Opposing Trajectories of Cancer Outcomes and Financial Concerns

Most methods of treating cancer have concomitant toxicities. Many chemotherapies can be toxic and lead to painful side effects. Radiotherapy causes skin toxicities and breakdown. The toxicities that cancer causes are not only somatic; they can also be psychological. In addition, cancer can cause financial stresses that often lead to another form of toxicity.

Anurag K. Singh, MD, is professor of oncology and director of radiation research at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and the senior author of a report on the effect financial distress can have on their patients with cancer.¹ He and his group work with patients who have head and neck cancer, and they are concerned about the burdens their patients undertake. Potential financial toxicity is just one of those burdens.

The National Cancer Institute defines financial toxicity as “problems a patient has related to the cost of medical care.”¹ The term is synonymous with economic or financial hardship or burden, and financial stress or distress.² Dr Singh and co-authors note that patients with cancer are more likely to have financial burdens than do people without cancer.

The Roswell group sought to evaluate the association between financial toxicity and survival in their patients. Cancer treatments such as radiation and chemotherapy are among the most expensive types of treatment a patient can undergo and have high out-of-pocket costs.¹ A 2018 American Society of Clinical Oncology (ASCO) survey found patients with cancer were less concerned about dying from their disease than they were about having their finances depleted by it.³

There are other concerning issues regarding financial toxicity and cancer. Bankruptcy, which the authors described as an extreme form of financial toxicity, was associated with an increase in mortality among cancer survivors. Cancer treatment often includes surgery, extended courses of chemotherapy, and radiation, as well as substantial supportive care and rehabilitation. Patients often turned to their personal savings, sold their personal assets, took out credit card loans, and even asked members of their families for help to relieve the financial burden.¹