Financial toxicity is, in the world of cancer, a very new term. It was first hinted at in 2011, but not truly introduced and defined until 2013. While not an 'official' term, it is gaining ground as more and more people come to accept the reality of just what a cancer diagnosis can mean to patients financially.
The Birth of Financial Toxicity
In 2011 researchers from the Fred Hutchinson Cancer Research Center in Washington state presented a study that determined that a cancer diagnosis could be considered a risk factor for personal bankruptcy [1]. In other words, of the many possible reasons an individual may have to file for personal bankruptcy, receiving a cancer diagnosis could sufficiently qualify as one of them.
The research team found that bankruptcy rates were almost twice as high among cancer patients one year after their diagnosis compared to the general population. On top of that, the median time to bankruptcy was just two and a half years after diagnosis.
"Patients diagnosed with cancer may face significant financial stress, owing to income loss and out-of-pocket costs associated with their treatment," said lead author Scott Ramsey, MD, PhD, at the American Society of Clinical Oncology 2011 Annual Meeting. "On average, bankruptcy rates increased 4-fold within 5 years of diagnosis."
One of the conclusions reached by the research team was that oncologists really needed to acknowledge and address the impact of the cost of cancer care on their patients on an individual basis.
Two years later, a pair of researchers from Duke proposed a term to describe a new adverse event in cancer treatment, writing,
Out-of-pocket expenses might have such an impact on the cancer experience as to warrant a new term: "financial toxicity." Out-of-pocket expenses related to treatment are akin to physical toxicity, in that costs can diminish quality of life. [2]
When the paper presented by the Fred Hutchinson researchers in 2011 was published in a peer-reviewed journal some months later, they noted the "strong evidence of a link between cancer diagnosis and increased risk of bankruptcy," which they believed "represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients."
The Impact of Financial Toxicity
So what does it mean to experience financial toxicity? It means that because of the extraordinarily high costs of cancer care, the cancer patient must make many difficult decisions, some of which can have a negative effect on their treatment and outcome. For instance, patients may feel the need to cut back on the groceries they buy, which can impact their diet and negatively impact their health; patients might cut back on medications they're supposed to be taking, or only partially fill prescriptions—or not get them filled at all—in order to save money (or in the event they simply don't have the money to afford them).
The substantial out-of-pocket costs-- such as repeated co-pays-- related to cancer treatment for those who are insured or who are considered to be insured but 'underinsured' can be catastrophic to patients, both with regard to their outcomes as well as their financial situations. Thus researchers felt that adding the idea of financial toxicity to the list of adverse events experienced by cancer patients was justified. Surely the many, many patients who have had to endure the stress of a diagnosis and then the stress of being unable to afford treatment would readily agree with them.
References:
1. Ramsey S et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood). 2013 Jun;32(6):1143-52. doi: 10.1377/hlthaff.2012.1263. Epub 2013 May 15.
2. Zafar SY, Abernethy AP. Financial toxicity, Part I: a new name for a growing problem. Oncology (Williston Park). 2013 Feb;27(2):80-1, 149.
