Financial Toxicity in Cancer Care: Why the Conversation Must Start Before Treatment Begins

The financial aspect of cancer care deeply affects the patient’s experience economically, physically, and psychologically. Patients experience financial stress and anxiety as they navigate treatment decisions and adherence. This financial burden often leads to diminished trust in the healthcare system and communication barriers.

One study found that nearly half of cancer patients report some level of financial hardship, ranging from depleting savings to accumulating debt or being unable to pay for basic needs.¹ Additionally, a Survivor Views survey from the American Cancer Society Cancer Action Network revealed that a majority of patients and survivors were unprepared for the costs of their care—both in terms of their ability to pay for it (54%) and in what they expected it would cost (64%).²

How Addressing Costs Before Treatment Improves Patient Experience

Proactive financial discussions before treatment build trust and reduce patient anxiety. Patients are more likely to adhere to treatment plans when they know the costs up front. Early conversations about costs increase patient satisfaction and help patients feel seen and supported as individuals rather than defined solely by their diagnosis.

Cancer treatment is among the most expensive medical care types. Even with insurance, patients often find their plans do not cover all expenses, leaving gaps such as uncovered medications, treatment limitations, and restrictions on care locations. Breakthrough therapies frequently require prior authorization, which can delay approval or result in denial. Surprise billing for labs, imaging, or specialists not in network further compounds the financial burden.

Recurring costs for appointments, maintenance therapies, and follow-up scans accumulate quickly, overwhelming patients. Additional expenses, such as travel, lodging, and lost income, create further financial strain.

Building Effective Communication

Patients and their families are often overwhelmed by medical terms and insurance jargon. Clear, simple language helps patients understand what to expect. Breaking down information into manageable steps ensures patients can process details and make informed decisions. Asking whether patients need information repeated or explained further promotes understanding. Visual or written materials can also aid in comprehension.

Active listening is critical in financial discussions. Giving patients full attention and responding empathetically helps build trust and ensures their concerns are heard.³ Care providers should avoid interrupting and instead reflect on what the patient has shared. Reassurance or solutions offered prematurely can frustrate patients, making them feel as though they are not coping adequately.³

Normalizing financial conversations is essential. Patients may feel embarrassed or uncomfortable discussing money, fearing it could impact their care. Oncology teams should remove this fear by making cost discussions a routine part of patient-centered care. Early financial conversations can prevent crises later.

Red Flags of Financial Distress

Recognizing signs of financial distress in cancer patients can enable timely intervention, support treatment adherence, and improve patient outcomes. Common red flags include:

• Missed or canceled appointments
• Delays in filling prescriptions or nonadherence to medications
• Avoidance of financial discussions
• Visible anxiety related to finances
• Lack of insurance or high-deductible plans
• Frequent job absences or job loss
• Repeated billing complaints
• Multiple referrals for financial counseling
• Technology and Transparency

Technology can improve financial transparency and support patients in navigating costs. Digital tools, such as cost estimators and real-time benefit applications, allow staff to calculate out-of-pocket expenses based on patients’ insurance coverage, deductibles, and formulary data.

Patient portals provide patients with access to personal health records, appointment details, test results, educational content, and financial information. Clear printed summaries of bills can reduce confusion and frustration. Oncology billing is complex, often involving multiple providers, services, and codes. Patients benefit from explanations of terms such as coinsurance and noncovered services, as well as detailed highlights of reimbursed amounts, outstanding balances, and patient responsibilities.

Creating a Culture of Openness

Leadership plays a vital role in establishing a culture of openness around financial discussions. Leaders should model transparency, empathy, and proactive communication, reinforcing the importance of cost conversations as a standard component of patient care.

Staff should initiate financial discussions before treatment begins and continue them throughout the patient’s cancer journey, ensuring barriers to care are minimized.⁴

Summary

Cancer care costs are emotionally and financially draining for patients and their families. The entire care team must recognize their role in addressing financial concerns and connecting patients to appropriate resources. Early intervention and ongoing support can reduce the burden of financial toxicity and improve overall patient satisfaction and outcomes.⁴

References

1. AccessHope. Financial Toxicity and Cancer: What You Need to Know and How to Get Help. July 1, 2025. Accessed March 25, 2026. www.myaccesshope.org/blog/financial-toxicity-and-cancer
2. American Cancer Society Cancer Action Network. Survey: Half of Cancer Patients and Survivors Report Incurring Cancer-Related Medical Debt; Over 70% Are Worried About Affording Care. March 17, 2022. Accessed March 26, 2026. www.fightcancer.org/releases/survey-half-cancer-patients-and-survivors-report-incurring-cancer-related-medical-debt-over
3. Murray K. Active listening: 10 tips to support someone with health issues. British Heart Foundation. March 17, 2025. Accessed March 25, 2026. www.bhf.org.uk/informationsupport/heart-matters-magazine/wellbeing/how-to-talk-about-health-problems/active-listening
4. National Cancer Institute. Financial Toxicity and Cancer Treatment (PDQ)–Health Professional Version. 2022. Accessed March 26, 2026. www.cancer.gov/about-cancer/managing-care/track-care-costs/financial-toxicity-hp-pdq