Financial Toxicity and Cancer Care: Predicting Financial Distress

The term “financial toxicity” is used to describe the effects of direct and indirect healthcare costs that place a significant financial burden on people with cancer and their caregivers. Researchers at Duke University first used this phrase in 2013. According to a study by the Institute of Medicine, “the costs of cancer treatments are rising unacceptably, making cancer care less affordable for people and their families and producing inequities in patients' access to high-quality cancer care.”

Financial toxicity affects psychological distress, patient outcomes, and quality of life. A person’s experience with healthcare costs change throughout their longitudinal care continuum. Direct costs are associated with initial diagnosis and treatment and indirect costs occur due to lost productivity or a reduced quality of life.

Financial toxicity due to treatment costs

The risk of financial toxicity may vary depending on the type of cancer, its severity, and the treatment approach. Financial toxicity is more likely to affect people with the following conditions:

• Advanced-stage cancer
• Cancer that has a poor prognosis
• More than one type of cancer
• Recurrent cancer
• Cancer with underlying disease (such as heart disease or diabetes)
• Chemotherapy and radiation therapy mostly require higher expenses

Financial toxicity due to patient factors

Your risk of financial toxicity can vary according to age, ethnicity, income, and employment status. According to studies, the risk of financial toxicity increases with age. Younger people with cancer and cancer survivors are more likely to file for bankruptcy than older people with cancer and cancer survivors or no cancer.

Younger people with cancer may experience financial toxicity because of the following reasons:

• Insufficient assets and savings.
• Other financial obligations, such as raising children.
• Not having health insurance (people younger than 65 years are not eligible for Medicare) or having a high-deductible health insurance plan with a high out-of-pocket expense. Going without health insurance puts you at risk of crippling debt due to rising cancer treatment costs. You still have to pay for your cancer treatment despite having health insurance.
• Financial difficulties could be more common among people who are pediatric cancer survivors. A childhood cancer diagnosis may cause academic disruption and reduce employment options. Due to their increased risk of developing subsequent cancers and the long-term repercussions of their cancer treatment, childhood cancer survivors may incur higher out-of-pocket expenses.
• Lower-income households.

Cancer treatment costs can be disastrous for people in terms of their prognoses and financial conditions.

• To save on copayment costs, cancer patients do not take their medications exactly as prescribed. Some miss doses or take less medication than advised to stretch their prescriptions and save money. People sometimes refuse to fill a prescription due to the cost. People are less likely to take their medications as prescribed when the copayment is higher.
• According to studies, individuals who experience financial toxicity report experiencing worsening symptoms, more discomfort, and a lower quality of life.
• According to a study, financial toxicity was more distressing than physical, mental, social, or family problems in some people with cancer. They are more prone to report the following symptoms:
  • Physical infirmity
  • Poor mental state, particularly depression
  • Being dissatisfied with social interactions and connections
  • Stress associated with cancer recurrence
• Financial toxicity may have adverse outcomes, such as debt and bankruptcy. In a study, cancer survivors reported the following financial toxicity issues:
  • Concerned about paying expensive cancer-related expenditures
  • Incurring debt
  • Declaring bankruptcy

Financial toxicity might be reduced in the following ways:

• Having a meeting with a financial navigator who will educate you on the health insurance plans and cost-cutting strategies for treatments that you qualify for
• Hospitals publish their rates so that people and healthcare professionals can compare costs before choosing the tests and treatments
• Implementing value-based pricing will allow the selection of more expensive treatments with reduced out-of-pocket expenses
• Passing laws that help people with cancer reform their health insurance