Financial Toxicity Screening Can Reduce Cancer Cost Burdens

Nancy A. Melville

August 30, 2023


Patients undergoing systemic therapy for advanced cancer who received monthly screening for financial toxicity for up to 1 year were less likely to develop financial difficulties or have their financial issues get worse.


  • About 1 in 5 cancer survivors report experiencing financial toxicity, but financial monitoring is not a routine part of clinical care.

  • In the current analysis, researchers evaluated whether screening for financial toxicity during routine care could prevent patients with advanced cancer from developing financial difficulties.

  • The study involved 1191 patients undergoing systemic therapy for metastatic cancer at 52 community oncology practices in the US. The practices were randomly assigned in a 1:1 ratio to use either digital symptom monitoring through patient-reported outcomes or usual care.

  • With the digital monitoring, patients received online or automated telephone surveys between visits inquiring about symptoms, functioning, and financial toxicity for up to 1 year.

  • The financial toxicity inquiry consisted of a single-item screening question, scored on a 0-5 scale, from the Functional Assessment of Chronic Illness Therapy COmprehensive Score for financial Toxicity (FACIT-COST): "In the last month, my illness has been a financial hardship to my family and me." Scores higher than 2, indicating "quite a bit or very much," triggered an automated alert to practice nurses.

  • At different points, patients in both groups also received a question to assess a change in financial difficulties from baseline: "During the past week, has your physical condition or medical treatment caused you financial difficulties?"


  • Among patients receiving financial toxicity screening, 30.2% developed or experienced worsening financial difficulties, compared with 39.0% of those treated at practices without the financial burden screening (P = .004).

  • The results corresponded to a number needed to screen of 11.4, meaning that, on average, 11.4 patients would need to be screened for one additional patient to avoid developing financial difficulties or having their financial challenges get worse.

  • Nurses and patients who were interviewed noted that financial screening helped them identify patients for financial counseling who otherwise may be reluctant to seek or were unaware of such assistance.

  • The intervention had a similar positive impact among While patients, men, and women compared with the overall study population but appeared to have no effect among Black patients (38% for intervention vs 39% for the control).


The findings suggest that "remote symptom monitoring, including [financial toxicity] screening, protected patients undergoing systemic therapy from experiencing worsening financial difficulties," the authors concluded. Given the relatively low number needed to screen, "financial toxicity screening appears to be a high-yield intervention."


The analysis, by Victoria S. Binder, MD, of Memorial Sloan Kettering Cancer Center, New York City, and colleagues was published online August 25 in the Journal of Clinical Oncology.


  • The use of a single-item measure could call the replicability of the findings into question.

  • Given that the financial toxicity monitoring did not appear to be effective among Black patients, the screening intervention may not adequately address all racial and ethnic groups.


The trial was sponsored by the Foundation of the Alliance for Clinical Trials in Oncology and was supported in part by a Patient-Centered Outcomes Research Institute Award IHS-1511-33, 392. The authors' disclosures are detailed in the published study.

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