Financial Toxicity Among People With Metastatic Breast Cancer

Cancer drugs and treatments are vital for people with metastatic breast cancer (MBC). They help extend and improve quality of life. But they are expensive. Cancer costs can cause serious financial stress for people with cancer and their families, especially those without insurance.¹

What is financial toxicity?

Experts estimate that at least 20 percent of people with cancer suffer serious financial hardship because of their disease. This negative effect that cancer care can have on a person's finances is called financial toxicity.^1,2

What are some metastatic breast cancer costs?

Cancer care costs vary depending on:³

• Your type of cancer
• Where you live
• Your age
• Specific hospital charges

Total cancer care costs can include both medical and non-medical costs. These costs can add up and put a large financial strain on families.⁴

Medical costs

Medical costs to consider when you have MBC may include:⁴

• Cancer treatments, such as hormone therapy, chemotherapy, and immunotherapy
• Medicines, such as pain relief or anti-nausea drugs
• Doctor appointments
• At-home or long-term care and medical support, if needed

Non-medical costs

Non-medical costs for those with MBC may include:⁴

• Parking costs at medical facilities
• Travel costs to and from appointments
• Eating out when you are away from home
• Possible childcare costs
• Loss of wages or job

How does financial toxicity affect people with metastatic breast cancer?

People with MBC are more prone to financial toxicity than people whose cancer has not spread. This is because metastatic cancer care costs are higher than early-stage cancer care costs. Treatment for MBC is expensive, and it can last for years.^2,5

The signs of financial toxicity vary, but they may include:⁶

• Difficulty paying medical expenses
• Increased debt and filing for bankruptcy
• Problems at work
• Changes in lifestyle
• Emotional distress

A study of advanced cancer and financial distress found that:²

• Nearly one-third of people with advanced cancer used most or all of their savings to pay for treatments.
• People with advanced cancer had a higher risk of job and income loss compared to those with lower-stage breast cancer.
• People with advanced cancer who had high financial distress also had higher rates of anxiety and depression.

Ethnicity, income, and financial toxicity

Studies have shown that financial toxicity is more common among certain racial groups. Income status can also affect a person's risk of developing financial distress from cancer care. People diagnosed with advanced cancers often come from uninsured, low-income, and non-white backgrounds.^2,5

When it comes to breast cancer, Black women:^7,8

• Are more likely to develop more aggressive and advanced-stage cancer than white women
• Are more likely to have a lower income than white women
• Have higher rates of both Medicaid and no insurance
• Experience a worse financial impact than white women

For people with low incomes, it can be especially hard to afford cancer costs. These people tend to work in jobs with not only lower pay but less flexibility and fewer healthcare benefits.^2,5

Quality of life and financial toxicity

High financial distress is linked to a lower quality of life as well as more symptoms and pain. This could be partly because people experiencing financial strain have to cut spending on social and leisure activities. They also have higher rates of anxiety and depression.⁶

A survey of women with MBC found:²

• Nearly 70 percent were worried about financial problems due to cancer care.
• Almost half reported high cost-related emotional stress.
• Over 30 percent were worried about the financial stress on their families.

What can you do about financial toxicity?

Tell your healthcare team if your cancer care is creating financial hardship. They need to know if the costs of your cancer care are hurting you. Hospital social workers should be able to help you find resources and understand your health insurance coverage.³

You can also speak to the billing office at your hospital. They may have options to make payment easier, such as: ³

• Payment plans
• Reduced rates
• Patient assistance
• Help from charities

Finally, several organizations provide emotional, practical, and financial support for people with cancer. You can find a list of them on the National Cancer Institute website.