Financial Toxicity in Adults With Cancer: Adverse Outcomes and Noncompliance

Thomas G. Knight; Allison M. Deal; Stacie B. Dusetzina; Hyman B. Muss; Seul Ki Choi; Jeannette T. Bensen; Grant R. Williams


J Oncol Pract. 2018;14(11) 

In This Article


Treatment for cancer in the United States has increasingly become specialized and expensive, with increased focus on targeted and personalized therapies.[1] Studies have documented average launch prices for anticancer drugs increased by 10% annually, or an average of $8,500 per year, from 1995 to 2013,[2,3] after accounting for inflation and health benefits. At the same time, national surveys revealed that retail prescription medicine expenditures for cancer treatment increased five-fold between these years, from $2.0 billion in 2001 to $10.0 billion in 2011.[4] These high medication costs are worrisome because they result in high out-of-pocket spending requirements for patients needing treatments, which, in turn, are often related to poorer adherence to medication therapies.[5–10] However, increasing medication costs, although important, are just one of many contributors to the financial burden for patients with cancer, which is now referred to as financial toxicity.[11–13] There is a growing national consensus on the importance of defining and finding interventions to ameliorate financial toxicity.[14]

Previous research in this area focused on identifying and characterizing the extent to which patients report financial distress or toxicity. These analyses include several small-scale pilot studies that used patient-reported data to quantify experiences with financial toxicity[11,15–18] and multiple studies that used large national databases focused on identifying the role of patient out-of-pocket costs on outcomes.[6,12,19–21] In this study, we used patient reported information from a large academic medical system in the southeastern United States to evaluate the prevalence of self-reported financial toxicity, the impact of financial toxicity on subsequent health services, and to identify potential areas of financial toxicity that could be targeted for intervention.