Prevalence of Financial Hardship and Health-Related Social Needs in Pediatric Oncology: A Practice-Level Analysis of Systematic Screening.

Background: Screening for financial hardship and health-related social needs (HRSN) in pediatric oncology is recommended, yet practices vary widely, and standardized implementation remains limited. We implemented systematic screening in a pediatric oncology clinic in New York City.

Procedure: We evaluated the implementation of financial hardship (two items) and HRSN (difficulty affording food, housing, transportation, eight items) screening in outpatient pediatric oncology clinic. Screening strategies included in-person screening by social work teams during inpatient or emergency department visits, and direct-to-patient screening via the electronic health record (EHR) patient portal for patients or caregivers who utilized the portal to check in for upcoming encounters. Data were extracted from the EHR of patients ≤18 years treated in the outpatient oncology clinic over a 2-year period. We analyzed response rates and calculated the prevalence of financial hardship and HRSN.

Results: Among 621 pediatric oncology patients, 76% responded to screening, with Hispanic and non-Hispanic Black patients more likely to respond than non-Hispanic White patients. Among those who responded, 21% reported food insecurity, with significantly higher rates among Hispanic (35%) and non-Hispanic Black (24%) patients compared with non-Hispanic White (6%) and Asian (7%) patients. Financial hardship was reported by 76%, with higher rates among patients who were Hispanic (87%), non-Hispanic Black (87%), and Spanish-speaking (97%).

Conclusions: Systematic screening for financial hardship and HRSN in pediatric oncology is feasible using a multipronged approach. Screening is crucial to early identification of at-risk families in order to implement timely interventions to prevent catastrophic financial situations and, potentially, to improve patient and household outcomes.