RFS news highlights resources, issues, and news relevant to in-training members of the ACR. If you have a topic idea or would like to contribute to the blog, please email RFS Secretary Patricia Balthazar, MD.




RO Corner: The Financial Toxicity of Cancer Care

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A recent American Society of Clinical Oncology podcast with ASCO CEO Clifford A. Hudis, MD, discussed findings from recent studies focusing on the financial toxicity associated with the high costs affiliated with cancer treatments. He went on to state that many patients “are not taking their prescribed medications because of cost” and “they’re often not paying their other household bills, or taking other drastic measures because cancer treatment that they have to receive has become so expensive.”

A study by Zafar et al., addressed the concept of “financial toxicity” in a pilot study, where the out-of-pocket expenses incurred was assessed, in addition to surveys which looked at the impact of healthcare costs on well-being and treatment. After surveying 254 patients they found that even insured patients who sought out copayment assistance often experienced considerable financial burden and may have altered their care to help defray the expenses.1 The Centers for Disease Control and Prevention have shown that one in three Americans experience financial burden with medical care, with cancer patients experiencing a higher burden.2 Three factors explaining the relationship between extreme financial distress and greater risk of mortality have been suggested including 1) poorer subjective well-being 2) impaired health-related quality of life, and 3) sub-par quality care (3). Higher out-of-pocket expenses often lead to lifestyle changes, longer work hours, and other cut backs to help defray costs.

With growing costs of prescription medications, patients often choose to forego treatment, and these rates of noncompliance with such medications as hormonal therapy for breast cancer have led to increased mortality. For example, a study by Hershman et al., found a roughly 4 to 6 percent detriment in 10-year survival for those with early discontinuation or non-adherence.4

Radiation oncology poses a unique financial burden in terms of access. Many patients in rural areas have to travel many miles and hours to reach a treatment facility, which often leads to delayed diagnoses and treatment. A recent article by Palmer et al., surveyed radiation oncologists about treatment costs and 53 percent reported being “very concerned” with treatment-related costs negatively affecting their patients. The associated toxicities include loss of income, difficulty paying rent/mortgage, and being unable to afford transportation and meals.

In my short career to date, I have seen the results of this first-hand with patients working, despite undergoing treatment and the resulting side effects, because they “have to pay the bills.” Ultimately we need to continue to work together and fight for a solution to ensure health equity for all, while helping to alleviate the mental and emotional burden associated with the financial toxicities of cancer care so that patients can focus on what matters the most — getting well.

Chelsea Miller, MD, is a radiation oncology resident at Loyola University of Chicago.


1. Zafar SY, Peppercorn JM, Schrag D, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. The Oncol. 2013 Apr;18(4)381-390.
2. Cohen RA, Gindi RM, Kirzinger WK, et al. Burden of medical care cost: early releast of estimates from the national health interview survey, January-June 2011. Online: http://www.cdc.gov/nchs/nhis/releases.htm
3. Zafar SY. Financial toxicity of cancer care: it’s time to intervene. Jour Nat Canc Inst. 2015 Dec;108(5).
4. Hershman DL, Shao T, Kushi LH, et al. Early discontinuation and non-adherennce to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Canc Res Treat. 2011 Apr;126(2):529-37.
5. Palmer JD, Patel TT, Elredge-Hindy H, et al. Patients undergoing radiation therapy are at risk of financial toxicity: a patient-based prospective survey study. Int J Radiat Oncol Biol Phys. 2018 Jun;101(2):299-305

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