Financial Toxicity

Out-of-pocket costs for treatment as well as indirect costs such as loss of income can incur financial stress on patients, affect their quality of life, and result in decreased treatment compliance.3 While higher-income patients may choose more expensive treatments, putting themselves at greater risk of bankruptcy, lower-income patients may forgo care as a result of cost.4


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Several presentations addressed the financial toxicity of cancer treatment. Veena Shankaran, MD, of the University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, spoke about contributing factors and potential solutions to the problem.5

She recommended developing tools to track patient costs and financial distress, developing strategies to connect patients with financial assistance, and improving transparency around treatment options and out-of-pocket costs.

“Oncologists should be aware that costs are often a problem for patients,” Dr. Shankaran wrote in an email to Cancer Therapy Advisor.

“They should be provided information about cost and trained to discuss this with patients within the shared decision-making model. Real-time financial assistance requires a team of professionals to help support the patient and oncologist to identify resources for financial assistance. A concerted effort by the oncology team to mitigate a patient’s financial stress will most likely improve adherence and outcomes.”

Dr. Shankaran said that practicing oncologists can assist efforts by organizations such as the American Society of Clinical Oncology to promote sustainable drug pricing and insurance design.

“Oncologists can participate in these efforts through engagement with their professional organizations,” she wrote. “Individual oncologists are also calling for changes in drug pricing via articles in the lay press.”

Dr. Shankaran’s research team is developing tools to measure financial burden in real time and a program that educates patients and offers financial counseling to them.

“We hope that developing and validating such tools that can be later introduced into clinical practice will help us at least track patients’ financial challenges,” she wrote. “The next step is actually intervening before patients face major financial hardship.” 

Yousuf Zafar, MD, MHS, of Duke University, Durham in NC, discussed how oncologists can intervene before the cost of care becomes toxic to patients.6 He recommended policy changes to reduce “unsustainable drug prices and promote innovative insurance models.”

Noting the unlikelihood of this being implemented soon, he proposed that oncologists focus on the value of care, initiate conversations about treatment costs with patients, be educated on how to engage patients regarding value, and improve patients’ health literacy regarding costs.

“While I can’t possibly keep up with the cost of every intervention I order, it is most definitely my responsibility to protect my patient from treatment-induced financial harm,” wrote Dr. Zafar in an email to Cancer Therapy Advisor.

RELATED: Understanding Financial Distress in Patients with Advanced Cancer

“As such, I check in with patients regarding their ability to pay for their cancer treatment. If they are having difficulties, I refer them to pharmacists, social workers, or financial counselors in my practice. Keeping an open dialogue with patients about their medical expenses is crucial.”

“Cost to patients should be an important part of treatment decision-making, as there is growing evidence that financial toxicity can be harmful to patients’ well-being,” he concluded.