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JAMA Oncology Patient Page
March 10, 2022

Financial Toxicity of Cancer Treatment

Author Affiliations
  • 1Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland
  • 2Masonic Cancer Center, University of Minnesota, Minneapolis
  • 3Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
JAMA Oncol. 2022;8(5):788. doi:10.1001/jamaoncol.2021.7987

What Is Financial Toxicity?

Cancer is one of the most expensive medical conditions to treat in the US. Financial toxicity is a term used to describe the harmful effect of high cost of treatment on a person’s quality of life. It may also be described as financial burden or financial distress.

Am I at Risk of Financial Toxicity During Treatment?

Many factors may cause financial stress during treatment:

  • Type of cancer, its severity, and treatment: Treatment may range from a single daily pill to daily or weekly visits or long hospital stays.

  • Financial status: Factors include whether you are the primary earner in your family, how much money you have saved, and whether you or a family member can continue working during treatment.

  • Health insurance coverage: This dictates your out-of-pocket costs during treatment.

What Are the Consequences of Financial Distress During Treatment?

Every household adjusts differently. Some people may use a large portion of their savings, open a new credit card, or refinance their home to help pay for treatment. Others may skip medical visits or take less medication than they are prescribed. Some families may cut back on food, clothing, or leisure activities, such as going to movies or vacations. Making ends meet in this manner can be stressful, which in turn can trigger symptoms of anxiety and depression. It is important to recognize these changes early and talk to your treatment team if you are having problems affording your care.

How Is Financial Toxicity “Treated”?

Having health insurance is the most effective way to reduce financial toxicity. Understanding your coverage and what you can expect to pay for treatment is important. Terms such as premium, deductible, copayment, and coinsurance are often difficult to fully understand, even for medical professionals.

Before you begin treatment, you should ask to speak with the financial team that will obtain authorization for your treatment so that you can understand the billing process and possibility of any “surprise” bills. Your social worker can help find grants from community programs, connect you with family or group support, and discuss medical leave options with your employer.

Even if you are uninsured or underinsured, they can help find financial assistance options. Open enrollment periods throughout the year allow you to enroll in a new federal, state, or private insurance plan or adjust current coverage to better fit future needs.

You can be your best advocate by raising concerns about costs at the beginning of or during treatment. Your quality of care will not change. In fact, this may give the team an opportunity to improve parts of treatment, such as switching to a generic drug, consolidating clinic visits, or giving vouchers for transportation or parking.

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Section Editor: Howard (Jack) West, MD.
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Article Information

Published Online: March 10, 2022. doi:10.1001/jamaoncol.2021.7987

Conflict of Interest Disclosures: Dr Dusetzina reported grants from Arnold Ventures, Commonwealth Fund, Leukemia & Lymphoma Society, and Robert Wood Johnson Foundation during the submitted work, and personal fees from West Health, National Academy for State Health Policy, and Institute for Clinical and Economic Review outside the submitted work, as well as serving on the Medicare Payment Advisory Commission. The views presented are those of the authors and do not reflect those of the Commission. No other disclosures were reported.

2 Comments for this article
Financial Toxicity
Daniel Krell, M.D. | Retired PCP
Again, a tragic, indefensible situation is presented, along with suggestions to patients and their families for ameliorating the financial toxicity. I understand that patients with cancer, trying to survive their illness and financial challenges, do not need to be exhorted to contact their representatives and advocate for a more rational health care system. That said, I would have liked to see a sidebar for physicians, reviewing the inequity and destructive dynamics at work, and suggesting advocacy for changing the system. I also understand the powerful financial forces that have shaped and protect the present system, and represent a formidable headwind to system improvement. How often do physicians need to be reminded of "primum non nocere," and recognize financial disaster for families as “nocere”?
Oxymoron Overdose
Alan Griffiths, D.O. | General practice - (retired)
"Financial toxicity" ?
Sounds like a systemic disease to me in which the cause is obscured by the symptoms.
When will "Financial Toxicity" be listed in the DSMV handbook ?

Sadly Ivan Illich (Medical Nemesis 1975) was prophetic in his scathing observations then, as the comment by Dr. Krell referencing nocere gently reminds us now.
CONFLICT OF INTEREST: Since 1975 I have worked with primary care physicians and researchers who believed in, and attempted to prove the existence of the mythical creature called "Preventive Medicine". They now like the euphemistic title have all but passed away.