These researchers have dedicated their careers to finding new treatments and cures for people with cancer.
Research focused on the financial burdens facing patients with colorectal cancer is helping oncologists mitigate financial toxicity more effectively across the cancer care continuum. Certain populations face an increased likelihood of developing colorectal cancer and dying of this disease. Colorectal cancer is on the rise in Black people and adults younger than age 40, and young adults who live in low-income areas are now more likely to die from it. These high-risk groups face greater barriers to accessing care and may be more likely to refuse or discontinue care due to cost-related concerns.
Advancing cancer research on financial toxicity is essential for ensuring more patients—especially those with metastatic disease—can access and complete potentially lifesaving treatment.
One innovator in this space is Dr. Shankaran, a medical oncologist at the University of Washington School of Medicine and Fred Hutch Cancer Center. Dr. Shankaran's research focus is on investigating the financial hardships facing patients after treatment and implementing solutions to mitigate financial toxicity.
“It [is] unfair that someone who is diagnosed with cancer must contend with debt, collections, and potentially bankruptcy—in addition to all the physical and emotional impacts of their disease,” she said. “Identifying patients at high-risk for financial hardship and providing early financial assistance may improve care access and outcomes.”
Initial Research Shows Promise
Using a grant supported by Conquer Cancer®, the ASCO Foundation, Dr. Shankaran launched a retrospective study on financial toxicity that was among the first population-based oncology projects of its kind. She collected survey responses from 284 patients with stage III colorectal cancer living in western Washington state and evaluated their financial outcomes post-treatment.
“We found that 38% of patients with colorectal cancer reported financial hardship following treatment, most notably in lower-income individuals,” she said.
These initial findings laid the foundation for Dr. Shankaran's subsequent research.
“My study was limited by its retrospective and cross-sectional study design,” she said. “I wanted to address these limitations by following a cohort of patients with advanced colorectal cancer longitudinally and prospectively during cancer treatment to understand the cumulative incidence of financial hardship in this population.”
Addressing Barriers, Alleviating Burdens
Supported by a subsequent Conquer Cancer grant, Dr. Shankaran launched an observational study focused on a group of 380 patients with metastatic colorectal cancer. She tested the implementation of a prospective financial impact assessment tool by evaluating the financial outcomes of patients during and after treatment. Her findings showed that most patients consistently struggled to make financial ends meet despite having access to health insurance.
“My funded study showed that financial hardship is much more common than previous studies had suggested—nearly 75% of patients with metastatic colorectal cancer experienced major financial hardship at 12 months post-diagnosis. This is particularly striking given that 98% of the 380 participants in this study had health insurance coverage,” Dr. Shankaran said. “We were surprised to find that financial hardship is so pervasive and affects insured patients regardless of income level. As a result of my Conquer Cancer–funded research, I've become much more aware of the scope and scale of cancer-related financial toxicity in the United States.”
Dr. Shankaran is integrating these takeaways into tangible solutions for mitigating the financial burdens of cancer care. She and her team have partnered with community organizations to build a financial counseling and navigation program for patients and caregivers. They are testing the utility of this program in an ongoing randomized multicenter study to improve treatment access and affordability. Dr. Shankaran's preliminary research made this project possible.
“Without the Conquer Cancer [grants], I would not have had the protected research time and funding to conduct two very important research studies that have contributed to our broader understanding of the incidence, prevalence, risk factors, and mechanisms for financial toxicity in oncology,” she said. “Ultimately, these studies led to our active, R01-funded randomized study testing the impact of a comprehensive financial program on patient and caregiver financial, psychosocial, and clinical outcomes. I have directly seen how programs like ours can help alleviate financial stress and provide meaningful financial assistance so that patients can focus on their treatment and health.”
Helping to address and alleviate financial burdens in cancer care, especially for patients from high-risk populations, remains at the heart of all Dr. Shankaran does to conquer cancer for every patient.
“All patients, regardless of their financial resources, should have the right to receive the best possible cancer care,” she said. “I hope that my research and advocacy will help mitigate financial barriers to high-quality cancer care.”