Cancer care has long been associated with physical, emotional, and psychological hardship. But for many patients, a quieter burden (the financial strain of treatment) shapes their experience in equally profound ways. Increasingly referred to as financial toxicity, this form of distress is emerging as a key determinant of cancer outcomes. Yet it remains under-recognized in day-to-day clinical care.

The high price of staying alive

Financial toxicity describes the economic hardship caused by the cost of cancer treatment. It encompasses not just out-of-pocket medical bills, but also indirect costs such as time off work, transportation, lodging, and child care. For many families, the financial toll begins at diagnosis and continues long after treatment ends.

Research paints a sobering picture. Patients with cancer are more likely than their peers to face debt, bankruptcy, and employment loss. A study published in JAMA Oncology found that over forty percent of cancer patients have depleted their life’s savings within two years of diagnosis, a figure that has likely grown with the rising costs of care and shifts in insurance design.

But the financial burden is not just a side effect; it can directly compromise treatment adherence. Some patients skip appointments or delay filling prescriptions. Others forgo recommended treatments altogether. These decisions, made under financial duress, can alter the trajectory of care.

The hidden cost: lack of transparency

One of the most frustrating aspects of financial toxicity is the unpredictability. Patients often do not know the cost of a scan, a lab test or a chemotherapy drug until after the bill arrives. Cost estimators, when available, are often vague. In many cases, patients feel forced to make life-altering decisions without the information they need to make informed choices. This lack of transparency can lead to shame, silence, and delay in seeking help. Financial stress is frequently internalized even though it is just as deserving of clinical attention as fatigue, pain, or nausea.

Why it is time to talk about money

The good news: Addressing financial toxicity starts with open communication between patients and care teams. Early honest conversations about the potential cost of care can reduce surprises and connect patients with available resources. Financial counselors, patient navigators, and social workers can assist with everything from applying for grants to negotiating payment plans. Yet many patients do not know these supports exist or feel too uncomfortable to ask.

It is time for clinicians to initiate these conversations proactively. Just as physicians routinely assess for side effects and social support, they should ask about financial strain and guide patients to help. When cost concerns are acknowledged and addressed, patients are more likely to complete their treatments and maintain quality of life.

Moving toward a more sustainable cancer care experience

While systemic reforms are needed to make cancer care more affordable and transparent, small shifts at the clinical level can make a meaningful difference today. Viewing financial toxicity as a modifiable risk factor and treating it with the same urgency as other complications could help more patients navigate treatment without sacrificing their financial health. Cancer is hard enough. Managing the costs should not be something patients have to face alone.

Yousuf Zafar is a nationally recognized oncologist, health care executive, and population health researcher with more than 20 years of experience in cancer care, informatics, and value-based delivery. He is a practicing oncologist and adjunct professor at Duke University and chief medical officer at AccessHope, where he focuses on expanding access to expert cancer care knowledge for patients treated in the community. Dr. Zafar is helping to facilitate knowledge-sharing within the oncology community by partnering with National Cancer Institute-Designated Comprehensive Cancer Centers to remotely deliver the latest cancer knowledge to the people and places who need it most: bridging a critical gap for those who do not have access to specialized centers.

Previously, he was senior vice president of medical informatics at Optum and Change Healthcare and held leadership roles at Duke Cancer Institute, where he led development of an AI-driven cancer risk model that reduced readmissions by 50 percent and doubled appropriate hospice referrals.

Dr. Zafar has authored over 100 peer-reviewed publications, which are available on ResearchGate, and has led research funded by the National Institutes of Health and the American Cancer Society. His expertise spans clinical trials, real-world evidence, precision medicine, and health equity.

He is a fellow of the American Society of Clinical Oncology and serves on advisory boards including Health Evolution, the Personalized Medicine Coalition, and WCG IRB. In addition, he is a board member of Family Reach, a nonprofit helping families manage the financial burdens of cancer care. Dr. Zafar also shares professional insights and updates on LinkedIn and X @yzafar.