Addressing Financial Toxicity and Food Insecurity in Cancer Care

In the evolving world of cancer care, financial navigation has become just as critical as clinical treatment. Patients increasingly face daunting questions—not just about survival, but about how they’ll afford to survive. Rifeta Kajdić Hodžić, senior program manager at the Association of Cancer Care Centers (ACCC), is at the forefront of efforts to improve financial navigation and tackle growing challenges like food insecurity.

In an interview with Targeted Oncology, Hodžić shared insights from recent research and discussions spearheaded by ACCC’s Financial Advocacy Network. From systemic challenges to on-the-ground innovation, she outlines how cancer programs can—and must—do better in supporting patients through the full spectrum of financial hardship.

Targeted Oncology: Can you discuss the rationale that prompted this line of research into financial toxicity?

Rifeta Kajdić Hodžić: The financial navigation landscape has changed drastically. Patients face far more complex needs today. There's a lack of standardized training and too few resources available for both patients and navigators. We wanted to understand what skills advocates need when helping patients navigate these issues and identify where we could support them with better tools and training.

Financial toxicity is a huge burden. Once patients move past the shock of a diagnosis, their next question is often, “How do I pay for treatment?” Costs have gone up. Prior authorizations are harder. Barriers are everywhere.

ACCC brought together 32 advocates for a semi-informal discussion. We asked: What are the core practices financial navigators need when having these sensitive conversations?

They emphasized 3 main things:

1. Empathy and emotional intelligence: Navigators must acknowledge patients’ emotions, be culturally mindful, and build trust.
2. Clear documentation and communication: Ensuring patients understand documents in their preferred language, with interpreters when needed.
3. Routine financial distress screening: Not just at the initial consult, but again at key points like treatment changes or three months in, when patients may start feeling the financial strain.

This also validated the guidelines we developed 2 years ago. We had already recommended financial screening at key intervals: initial, 3, 6, 9 months, or with any clinical change.

What are the barriers to implementing regular financial screening in clinics?

There are many. Some cancer programs still do not have any financial navigators. Others are understaffed, and burnout is real. There’s also a lack of standardization and no clear career path for financial advocates. That leads to high turnover.

Often, people hired for these roles think they will be doing billing or claims. But the job is much broader—interpreting medical necessity, discussing disability forms, helping with insurance and copay assistance. It can be overwhelming.

Also, many programs do not have the resources to train or retain good staff. There are not always continuing education days or funding for advocates to attend conferences. And since their role isn’t always viewed as clinical, they’re excluded from development opportunities.

Advocates are stuck in the middle: helping patients while ensuring hospitals meet reimbursement requirements. Balancing both sides is tough, especially when the field keeps evolving and demands keep growing.

For physicians and clinical teams, what are the key takeaways from this research?
Financial questions from patients are only increasing. Clinicians should push for their hospitals to invest in financial navigation: hire someone if they do not have one and expand support if they do.

These navigators should be part of the care team. You cannot seriously discuss treatment without discussing the financial impact. Navigators deserve a seat at the table—they are essential to helping patients access and complete care.

Yes—the guidelines we developed were helpful, but members asked, “How do we measure ourselves against them?” We created a free, accessible gap assessment tool. Cancer programs can use it to assess their current efforts and get a personalized report showing strengths and areas for improvement. It helps them build or enhance their programs—and supports quality improvement efforts that can help meet Commission on Cancer standards.

I encourage administrators to take these roles seriously. Financial navigation can directly impact accreditation and patient outcomes.

Regarding your research on food insecurity, what prompted this?
We kept hearing from our Financial Advocacy Network that food insecurity was coming up again and again in patient screenings. Advocates were scrambling, calling local food pantries, giving out grocery gift cards, doing whatever they could.

We wanted to understand how programs were responding. One had a large, well-resourced pantry. Another literally started theirs in a closet. It showed us how innovative teams are becoming, especially as food insecurity rises to the top of distress screening results.

The key is screening. Patients may not mention food issues upfront, but they are real. It is about helping people get through treatment without having to choose between dinner and a radiation appointment.

What are the barriers to screening for food insecurity?
One major issue is integration into the electronic health record [EHR]. Many programs still use paper forms, which can get lost or delayed. Without automation, patients fall through the cracks.

I used to be a navigator. Sometimes we would learn about a food issue only because a nurse overheard a conversation in the chemo suite. That is not a sustainable system.

We need to ask every patient the right questions at the right time, and we need a system that connects that data to support quickly. Food insecurity does not seem like a big medical issue on the surface, but it directly affects whether patients can show up and stick with treatment.

How can practices address food insecurity more effectively?
First, acknowledge the issue. Then build systems to screen for it actively, ideally integrated into the EHR. It’s a sensitive topic but ignoring it risks treatment adherence.

The best programs are the ones looking at the whole patient, not just insurance coverage or treatment plans. They are finding creative ways to help, whether that's pantries, stipends, or better referrals. But long-term, we need policy changes and more cross-sector collaboration to truly address it.