Financial Toxicity Experienced by Adults With Cancer


Key Points

  • Overall, 26% of patients reported financial toxicity.
  • Those with financial toxicity were more likely to be noncompliant with care in numerous domains, including medication and doctor visits.   

In a study reported in the Journal of Oncology Practice, Knight et al found that 26% of patients with cancer acknowledged ‘financial toxicity’—treatment-related financial harm—with respect to cancer care, and that this toxicity was associated with consequences such as medication noncompliance and missing visits for care.

The study involved completed surveys of 1,988 adult patients with cancer identified between May 2010 and November 2015 from a Health Registry/Cancer Survivorship Cohort within the University of North Carolina Health Care Oncology outpatient clinics. Financial toxicity was defined as agreement with the phrase you have to pay for more medical care than you can afford from the Patient Satisfaction Questionnaire-18.

Survey Findings

Of the 1,988 participants, 524 (26%) reported financial toxicity. Patients reporting financial toxicity were more likely to be aged ≤ 65 years, female, nonwhite, non–English speaking, not married, less educated, and to have received a diagnosis more recently (all P < .001). In adjusted analysis, those reporting financial toxicity were more likely to report that they were noncompliant with medication due to inability to afford prescription drugs (relative risk [RR] = 3.55, 95% confidence interval [CI] = 2.53–4.98) and were more likely to forgo mental health care (RR = 3.89, 95% CI = 2.04–7.45), doctor visits (RR = 2.98, 95% CI = 1.97–4.51), medical tests (RR = 2.54, 95% CI = 1.49–4.34), and dental care (RR = 2.86, 95% CI = 2.20–3.73) due to financial reasons.

In adjusted analysis among all patients reporting delays in care during the prior year, those with vs without financial toxicity were more likely to cite the following as causes: not having transportation (RR = 1.82, 95% CI =1.04–3.20), lack of insurance (RR = 1.92, 95% CI = 1.33–2.76), inability to pay their general household expenses (RR = 2.73, 95% CI = 2.01–3.70), inability to pay for travel (RR = 2.32, 95% CI = 1.40–3.86), and inability to take time off of work (RR = 2.72, 95% CI = 1.67–4.42).

The investigators concluded, “More than 25% of adults with cancer reported financial toxicity that was associated with an increased risk for medical noncompliance. Financial toxicity remains a major issue in cancer care, and efforts are needed to ensure patients experiencing high levels of financial toxicity are able to access recommended care.”

The Health Registry/Cancer Survivorship Cohort is funded in part by the University of North Carolina Lineberger Comprehensive Cancer Center’s University Cancer Research Fund.

Thomas G. Knight, MD, of the Levine Cancer Institute, Atrium Health, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: See study authors’ full disclosures at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.