Financial toxicity in cancer care: origins, impact, and solutions

Abstract

Financial toxicity describes the financial burden and distress that can arise for patients, and their family members, as a result of cancer treatment. It includes direct out-of-pocket costs for treatment and indirect costs such as travel, time, and changes to employment that can increase the burden of cancer. While high costs of cancer care have threatened the sustainability of access to care for decades, it is only in the past 10 years that the term “financial toxicity” has been popularized to recognize that the financial burdens of care can be just as important as the physical toxicities traditionally associated with cancer therapy. The past decade has seen a rapid growth in research identifying the prevalence and impact of financial toxicity. Research is now beginning to focus on innovations in screening and care delivery that can mitigate this risk. There is a need to determine the optimal strategy for clinicians and cancer centers to address costs of care in order to minimize financial toxicity, promote access to high value care, and reduce health disparities. We review the evolution of concerns over costs of cancer care, the impact of financial burdens on patients, methods to screen for financial toxicity, proposed solutions, and priorities for future research to identify and address costs that threaten the health and quality of life for many patients with cancer.

Navigating financial toxicity in patients with cancer: A multidisciplinary management approach

“…Recognition of FT has accelerated in oncology professional communities, scientific literature, and the lay press 4‐6 . Initial characterizations of FT focused primarily on patients’ out‐of‐pocket cost burden for cancer care 7 ; however, the current conceptualization of FT has evolved. FT includes not just material hardships of cancer care (eg, out‐of‐pocket medical expenditures and interruptions of income and employment) but also accompanying psychological burden (eg, financial worry) and coping behaviors (eg, reduction in spending on food and necessary medications) 8‐11 …”

“…Complications, relapse, or disease progression can require additional care costs for which it is difficult to plan 34 . These aspects of cancer and its treatment are patient‐level factors that exacerbate upstream causes of FT, such as high prices and intensive use of cancer care and drug therapy 7,35 . Yabroff et al conceptualize how patient‐level factors that drive FT are nested within additional multilevel system factors 36 .…”

“…Yabroff et al conceptualize how patient‐level factors that drive FT are nested within additional multilevel system factors 36 . Therefore, fully mitigating cancer‐related FT will also require accompanying multilevel interventions that address upstream causes of cancer‐related financial burdens at the state and federal, insurer/payer, employer, and provider/practice policy levels 7,36 …”

“…34 These aspects of cancer and its treatment are patient-level factors that exacerbate upstream causes of FT, such as high prices and intensive use of cancer care and drug therapy. 7,35 Yabroff et al conceptualize how patient-level factors that drive FT are nested within additional multilevel system factors. 36 Therefore, fully mitigating cancer-related FT will also require accompanying multilevel interventions that address upstream causes of cancer-related financial burdens at the state and federal, insurer/payer, employer, and provider/practice policy levels.…”

Equitable Representation of Latinos in Clinical Research Is Needed to Achieve Health Equity in Cancer Care

“…The cumulative financial toll of out-of-pocket expenses can have a devastating and long-term effect on patients with cancer and their families. 30 Financial toxicity and its related stress can also have a direct impact on quality of life and cancer outcomes. 30,31 Multiple strategies have been suggested to address financial toxicity, including health policy changes to standardize insurance coverage for CT treatment, financial navigation and support, travel/transportation, lodging and parking coverage by trial center, and even normalizing noncoercive financial support to participants.…”