Cancer is expensive, and “[m]itigating patient’s financial toxicity is an important unmet need in optimizing cancer treatment,” a team of researchers recently noted in a retrospective analysis.

But what are the knowledge gaps of patients with cancer? And what strategies could help address the problem? Those are the questions that a team of researchers from the University of Michigan and University of Texas MD Anderson Cancer Center hoped to answer in their analysis published in JCO Oncology Practice

Of 116 invited participants, the researchers chose 32 who had undergone treatment for breast cancer. All of the participants had received financial aid from the nonprofit organization The Pink Fund during their cancer treatment to offset some of the costs they incurred. The researchers performed qualitative semistructured interviews during a period from November 2019 to November 2020. 

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As the researchers interviewed the patients, they discovered overarching themes that confirmed an existing financial toxicity framework: objective burdens and subjective distress. They also learned about another recurring theme: patient knowledge and expectations related to treatment cost and burden. “Expectations affected both objective financial burden and subjective financial distress and thus patients’ experience of financial toxicity,” the researchers explained. 

The knowledge gaps, or areas of concern, patients experienced were lack of social support, inability to identify resources, incorrect treatment expectations, and lack of provider conversations.

Patients expressed that they wished they had been better prepared for the financial burdens of treatment and encouraged the exploration of strategies to help patients manage their expectations and reduce the financial toxicity of treatment. For example, some expressed a desire for better access to allied health providers who could help them seek out resources. 

This information can be used to inform future research and devise effective mitigation strategies, stated the researchers. 

“Strategies for mitigation may span from organizational efforts that aim at the health care system, to interpersonal efforts aimed at patient-provider interactions, to individual efforts seeking to arm patients with knowledge that can mitigate financial toxicity,” the researchers added.

Although efforts were made to select a diverse group, the analysis was limited by its sample size. All participants were able to find financial assistance, and how patients who were not able to find such help or did not have the resources to search would have fared is unknown. Also, the participants were interviewed between 1 and 3 years after treatment, which may have produced some recall bias.

Disclosure: The study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Gharzal LA, Ryan KA, Szczygiel L, et al. Financial toxicity during breast cancer treatment: a qualitative analysis to inform strategies for mitigation. JCO Oncol Pract. 2021;17(10):e1413-e1423. doi:10.1200/OP.21.00182