Financial toxicity in clinical care today: a “menu without prices”

We thank Currow and Aranda1 for raising awareness about the importance of financial toxicity in their recent article. Financial toxicity — a term increasingly used in oncology — is known to not just worsen the quality of life of people affected by cancer, but in some cases, such as bankruptcy, is associated with reduced survival.2

To add to the discussion, we would like to point out that one of the under-recognised aspects of financial toxicity is the impact of cancer and its treatment on the ability to work, which, indirectly, leads to reduced income and inability to meet the cost of care. Data show that cancer survivors have a 37% greater likelihood of unemployment compared with cancer-free controls and greater impairments to work ability than individuals affected by other chronic conditions.3 For example, patients with colorectal cancer in Australia were found to have a median 3 months off work through treatment and recovery, while 27% had stopped working at 12 months.4 Individuals with manual occupations and the self-employed are especially vulnerable as they work long hours and need to be at their physical best. While reduced work participation is a predictor of financial hardship, the surveys of financial toxicity rarely examine changes to household income, and the impact on employment is rarely discussed as a potential risk of cancer treatment.

As pointed out by Aranda and Currow, discussions between doctors and patients of the patients’ financial situation are a positive step towards considering potentially less expensive treatment options. However, it is time to acknowledge the broader determinants of financial toxicity and to use valid tools to assess its risk and magnitude in all its aspects so we can manage it appropriately.5 Without this, in addition to giving patients a menu without prices, we may be taking away their lunch money as well.