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QS7. Impact of Financial Navigation on Financial Catastrophe and Distress for Cancer Patients in Nigeria: Interim Results from the COST-FIN TRIAL

Thursday, March 5, 2026
10:15 AM - 10:19 AM MST
Location: Immuno-Oncology HUB Zone
Introduction:  Cancer care presents a huge financial burden globally, with patients in low- and middle-income countries (LMICs) facing particularly high risks of catastrophic health expenditure. Financial Navigation Programs (FNPs) have been shown to mitigate financial toxicity in cancer care and improve treatment adherence, but there is a paucity of high-quality data on this intervention in resource-constrained settings.

Methods: We designed the COST-FIN trial, a multi-site single-blinded randomized controlled trial of newly diagnosed (< 6 weeks from diagnosis) adults (≥18 years) with breast, colorectal, or prostate cancer at two tertiary cancer centers in Nigeria. Participants were randomized (1:1) to either the intervention (FNP) or a control arm. Data on individual, treatment, and financial parameters were collected via structured interviews and chart abstraction at baseline, 3, 6, and 12-month follow-up. Here, we present 6-month follow-up interim results. Primary outcomes were financial catastrophe (FC), defined as out-of-pocket expenditure >40% of non-subsistence household expenditure, and financial distress (FD), measured by COST-FACIT scores. Treatment adherence was also assessed as a secondary outcome. Analyses employed linear and logistic mixed-effects models, adjusting for demographic, clinical, and socioeconomic covariates.


Results:  A total of 156 participants have been enrolled across both study sites, with 51% in the FNP arm and 49% in the control arm (RC). The median age was 56 years (range: 24–87), most participants were female (65%), nearly half were employed (47%), and 52% reported being the head of household. The most common diagnosis was breast cancer (62%), followed by prostate (20%) and colorectal (18%) cancers. FC rates were similar between both study arms at baseline; however, at 6-month follow-up, patients in the financial navigation arm had 90% lower odds of FC relative to controls (OR = 0.096, 95% CI: 0.01–0.91, p = 0.042). For all study participants, mean FD scores improved significantly at 6 months compared to 3 months (β = 3.84, SE = 1.88, p = 0.043), with no differential effect by treatment arm. Strikingly, 16% of patients in the control arm reported cost-related treatment abandonment at 6 months, while all patients in the FNP arm continued treatment (p = 0.048, Fisher’s exact test).


Conclusions:  Interim results from this first-of-its-kind study in sub-Saharan Africa indicate that a pragmatic financial navigation program significantly reduces the risk of FC and cost-related treatment abandonment in Nigerian cancer patients.

Learning Objectives:

  • Describe the design and implementation of a Financial Navigation Program (FNP) in a low-resource setting
  • Understand measures of evaluating financial toxicity and distress in cancer patients
  • Appreciate the potential impact of equitable international and multi-institutional partnerships to advance global oncology care