I hear the term “financial toxicity” used more and more when people are discussing the cost of cancer treatments. What exactly is financial toxicity?
As most people who work in oncology are aware, the costs of cancer treatments continue to increase, with many new treatments costing more than $10,000 a month. Patients bear an increasing proportion of this cost, typically in the form of copays, deductibles, or the Medicare “donut hole.” These increased costs affect both patients receiving oral chemotherapy and those receiving parenteral treatments.
One 2014 survey found that nearly one-fourth of insured adults younger than 65 years paid 10% or more of their household income on health care costs.1 Additionally, the patient’s household finances may be impacted by the loss of income due to a patient or caregiver’s need for time off from work due to the illness or caregiving needs.
For many cancer patients, the financial toll may impact their household finances for years after they have completed treatment. Financial toxicity is one of the more common terms used to describe the impact of cancer, cancer treatments, and long-term effects on a patient’s (or their family’s) finances. Some other terms you may see include financial distress, economic burden, and financial hardship.
Awareness of financial toxicity in the medical and oncology community has increased over the last several years. Some national organizations are calling for a value-based framework (the drug’s cost would be at least partially based on the magnitude of its benefit to patients) in drug approvals and pricing. Other organizations are focusing on health care reform to minimize the costs to the patient. Many emphasize the need for an up-front conversation with patients about treatment costs, and to include the financial impact in the conversation when health care providers counsel patients on the adverse effects and benefits of a proposed treatment course.
To facilitate these conversations, the National Comprehensive Cancer Network (NCCN) began including “evidence blocks” in their oncology treatment guidelines. These evidence blocks are designed to call attention to the affordability, efficacy, and safety of a treatment option, as well as the type and consistency of data supporting use of the regimen (eg, if multiple well-designed trials have shown a benefit to using the regimen or if it is based on a single, small study).2
Because the problem of financial toxicity is multifaceted, there is no easy answer for how to minimize the impact of this on patients. Nurses play a key role in educating and advocating for their patients regarding financial and other toxicities.
1. Financial toxicity and cancer treatment (PDQ®) – health professional version. National Cancer Institute web site. https://www.cancer.gov/about-cancer/managing-care/financial-toxicity-hp-pdq. Accessed May 2, 2017.
2. NCCN clinical practice guidelines in oncology (NCCN Guidelines®) with NCCN Evidence Blocks™. National Comprehensive Cancer Network web site. https://www.nccn.org/evidenceblocks/default.aspx. Accessed May 2, 2017.