# Financial toxicity

Source: https://onco.cc/terms/financial-toxicity/  
OnCo record `financial-toxicity` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The harm caused to patients by the cost of cancer care: depleted savings, debt, skipped medication and worse survival. Measured like any other side effect and, increasingly, treated like one.

## Summary

Coined by Zafar and Abernethy (2013). Components: material hardship (out-of-pocket costs, income loss), psychological distress and coping behaviours (non-adherence, skipping visits). Prevalence 30-50% of US patients; associated with lower quality of life, treatment non-adherence and higher mortality (bankruptcy linked to 79% higher mortality). Measured by the COST-FACIT instrument. Drivers include drug prices, cost-sharing designs, oral-parenteral parity gaps, travel, and employment loss; higher among younger, minority, low-income and rural patients. Financial navigation, assistance programmes, cost conversations and policy (out-of-pocket caps, Medicaid expansion) reduce it.

## Fields

- Kind: Term
- Last checked: 2026-09-08
- Tags: gap-fill

## Notes

- Triple-negative breast cancer treatment lasts most of a year and often falls in working life. Macmillan says the law treats cancer as a disability (Equality Act 2010 in England, Scotland and Wales), that employers must make reasonable adjustments once they know, that you do not have a legal right to paid time off for appointments unless your contract says so, and that its money advisers give free confidential advice on benefits and grants; Access to Work grants can help people with a health condition keep working.
- Pancreatic Cancer UK says you are protected from discrimination at work and your employer must make reasonable adjustments; that PIP, Attendance Allowance or Carer's Allowance may apply; that where the cancer cannot be cured an SR1 form from your doctor or nurse speeds up claims; that prescriptions are free in England with a medical exemption certificate (form FP92A) for anyone having cancer treatment; and that Macmillan's benefits advisers and calculator can work out what you can claim.
- Bowel cancer in the UK: Bowel Cancer UK says that from diagnosis you are protected from discrimination at work by the Equality Act 2010 (the Disability Discrimination Act 1995 in Northern Ireland), that your employer must make reasonable adjustments such as different or part-time hours, time off for appointments or changed duties, that a phased return is a normal request, and that the Access to Work schemes can fund equipment and sometimes taxis. It lists the benefits that may apply, including Personal Independence Payment, Adult Disability Payment in Scotland, Attendance Allowance and Carer's Allowance.
- Lymphoma in the United Kingdom: Lymphoma Action's work material signposts statutory sick pay, New Style Employment and Support Allowance, Universal Credit, Personal Independence Payment and Adult Disability Payment in Scotland, council tax reduction, help with transport costs, help with health costs, Carer's Allowance and Carer's Credit, and grants from Macmillan and Turn2us, alongside the Equality Act protections and reasonable adjustments an employer must consider. Treatment at a cell-therapy centre adds four weeks of accommodation near the hospital for two people, which is the lymphoma-specific cost that catches households out.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Financial_toxicity
- Zafar 2013 (Oncologist): https://doi.org/10.1634/theoncologist.2012-0279
- COST-FACIT: https://www.facit.org/measures/facit-cost
- Macmillan: work and cancer: https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/work-and-cancer
- Macmillan: money and work: https://www.macmillan.org.uk/cancer-information-and-support/get-help/financial-and-work
- Pancreatic Cancer UK: work and money: https://www.pancreaticcancer.org.uk/information-and-support/dealing-with-pancreatic-cancer/daily-life-with-pancreatic-cancer/work-and-money/
- Bowel Cancer UK: work, money and travel: https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/work,-money-and-travel/
- Colostomy UK: returning to work after stoma surgery: https://www.colostomyuk.org/information/returning-to-work-after-stoma-surgery/
- Lymphoma Action: lymphoma, work and you: https://lymphoma-action.org.uk/information-and-support/living-and-beyond-lymphoma/day-day-living/lymphoma-work-and-you
- GOV.UK: statutory sick pay: https://www.gov.uk/statutory-sick-pay

