Financial toxicity: A practical review for gynecologic oncology teams to understand and address patient-level financial burdens.

Financial toxicity describes the adverse impact patients experience from the monetary and time costs of cancer care. The financial burden patients experience comes from substantially increased out-of-pocket spending that often occurs concurrent with reduced income due to sick leave from work. Financial toxicity is common affecting approximately half of patients with a gynecological cancer depending on the validated instrument used for measurement. Financial toxicity is experienced by patients in three domains: economic hardship affecting patients' material conditions (i.e., medical debt), psychological response (i.e., distress), and health-related coping behaviors that patients adopt (i.e., foregoing care due to costs). Higher financial toxicity among cancer patients has been associated with decreased quality of life, impaired adherence to recommended care, and worse overall survival. In this review, we describe the current literature on financial toxicity, including how it can be assessed with validated tools, the downstream impact on patients, risk factors, and employment concerns of survivors. Whenever possible, we highlight data from research featuring patients with gynecologic cancer specifically. We also review studies with interventions aimed to mitigate financial toxicity and offer the reader real world examples of interventions currently being used. Lastly, we provide an overview of health policy developments relevant to financial toxicity and advocate for innovation in the development and implementation of strategies to decrease the financial toxicity patients experience following a diagnosis of gynecologic cancer.
Competing Interests: Declaration of Competing Interest MIL reports the following disclosures unrelated to this work: grant funding from the National Center for Complementary and Integrative Health and National Cancer Institute (U24AT011310). LAM reports the following disclosures unrelated to this work: grant funding from the National Cancer Institute (K07CA201013) and from AstraZeneca, consulting fees from Bristol Myers Squibb as a research participant, advisory board for GSK, leadership on National Cancer Institue PDQ Cancer Screening and Prevention Board, and stock in Invitae, Bristol Myers Squibb, Denali, and Johnson & Johnson. All other authors report no conflicts of interest.
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