hospital equipment) must be purchased or rented by the patient, incurring additional expenses often not covered by traditional health insurance. Cancer Services Inc. plays an important role in facilitating the procurement of much-needed cancer care supplies and services that are not paid for by insurance-predominately medication. Such support alleviates the financial toxicity of cancer care, which according to a recent study reported in Cancer, affects 29% of cancer survivors the majority of whom (86%) have health insurance. The financial burden of cancer is a health equity issue, affecting all patients, but especially those with the least resources.
Citation Format: Carla Strom, Julie Lanford, Kristie Foley. [Advocate Abstract:] What patients need, but cannot afford: Uptake and value of supplies and services provided by Cancer Services, Inc, a community-based, non-profit cancer support agency in NC. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A36.