The financial burden and distress of patients with cancer: Understanding and stepping-up action on the financial toxicity of cancer treatment

CA Cancer J Clin. 2018 Mar;68(2):153-165. doi: 10.3322/caac.21443. Epub 2018 Jan 16.


"Financial toxicity" has now become a familiar term used in the discussion of cancer drugs, and it is gaining traction in the literature given the high price of newer classes of therapies. However, as a phenomenon in the contemporary treatment and care of people with cancer, financial toxicity is not fully understood, with the discussion on mitigation mainly geared toward interventions at the health system level. Although important, health policy prescriptions take time before their intended results manifest, if they are implemented at all. They require corresponding strategies at the individual patient level. In this review, the authors discuss the nature of financial toxicity, defined as the objective financial burden and subjective financial distress of patients with cancer, as a result of treatments using innovative drugs and concomitant health services. They discuss coping with financial toxicity by patients and how maladaptive coping leads to poor health and nonhealth outcomes. They cover management strategies for oncologists, including having the difficult and urgent conversation about the cost and value of cancer treatment, availability of and access to resources, and assessment of financial toxicity as part of supportive care in the provision of comprehensive cancer care. CA Cancer J Clin 2018;68:153-165. © 2018 American Cancer Society.

Keywords: antineoplastic agents; costs and cost analysis; decision making; health financing; oncologists; precision medicine; referral and consultation; supportive care.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Antineoplastic Agents / economics*
  • Cost of Illness*
  • Financing, Personal / statistics & numerical data*
  • Health Care Costs*
  • Health Policy
  • Humans
  • Neoplasms / drug therapy*
  • Neoplasms / economics*
  • Neoplasms / psychology*
  • Stress, Psychological / economics*


  • Antineoplastic Agents