Financial toxicity: a devastating side effect of cancer treatment
Luis* emigrated to NYC from Latin America with his wife and child. With Luis working hard in a well-paying job, it seemed like the family was on their way to realizing the American dream that they had come so far to achieve—until calamity struck. Luis was diagnosed with a rare and aggressive type of cancer and could no longer work. Luis’ wife went to work at a nail salon but quickly lost her job when the COVID-19 restrictions began. The family is without authorized immigration status and cannot access government benefits or most pandemic relief, despite having consistently paid taxes. With the double whammy of cancer and the COVID-19 pandemic, Luis was at risk of severe cancer-associated financial toxicity.
Financial toxicity describes a devastating, but increasingly common, cancer treatment side effect. Cancer treatment is expensive, and the high costs can quickly spiral. At the same time, many patients experience cancer-related job loss or work fewer hours during treatment. The imbalance of reduced income and rising medical costs leaves our most vulnerable patients facing stark choices, such as feeding their family or filling their prescription medications.
Trying to save money by skipping or delaying treatment is dangerous, but for patients with severe financial toxicity, it may appear to be the only option. It can lead to serious health consequences, such as worsening of disease, depression, reduced quality of life, and premature death. Low-income immigrant, minority, and other underserved patients are the most vulnerable.
Having unmet socioeconomic needs, such as for food, housing, and affordable medical care, puts low-income immigrant, minority, and other underserved patients in NYC at risk of missing medical appointments and delaying medication. However, clinic-based patient navigation is an effective way to prevent or treat financial toxicity. IHCD’s comprehensive multilingual patient navigation program, ICCAN (Integrated Cancer Care Access Network), assists high-need patients in eleven MSK and safety-net cancer clinics throughout NYC. Our Breast Cancer and the Workforce program helps patients and employers to negotiate workplace accommodations so that patients may stay in employment and retain any workplace benefits.
Patient navigators identify patients’ socioeconomic and treatment needs and help address the essential needs barriers that they face, with referrals to resources such as food, transportation, housing, government benefits, free/low-cost health insurance, legal assistance (for work, immigration, housing, etc.), foundation grants, and prescription assistance programs. ICCAN helped Luis to access an intensive cancer treatment regimen, along with assistance with rent, food, immigration issues, and supportive care for him and his family, although their situation remains distressing.
Addressing financial toxicity is an essential step towards achieving cancer health equity. The economic impacts of COVID-19 mean that more patients than ever are vulnerable to financial toxicity. However, patients can be reluctant to raise financial concerns with the care team, fearing that it might negatively affect their treatment. Discussing treatment costs, in a safe and reassuring context, should be part of the standard of care, so that patients with need can be identified early and referred to patient navigation or other appropriate resources before the onset of acute financial toxicity and its worst, potentially fatal, consequences.
*Name changed to protect patient identity.