## Connected records

- technologies: [After treatment in low and middle income countries: mostly nothing](https://onco.cc/technologies/rejuv-access-survivorship-care-lmic/), [Employment rights with cancer in the United States](https://onco.cc/technologies/rejuv-life-employment-rights-us/), [EQ-5D: health reduced to one number, and what that number is for](https://onco.cc/technologies/rejuv-measure-eq-5d/), [Financial toxicity and financial navigation](https://onco.cc/technologies/financial-navigation/), [Going back to work after cancer: the rates, and the programmes that change them](https://onco.cc/technologies/rejuv-life-return-to-work/), [Insurance, mortgages and the right to be forgotten](https://onco.cc/technologies/rejuv-life-insurance-loans-and-the-right-to-be-forgotten/), [Money after treatment: what the cost of cancer does once the treatment has finished](https://onco.cc/technologies/rejuv-life-money-after-treatment/), [What recovery costs in the rest of the world](https://onco.cc/technologies/rejuv-access-what-it-costs-elsewhere/), [What recovery costs in the UK, and what it does not](https://onco.cc/technologies/rejuv-access-what-it-costs-uk/), [What recovery costs in the United States](https://onco.cc/technologies/rejuv-access-what-it-costs-us/), [Who misses out on recovery care, measured](https://onco.cc/technologies/rejuv-access-who-misses-out/)
- terms: [340B Drug Pricing Program](https://onco.cc/terms/340b-program/), [Cancer health disparities and equity](https://onco.cc/terms/cancer-health-disparities/), [China National Reimbursement Drug List negotiation and volume-based procurement](https://onco.cc/terms/china-vbp-nrdl/), [Emotional support and helplines (UK)](https://onco.cc/terms/emotional-support-cancer-uk/), [Going back to work after lymphoma, and the money in the meantime](https://onco.cc/terms/lymphoma-living-returning-to-work/), [Health technology assessment (HTA), reimbursement and QALYs](https://onco.cc/terms/hta/), [Inflation Reduction Act 2022: Medicare drug price negotiation](https://onco.cc/terms/inflation-reduction-act/), [NICE technology appraisal methods (2022)](https://onco.cc/terms/nice-methods/), [Oncology drug pricing and price transparency](https://onco.cc/terms/drug-price-transparency/), [Quality of life](https://onco.cc/terms/quality-of-life/), [Quality of life and patient-reported outcomes (QoL, PRO)](https://onco.cc/terms/qol-pro/), [Quality-adjusted survival (QALYs and Q-TWiST)](https://onco.cc/terms/quality-adjusted-survival/), [State biomarker testing coverage laws](https://onco.cc/terms/state-biomarker-testing-laws/), [Treatment at the local hospital or at a cell-therapy centre far from home](https://onco.cc/terms/lymphoma-decision-local-or-car-t-centre/), [Work and money during breast cancer treatment (UK)](https://onco.cc/terms/work-and-money-breast-cancer-uk/), [Work and money with bowel cancer (UK)](https://onco.cc/terms/work-and-money-bowel-cancer-uk/), [Work and money with pancreatic cancer (UK)](https://onco.cc/terms/work-and-money-pancreatic-cancer-uk/)
- cancers: [Adolescent and young adult cancers (ages 15 to 39)](https://onco.cc/cancers/aya-cancers/), [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Burkitt lymphoma](https://onco.cc/cancers/burkitt-lymphoma/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Cutaneous T-cell lymphoma (mycosis fungoides and Sezary syndrome)](https://onco.cc/cancers/cutaneous-t-cell-lymphoma/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)](https://onco.cc/cancers/malt-lymphoma/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Marginal zone lymphoma](https://onco.cc/cancers/marginal-zone-lymphoma/), [Nodal marginal zone lymphoma](https://onco.cc/cancers/nodal-marginal-zone-lymphoma/), [Nodal T-follicular helper cell lymphoma, angioimmunoblastic type (angioimmunoblastic T-cell lymphoma)](https://onco.cc/cancers/angioimmunoblastic-t-cell-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/), [Sezary syndrome](https://onco.cc/cancers/sezary-syndrome/), [Splenic marginal zone lymphoma](https://onco.cc/cancers/splenic-marginal-zone-lymphoma/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Waldenström macroglobulinaemia](https://onco.cc/cancers/waldenstrom/)
- fronts: [Recovery & Rejuvenation](https://onco.cc/fronts/rejuvenation/)
- key papers: [The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient's experience](https://onco.cc/key-papers/paper-zafar-oncologist/)
- ideas: [Bring the oncologist to the local clinic by video and the drug to the local pharmacy](https://onco.cc/ideas/idea-cost-travel-teleoncology/), [Cap what Original Medicare patients pay for Part B cancer drugs](https://onco.cc/ideas/idea-cost-part-b-cap/), [Extend Medicare's inflation rebates to employer plans](https://onco.cc/ideas/idea-cost-inflation-rebates-commercial/), [Federal oral chemotherapy parity for self-funded employer plans](https://onco.cc/ideas/idea-cost-federal-oral-parity/), [Pass 340B discounts on cancer drugs through to the patient's bill](https://onco.cc/ideas/idea-cost-340b-pass-through/), [Pay the same for an infusion whether it is given in a hospital or a clinic](https://onco.cc/ideas/idea-cost-site-neutral-infusion/), [Screen every patient for money trouble the way we screen for pain](https://onco.cc/ideas/idea-cost-financial-toxicity-screening/), [Transparent cost-plus pricing for every oral oncology generic](https://onco.cc/ideas/idea-cost-transparent-generic-pricing/)
- journals: [JCO Oncology Practice](https://onco.cc/journals/jco-oncology-practice/)
- institutions: [National Healthcare Security Administration](https://onco.cc/institutions/nhsa/), [Philippine General Hospital](https://onco.cc/institutions/philippine-general-hospital/)
- collections: [Lazarex Cancer Foundation](https://onco.cc/collections/lazarex-cancer-foundation/)

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