Understanding Financial Toxicity and Navigating the System During Cancer

Kasey Bowden highlights the importance of recognizing financial toxicity and shares advice with those who feel lost in the healthcare system during cancer.

It is the hope of many providers that cancer care evolves beyond survival, according to Kasey Bowden, a nurse practitioner at University of Colorado Hospital (UCH), in Denver, who explained that it is important to focus not just on extending life, but also on improving how patients live through treatment. However, this remains to be seen, as many people currently navigating the health care system remain overwhelmed emotionally, physically, and financially.

As care becomes more complex, patients face additional costs, yet with limited communication from their care team, and are faced with difficult decisions. At the center of this unmet need is an urgent call to action for care models to recognize the full experience of the person, not just the disease.

“My hope is [for] patients to become powerful advocates and push for meaningful change in their home communities and states,” Bowden, who is also the medical director of the UCHealth Clinical Assessment and Rapid Evaluation (CARE) Clinic on the Anschutz Medical Campus, stated “By demanding this kind of value-based care, patients can encourage cancer centers and legislation to incorporate it into oncology care.”

To delve deeper into this research initiative, Bowden sat down for an interview with CURE, in which, she discussed the importance of palliative care, recognizing financial toxicity, as well as provided advice for patients who may feel lost in the system or are unsure of where to turn following their cancer diagnosis.

Moreover, she is the associate division head of the CU Division of Hospital Medicine, director of Value-Based Care for the CU Division of Oncology, and associate professor of Medicine–Hospital Medicine and assistant professor at the University of Colorado School of Medicine.

CURE: Can you explain what palliative care means and how it benefits patients even early on in their cancer journey?

Bowden: Palliative care providers are essentially experts. I always say that they are experts in symptom management and in aligning patients' goals of care with their plan of care. Palliative care providers are truly wonderful in working with patients who are undergoing anti-cancer treatment. I would argue that cancer is different from any other disease because both the disease itself and the treatment cause suffering. Suffering is inherent to both.

I think sometimes in our system, we have a tendency to become accustomed to suffering. We sort of brush it off as being expected as a result of the disease. I think often that's because our metric of success in cancer is life and death. However, I think as a system, we can do better than that. I think that we can not only have patients receive the newest and most evidence-based treatments available, but we can also ensure that they live well while they do it.

For patients with advanced cancer, which is still many, palliative care can really help them as they go through their care trajectory by aligning their goals and what is important to them, and by making sure that the treatment we decide on aligns with those goals. I think another way that cancer care has really evolved is that there are so many more treatment options available than there used to be. Again, that's a wonderful thing, but we have a saying in medicine that sometimes when you're a hammer, everything is a nail. Having option after option can just put us on a train without stopping.

It's well-intended; it's because the oncologist and the care team are pulling out the tools that are in their toolbox. But sometimes that train gets moving at a really rapid pace, and the system doesn't allow the time and space in some of those oncology visits — which are often 15 to 30-minute pre-chemo visits — to have these really complex conversations about the risks versus benefits and how it aligns with the things that are truly important to patients and their families. That's why we think it is so valuable to have that within the care clinic.

That said, our goal is really to create a system that does a better job of meeting patients where they are at. I believe our system is often built for patients to meet the system, to come to our facility, to our location, no matter how many days a week it is, etc. While we still have a long way to go, our goal is to create a system that does a better job of meeting patients where they are. I think palliative care can be beneficial, and I think thinking about these things is beneficial for everyone, regardless of what diagnoses you do or don't have. These are valuable things to think about. That said, I can understand that if someone has a diagnosis and is doing well on treatment and feeling well on treatment, their sense of urgency and desire to see and talk to palliative care is less. While I think it's valuable and important at any time for any patient, I understand that.

For patients who may feel lost in the system or are unsure of where to turn, what would you like them to know?

For patients and families who feel lost within the system, my first message would be one of empathy and understanding. I know from my own experience working in the system that it is enormous and complicated. I believe we, as a system, have a responsibility to do better. It is my hope and dream that an intensive supportive care structure becomes a part of every cancer center all over the country because more and more patients are being diagnosed with cancer and living with it. We need to support them through this process; we need to do better as a system. So first, I would say I understand, empathize, and believe, and I think as a system, we should be encouraged to advocate, to do better, to help those patients not feel lost.

As patients go through anti-cancer treatment, I think nurse navigators can often be invaluable resources. However, it's individual to each cancer center who the point person is to guide someone through their anti-cancer process. In our model, our goal is to have a space available seven days a week that patients can call with any and all of these kinds of offshoot questions, concerns, symptoms, and side effects.

Even if we're not the place to address it, we can hopefully get them to the right place. If your institution doesn't have a care clinic available, I think I would ask your team, “Who is my seven-day-a-week person to call and help me navigate through the system?”

This is a disease that has acute and unexpected things [happen] all the time. We need to build systems to address the acute and unexpected rather than relying on our already overfraught, overextended, and expensive emergency department to address those things. Especially with all the new and emerging treatments, emergency physicians are not trained in them, as they shouldn't be. That's not a viable model anymore.

My goal and dream are for places to have a model like ours because, otherwise, I think patients are left in a system that's really hard to understand. If a place doesn't have somewhere like a Care Clinic is to ask, “Who's my day-to-day contact?” and then “Who's my urgent and unexpected contact that I can reach seven days a week?” If the answer is the emergency department, I would press a little bit.

Certain things should automatically go to the emergency department, of course, but not feeling well shouldn't automatically go there. We can do better for our patients.

How is your cancer center addressing financial toxicity, and what role do value-based care models play in that effort?

There are three major elements of financial toxicity that the system can identify.

The first is pathway-driven anti-cancer treatment, which involves using evidence-based treatment and the most cost-effective version. This is the biggest one because so much money is tied up in the drugs. In a large academic system like ours, we already have programs to automatically switch to generics and other cost-effective options.

The other two areas are decreasing preventable acute care and improving end-of-life care. For example, we work to reduce hospitalizations and emergency department visits at the end of life and avoid giving chemotherapy in the last two weeks of a person's life. These are all things that align with better outcomes and lower costs.

The Care Clinic has a role in value-based care and in addressing financial toxicity, but it's also part of a larger philosophy and purpose within the cancer center. My hope is that the reputation of programs like this will drive patients to become powerful advocates and push for meaningful change in their home communities and states. By demanding this kind of value-based care, patients can encourage cancer centers and legislation to incorporate it into oncology care.

Reference

1. “CARE (Clinical Assessment and Rapid Evaluation) Clinic,” by University of Colorado Anschutz Medical Campus. Accessed July 21, 2025.

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