Abstract C048: Addressing financial toxicity in cancer clinical trials: Acceptability and feasibility of a text-based intervention for the offering, screening, and enrolling of patients in a financial reimbursement program
Authors: Santaniello Ashley , Ramos Elizabeth , Patel Hena , Nguyen Vivian , Dornsife Dana , Johnson Robert G , Milinski Sarah , Wileyto E. Paul , Vonderheide Robert H , Guerra Carmen E 
Published: September 2024

Abstract
Out-of-pocket (OOP) costs in cancer clinical trials (CCT) are a barrier to recruitment and retention and add to the high financial toxicity (FT) experienced by participants. To address FT in CCTs, the Lazarex Cancer Foundation created the Improving Patient Access to Cancer Clinical Trials (IMPACT) Program, a financial reimbursement program (FRP) for OOP travel and lodging costs incurred during CCT participation. We previously showed that barriers to enrolling in the FRP include lack of program awareness and delayed program introduction by the CCT research team and administrative burden. To overcome these challenges, we designed an automated text message intervention to systematically offer, screen, and enroll patients in the IMPACT program via the Way to Health platform. Here, we present the patient acceptability and feasibility of this intervention. At our academic cancer center from March - May 2024, 25 patients (68% White, 20% Black, 12% Other Race; 60% Female, 40% Male; μ Age=58 σ=12) were referred from treatment CCTs for Breast, Leukemia, and CAR-T treated neoplasms (lymphoma, glioblastoma, prostate and pancreatic adenocarcinoma). All were enrolled in an automated text-message program during which they confirm their identity, confirm consideration of a CCT, screen for income eligibility, choose to receive the program application link via call, text, or email, and finally, complete the Net Promoter Score (NPS) survey. Of the 25 patients who received texts, 11 (44%) completed the text conversation and 14 (56%) did not. Of those who completed the text conversation, the mean age (51) was younger than those who did not (65, p=0.072*) and the proportion of female patients (72%) was greater than those who did not (50%, p=0.4592**) but the results did not reach statistical significance. Of those who did not complete the text conversation, 2 opted out after the initial message, 3 requested to screen via phone, and 9 stopped responding at various other points. Almost all (23) patients confirmed their identity, 22 indicated they are considering or enrolled in a trial while 1 confirmed they are not, and 18 agreed to screen for IMPACT eligibility (15 via text, 3 via phone call). Of those who screened via text, 13 indicated their household size, and 12 went on to confirm their income level (7 qualifying and 5 disqualifying financially). Of the 7 eligible patients, 6 requested an application via email and 1 via text. The final NPS (NPS = % promoters (55%) - % detractors (18%), expressed as an integer), calculated from the 11 patients who completed the measure via text, is 36, indicating favorable degrees of patient satisfaction. The reported high engagement (92%), screening rate (72%), and enrollment rate among eligible patients (57%) demonstrates that using text messages is a feasible and acceptable way to offer, screen, and enroll patients in the IMPACT FRP. This provides a potential, low-cost, opportunity to scale the program to other institutions. * Welch Two Sample t-test ** 2-sample test for equality of proportions with continuity correction
Citation Format: Ashley Santaniello, Elizabeth Ramos, Hena Patel, Vivian Nguyen, Dana Dornsife, Robert G Johnson, Sarah Milinski, E. Paul Wileyto, Robert H Vonderheide, Carmen E Guerra. Addressing financial toxicity in cancer clinical trials: Acceptability and feasibility of a text-based intervention for the offering, screening, and enrolling of patients in a financial reimbursement program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C048.