The financial burden and distress of patients with cancer: Understanding and stepping‐up action on the financial toxicity of cancer treatment

Abstract

"Financial toxicity" has now become a familiar term used in the discussion of cancer drugs, and it is gaining traction in the literature given the high price of newer classes of therapies. However, as a phenomenon in the contemporary treatment and care of people with cancer, financial toxicity is not fully understood, with the discussion on mitigation mainly geared toward interventions at the health system level. Although important, health policy prescriptions take time before their intended results manifest, if they are implemented at all. They require corresponding strategies at the individual patient level. In this review, the authors discuss the nature of financial toxicity, defined as the objective financial burden and subjective financial distress of patients with cancer, as a result of treatments using innovative drugs and concomitant health services. They discuss coping with financial toxicity by patients and how maladaptive coping leads to poor health and nonhealth outcomes. They cover management strategies for oncologists, including having the difficult and urgent conversation about the cost and value of cancer treatment, availability of and access to resources, and assessment of financial toxicity as part of supportive care in the provision of comprehensive cancer care. CA Cancer J Clin 2018;68:153-165.

‘It was a big monetary cut’—A qualitative study on financial toxicity analysing patients’ experiences with cancer costs in Germany

“…Even the recent frameworks for financial toxicity include primarily direct medical costs and related treatment costs in their definitions of objective financial burden. Although some reviews have also considered the indirect costs of income loss, they have not accounted for the phenomenon of decreased non‐medical costs (Altice et al, ; Carrera et al, ; Gordon, Merollini, et al, ; McNulty & Khera, ). Therefore, it is not possible to directly compare our results with those of other studies on the risk factors for the financial impact of a cancer diagnosis.…”

“…One major problem is the prevalence of financial toxicity following a cancer diagnosis, which ranges between 15% and 79% of patients who experience financial burden depending on the underlying measurement and country (Azzani, Roslani, & Su, ). Financial toxicity is defined as the objective financial burden and subjective financial distress experienced by patients (Carrera, Kantarjian, & Blinder, ). The objective financial burden refers to costs in relation to wealth and income.…”

“…In addition to a deeper understanding of the costs that induce financial toxicity, identifying high‐risk patients is important (Carrera et al, ). Medical and non‐medical out‐of‐pocket costs have been found to be higher for patients with, for example, younger age, higher household income and longer distance from treatment centres (Baili et al, ; Davidoff et al, ; Newton et al, ; Pisu, Azuero, Benz, McNees, & Meneses, ; Valtorta & Hanratty, ).…”

Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities

“…7 Hospital deaths contribute to higher costs near the end of life: approximately 70% of Medicare expenditures ($130 billion) are spent on inpatient services. 15 Since 1999, the number of patients served by hospice in the United States has tripled to >1.5 million, 16 and the number of hospice programs has nearly doubled. 10,11 Thus, patient-centered and family-centered end-of-life outcomes are improved with the increased use of hospice, 7 with decreased caregiver burden 12 and improved health care economics.…”

Cancer screening – Why do we still debate about the benefits?

“…At the same time, treatment options for cancer are expanding, but many of these new drugs are costly. There is concern surrounding how health care systems as well as patients will be able to manage increasing costs, and this economical discussion has largely focused on the expence of new cancer drugs 2 …”