Financial Toxicity

We’ve all heard firsthand accounts from our patients describing their experiences paying for cancer treatment and its associated indirect costs, such as travel costs, lost time from work, and so on. Two physicians from Duke Cancer Institute, S. Yousuf Zafar and Amy P. Abernethy, recently published a two part article on financial toxicity and called it “a new name for a growing problem.” They correctly note that most clinicians do not consider financial distress in the same way that they view other treatment-related toxicities, such as nausea and fatigue, and point out that few clinicians have the training and/or experience to address and alleviate financial distress. Part I of their article describes the patient-level impact of the cost of cancer care, which they term “financial toxicity.”

The physicians note that it’s been documented that people receiving cancer treatment are paying more out of pocket because cancer treatment has become more expensive (especially targeted agents) and cancer treatment often is over-utilized. As a result, out of pocket expenses have increased, even for people that most would call well-insured. As healthcare insurers bear the increasing cost burden of cancer treatment, they shift a portion of these costs on to patients. And health insurance itself has become cost-prohibitive for many patients; as the authors noted, health insurance premiums increased 170% between 1999 and 2011. Prescription drug copayments have increased as well; between 2000 and 2012, the proportion of workers whose drug plan had three tiers increased from 27% to 63%.

An expanding body of evidence suggests that patients with insurance (and certainly those without health insurance) are dealing with cost implications as a part of their cancer experience. Data have identified both objective financial burden and subjective financial distress as key components of financial toxicity. Objective financial burden includes copayments and non-covered costs. Much less is known about subjective financial distress, which affect patients’ well-being and quality of life. Financial distress has been linked to treatment non-adherence and in some cases, decline of treatment because of its associated financial costs. Incorporating discussions about the financial aspects of care needs to occur early on in the treatment trajectory, and clinicians have a key role in initiating these discussions.

Reference

Zafar SY & Abernathy AP. Financial toxicity, part I: a new name for a growing problem. Oncology; 2013; 27 (2), 80-81, 149.