Financial Toxicity (Financial Distress) and Cancer Treatment (PDQ®)–Patient Version

General Information About Financial Toxicity (Financial Distress) and Cancer Treatment

KEY POINTS

Financial toxicity describes problems a cancer patient has related to the cost of treatment.
Several studies show that cancer patients and survivors are more likely to have financial toxicity than are people without cancer.
The level of financial toxicity you may have will depend on several factors in your household.
Cancer treatment can affect your ability to work and pay your bills.

Financial toxicity describes problems a cancer patient has related to the cost of treatment.

The terms financial toxicity and financial distress are used to describe how out-of-pocket costs can cause financial problems for a patient. Out-of-pocket costs are what you pay for your medical care that is not covered by your health insurance. Out-of-pocket costs include the following:

Copayments: Amount you pay for each healthcare service, such as a doctor appointment or prescription.
Deductibles: Amount you pay for your medical care before your health insurance plan begins to pay.
Coinsurance: Percentage of costs you pay for a service that your health insurance covers after you have paid your deductible; for example, you pay 20% and your insurance pays 80%.

These costs can be for hospital stays, outpatient services (procedures and tests that can be done without staying overnight in the hospital), medical appointments, and prescription drugs.

Cancer survivors usually report higher out-of-pocket spending than people who have not had cancer. Some cancer survivors report spending more than 20% of their annual income on medical care.

Financial toxicity may also be called: financial stress, financial hardship, financial burden, economic burden, and economic hardship.

There have been no randomized clinical trials studying cancer patients and financial toxicity. The information in this summary is mainly based on studies that only included patients with certain cancers and survivors, so it may not apply to all cancer patients.

Several studies show that cancer patients and survivors are more likely to have financial toxicity than are people without cancer.

Cancer is one of the most expensive medical conditions to treat in the United States. Cancer patients with health insurance are paying higher premiums than in the past. They are also paying more for copayments, deductibles, and coinsurance.

Compared to ten years ago, patients receive more expensive chemotherapy, immunotherapy, and other new types of treatments. Copayments for prescription drugs covered by health insurance may be more for higher priced drugs or brand name drugs (versus generic drugs). These copayments and coinsurance for drugs may cause financial toxicity even for cancer patients who have health insurance.

Cancer survivors may have financial problems many years after they are diagnosed. This is because they may be paying for ongoing cancer treatment or care for late effects from their treatment.

The level of financial toxicity you may have will depend on several factors in your household.

When you are diagnosed with cancer, the following factors in your household may affect your risk of financial toxicity:

Whether you make the most money for your household.
How much money other people in your household make.
How much debt you had before you were diagnosed with cancer.
Your assets.
Costs related to your cancer.
How the cancer and its treatment affect your ability to work.
Whether you have health and disability insurance and what they cover.

You and your family may have the following problems because of your cancer diagnosis:

Less income and assets.
Debt because of the cost of your cancer care.
Trouble paying for housing, food, and bills.
Bankruptcy.

Cancer treatment can affect your ability to work and pay your bills.

Having cancer may make it hard for you to do the physical and mental tasks for your job. You may miss time at work, or not be able to work at all. One study showed that working people who are getting cancer treatment missed about 22 more workdays a year than those who did not have any cancer treatment. Not being able to work may affect your employment-based health insurance (this is when part or all of your premium is paid by your employer).

You may also worry and have stress about paying medical bills related to your cancer. Cancer patients have reported worrying about wages lost for sick time or going to medical appointments. You may also have difficulty and stress when trying to understand complex medical bills.

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Risk Factors Related to Financial Toxicity (Financial Distress)