Financial toxicity describes the negative impact medical expenses can have on patients in terms of their health-related quality of life.[1] It leads to negative mental and physical effects as well as, in some cases, bankruptcy, loss of job or income, or even homelessness.[2][3][4]
The term financial toxicity was used in a 2009 article about the cancer drug industry "as a side effect of cancer drug treatment, along with nausea and hair loss".[5]
The cost of medical treatment has become a major complication of treatment in the United States, leading to suffering comparable to physical suffering and damaging a person's ability to recover from their illness, according to a 2013 study published in The Oncologist Journal.[6] Patients can forgo treatments or opt for less-cost treatments, which can have a negative impact on their health.[7]
In a study from Oregon, almost 20% of older adults with advanced cancer experienced financial toxicity.[8] This was assessed using 3 simple questions: "At any time in the past 3 months have you taken less medication than was prescribed for you because of the cost?" (Delayed medications); the second question was, "When you think about the amount of income that you have available in a typical month, is there enough for your food and housing costs?" (income available) and the third question was, "When you think about the amount of income that you have available in a typical month, is it enough for things you really need like clothing, medicine, repairs to the home or transportation” (enough income).[8]
As of 2020, preexisting debt, prediagnosis conditions, type of employment like hourly versus salaried, and asset levels are "areas in need of further study" according to the National Cancer Institute.[9] Certain types of cancer treatments requiring daily attendance to a clinic or healthcare provider can increase the risk of financial toxicity on patients.[4][10][2][11][12]
Since 2009, the American Society of Clinical Oncology has recommended ~ guidance on how healthcare professionals talk to patients about costs.[13] Providing financial information and counseling patients with "financial navigators" have been suggested. However, cancer treatment cost information is transparent.[9][14]
Increasing insurance accessibility and putting trauma-informed treatment practices in place, with the result that health insurance helps lessen financial toxicity.[15]
Patel, T.; Keith, S.; Eldredge-Hindy, H.; Fisher, S.A.; Palmer, J.D. (2019-09-01). "Development of a Financial Toxicity Screening Tool for Radiation Oncology: A Secondary Analysis of a Prospective PROs Study". International Journal of Radiation Oncology, Biology, Physics. 105 (1): E589–E590. doi:10.1016/j.ijrobp.2019.06.1184. ISSN 0360-3016. Palmer, Joshua D.; Patel, Tejash T.; Eldredge-Hindy, Harriet; Keith, Scott W.; Patel, Tapas; Malatesta, Theresa; DiNome, Jessie; Lowther, Anne; Ferguson, Linda; Wagenborg, Sally; Smyles, John (2018-06-01). "Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study". International Journal of Radiation Oncology, Biology, Physics. 101 (2): 299–305. doi:10.1016/j.ijrobp.2018.03.014. ISSN 0360-3016. Ali McBride, Lisa M. Holle, Colleen Westendorf, Margaret Sidebottom, Niesha Griffith, Raymond J. Muller, James M. Hoffman, National survey on the effect of oncology drug shortages on cancer care, American Journal of Health-System Pharmacy, Volume 70, Issue 7, 1 April 2013, Pages 609–617, doi:10.2146/ajhp120563 Arastu, Asad; Patel, Arpan; Mohile, Supriya Gupta; Ciminelli, Joseph; Kaushik, Ramya; Wells, Megan; Culakova, Eva; Lei, Lianlian; Xu, Huiwen; Dougherty, David W.; Mohamed, Mostafa R. (2020-12-07). "Assessment of Financial Toxicity Among Older Adults With Advanced Cancer". JAMA Network Open. 3 (12): e2025810. doi:10.1001/jamanetworkopen.2020.25810. ISSN 2574-3805. PMC 8184122. PMID 33284337. Wages, Nolan A.; Sanders, Jason C.; Smith, Amy; Wood, Songserea; Anscher, Mitchell S.; Varhegyi, Nikole; Krupski, Tracey L.; Harris, Timothy J.; Showalter, Timothy N. (2021-04-01). "Hypofractionated Postprostatectomy Radiation Therapy for Prostate Cancer to Reduce Toxicity and Improve Patient Convenience: A Phase 1/2 Trial". International Journal of Radiation Oncology, Biology, Physics. 109 (5): 1254–1262. doi:10.1016/j.ijrobp.2020.11.009. ISSN 0360-3016. PMC 7965239. PMID 33227441. Johnstone, Gregory P.; Johnstone, Peter A.S. (2018-06-01). "The Oncologist's Role in Managing Financial Toxicity". International Journal of Radiation Oncology, Biology, Physics. 101 (2): 306–308. doi:10.1016/j.ijrobp.2017.11.046. ISSN 0360-3016. Palmer, Joshua D.; Patel, Tejash T.; Eldredge-Hindy, Harriet; Keith, Scott W.; Patel, Tapas; Malatesta, Theresa; DiNome, Jessie; Lowther, Anne; Ferguson, Linda; Wagenborg, Sally; Smyles, John (2018-07-15). "Patients Undergoing Radiation Therapy Are at Risk of Financial Toxicity: A Patient-based Prospective Survey Study". International Journal of Radiation Oncology, Biology, Physics. 101 (2): 299–305. doi:10.1016/j.ijrobp.2018.03.014. ISSN 0360-3016. Lentz, Robert; Benson, Al B.; Kircher, Sheetal (July 2019). "Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies". Journal of Surgical Oncology. 120 (1): 85–92. doi:10.1002/jso.25374. ISSN 0022-4790. Chervu, Nikhil; Branche, Corynn; Verma, Arjun; Vadlakonda, Amulya; Bakhtiyar, Syed Shahyan; Hadaya, Joseph; Benharash, Peyman (2023-06-01). "Association of insurance status with financial toxicity and outcome disparities after penetrating trauma and assault". Surgery. 173 (6): 1493–1498. doi:10.1016/j.surg.2023.02.033. ISSN 0039-6060.
