Does financial advocacy improve appointment keeping in patients receiving chemotherapy?

75 Background: Financial hardship leads to treatment nonadherence including missed medical appointments. This study describes a financial advocacy intervention, developed in response to Medicare’s Oncology Care Model’s price estimate requirement, and measures its effect on patient-initiated missed appointments (no-shows/cancellations). Methods: Logistic regression was used to analyze the clinical records of 2523 chemotherapy patients, before and after program implementation, at one semi-rural cancer center (2015 – 2018). Cluster-correlated covariance was used to correct variances for repeated measures. Results: Patients were assigned an advocate who provided out-of-pocket price estimates, health insurance education, and followed-up with the patient every 30 days for 6 months. 1,271 patients (50.4%) received the intervention. Average age was 64.1 and the average number of missed appointments was 8.7. After accounting for age, gender, marital status, insurance type, and number of chemotherapy infusions, receiving financial advocacy was associated with a 9% reduction in the odds of a missed appointment (OR = 0.91; 95% CI= 0.84 – 0.98; p = 0.013). Medicaid (OR = 1.36; 95% CI = 1.17 – 1.58; p = 0.000) and divorce (OR = 1.19; 95% CI = 1.03 – 1.37; p = 0.015) increased the odds of missed appointments, older age (OR = 0.99; 95% CI = 0.99 – 1.00, p = 0.000) and male gender (OR = 0.90; 95%CI = 0.84 – 0.98; p = 0.011) reduced the odds of missed appointments. Conclusions: The intervention provided some protection against missed appointments. However, marital status, age, gender, and insurance type remained significantly associated with missed appointments, even after accounting for financial advocacy. These findings indicate the need for more research on financial advocacy to identify the effective core components, target at-risk populations, and understand the effect of implementation on intervention effectiveness.[Table: see text]