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Cancer. 2018 Sep 15;124(18):3668-3676. doi: 10.1002/cncr.31532. Epub 2018 Jul 23.

Unmet need for clinician engagement regarding financial toxicity after diagnosis of breast cancer.

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Department of Radiation Oncology, Center for Bioethics and Social Science in Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
Department of Medicine, Stanford University, Stanford, California.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.
Ann Arbor VA Center of Excellence in Health Services Research and Development, Ann Arbor, Michigan.



Little is known regarding whether growing awareness of the financial toxicity of a cancer diagnosis and its treatment has increased clinician engagement or changed the needs of current patients.


The authors surveyed patients with early-stage breast cancer who were identified through population-based sampling from 2 Surveillance, Epidemiology, and End Results (SEER) regions and their physicians. The authors described responses from approximately 73% of surgeons (370 surgeons), 61% of medical oncologists (306 medical oncologists), 67% of radiation oncologists (169 radiation oncologists), and 68% of patients (2502 patients).


Approximately one-half (50.9%) of responding medical oncologists reported that someone in their practice often or always discusses financial burden with patients, as did 15.6% of surgeons and 43.2% of radiation oncologists. Patients indicated that financial toxicity remains common: 21.5% of white patients and 22.5% of Asian patients had to cut down spending on food, as did 45.2% of black and 35.8% of Latina patients. Many patients desired to talk to providers about the financial impact of cancer (15.2% of whites, 31.1% of blacks, 30.3% of Latinas, and 25.4% of Asians). Unmet patient needs for engagement with physicians about financial concerns were common. Of 945 women who worried about finances, 679 (72.8%) indicated that physicians and their staff did not help. Of 523 women who desired to talk to providers regarding the impact of breast cancer on employment or finances, 283 (55.4%) reported no relevant discussion.


Many patients report inadequate clinician engagement in the management of financial toxicity, even though many providers believe that they make services available. Clinician assessment and communication regarding financial toxicity must improve; cure at the cost of financial ruin is unacceptable. Cancer 2018;000:000-000. © 2018 American Cancer Society.


breast cancer; cost; finances; financial toxicity; patient-provider communication

[Available on 2019-09-15]

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