Malignant Financial Toxicity
The Cancer Conversation to Have Before Crisis Hits
Sarah thought she was prepared. She had health insurance. She’d read the treatment plan. She knew cancer would be hard.
What she didn’t know was that managing her cancer would cost her nearly everything she’d saved.
The Cost Nobody Talks About
Studies show that 3 out of 4 people with cancer worry about how they will pay for cancer treatment and keep up with their day-to-day costs. But most people don’t discover this reality until they’re drowning in it.
“Financial toxicity is a big issue in people diagnosed with cancer. It’s a real thing,” says Dr. Lise Alschuler, naturopathic oncologist and breast cancer survivor. “I mean, I’ve seen patients who have burned through their insurance, some conventional treatment, and they’re now facing huge medical bills.”
The term “financial toxicity” isn’t metaphorical. Financial toxicity describes problems a patient has related to the cost of medical care, and several studies show that people with cancer and survivors are more likely to have financial toxicity than people without cancer.
And it happens on both sides of the treatment equation—conventional and integrative.
Why Cancer Costs Spiral
By one 2020 estimate, the average cost of medical care and drugs is more than $42,000 in the year following a cancer diagnosis. But that’s just the beginning.
Up to 85% of cancer patients leave the workforce during their initial treatment, and more than 40% of patients spend their entire life savings in the first two years of treatment.
Let that sink in: More than 40% spend their entire life savings in two years.
You’re not just facing higher expenses—you’re likely facing reduced or eliminated income. About 75 percent of cancer patients require extended time off or a reduction in work, creating substantial financial strain, especially if there are no disability benefits or sufficient savings.
Then come the expenses you never anticipated:
Transportation to appointments (especially if you’re traveling for specialized care)
Parking fees that add up over dozens of visits
Childcare when you’re too sick to parent
Home care assistance
Specialized dietary needs
The supplements and integrative therapies insurance doesn’t cover
“I’ve also seen patients who are spending an exorbitant amount on supplements and IV treatments, and maybe even trips to specialized clinics in Europe,” Dr. Alschuler says. “They’re just racking up debt to a point where it’s really toxic for them.”
The Health Consequences of Financial Stress
The cruel irony: financial toxicity makes your cancer outcomes worse.
Over a quarter of cancer patients delay medical care, go without care, or make changes in their cancer treatment because of cost. To afford their cancer treatments, many patients cut back on food, utilities, and other necessities.
In one study, cancer patients who declared bankruptcy—particularly those with common colon and prostate cancer—had a nearly 80% greater mortality risk than those who did not. Importantly, the higher mortality was not because the patients with financial toxicity had more advanced cancers—they had the same curable cancers and received the same treatments.
The same cancers. The same treatments. But financial stress nearly doubled their mortality risk.
A systematic review of 74 studies found that 49% of cancer patients experience some form of financial burden, rivaling the frequency of common clinical toxicities like cardiotoxicity and peripheral neuropathy from cancer therapies.
Have the Money Conversation Early
Dr. Alschuler’s advice is clear: “I think it’s important to just be mindful about if you’re at risk for experiencing that, open up the conversation with your provider or integrative provider and let them know that you are at a point where the cost of treatment is becoming problematic.”
Don’t wait until you’re in crisis. Don’t suffer in shame.
Talk to your oncologist’s financial navigator or social worker BEFORE you start treatment. They can help you:
Understand your insurance coverage and limitations
Identify financial assistance programs
Plan for income changes
Access transportation and lodging support
Find community resources
For integrative care, Dr. Alschuler uses a helpful metaphor: “Maybe you are gonna have to get the compact car, which will still get you where you need to go, just not gonna be as easy and as luxurious as the luxury vehicle.”
In other words: there are always ways to scale back while still providing benefit.
“I guarantee [providers will] have ways to scale it back and still provide you with a lot of benefit,” she says. “There’s options.”
The Compact Car vs. Luxury Vehicle Approach
When a patient tells Dr. Alschuler they’re hitting their financial limit, she doesn’t abandon them. She gets creative:
Maybe you can’t afford the full supplement protocol, but these three are the most important
Maybe you can’t do weekly IV vitamin C, but monthly might still help
Maybe you can’t see a naturopathic oncologist regularly, but a consultation every few months could guide your oncologist
Maybe you focus on the free interventions: stress management, walking, sleep optimization, and community support groups
“Even if you can’t afford all the bells and whistles, there are core interventions that matter most,” she explains. “And those might be within reach.”
Who’s at Highest Risk?
Patients with the following have higher risk of financial toxicity: younger age at diagnosis (people younger than 65 years are not eligible for Medicare), not having health insurance or having high-deductible health insurance plans, belonging to racial and ethnic minority groups, and being from lower-income households.
If you’re under 65, you’re particularly vulnerable. Treatment costs are higher for younger patients, potentially because their treatment regimens tend to be more aggressive. For example, average stage IV breast cancer costs for patients 18-64 years old were approximately $190,000, whereas costs were approximately $120,000 for patients 65 and older.
What You Can Do Right Now
Before treatment starts:
Meet with a financial counselor or navigator through your cancer center
Calculate your financial breaking point (check out the financial calculator at joellekaufman.com)
Understand your insurance - deductibles, out-of-pocket maximums, coverage limitations
Research financial assistance programs for your specific cancer type
Talk to your employer about FMLA, disability benefits, flexible work arrangements
During treatment:
Track all expenses - medical and non-medical
Ask about patient assistance programs for expensive drugs
Tell your integrative providers your budget limits - they can adjust
Look for clinical trials - often cover treatment costs
Connect with nonprofit organizations specific to your cancer type
If you’re already in financial crisis:
Contact your hospital’s financial assistance department immediately
Reach out to organizations like CancerCare, Patient Advocate Foundation, or HealthWell Foundation
Consider negotiating medical bills or setting up payment plans
Talk to a financial counselor about protecting assets
The Conversation Your Doctor Wants to Have
Cost concerns are prevalent among cancer patients, but evidence suggests they are not frequently addressed. In one survey, 47% of patients reported high financial stress, but 71% reported that they rarely had discussions of cost with their providers.
Your doctors want to help. But they can’t help if they don’t know.
“This is an issue that’s really all about the person diagnosed, but also their family members, their caregivers,” Dr. Alschuler acknowledges. Cancer doesn’t just affect you financially—it affects everyone trying to support you.
Bottom line: Financial toxicity is as real as chemotherapy side effects, and potentially more dangerous to your survival. Have the money conversation early. Ask for help before you need it desperately. Scale back integrative protocols if needed. Protect your financial health as fiercely as you’re fighting your cancer.
Because surviving cancer only matters if you can also survive the aftermath.
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