Financial Toxicity: A Side Effect of Radiation Therapy for Cancer?

The field of oncology is ever-changing, as new treatment options become available and treatment plans are unceasingly optimized. While the US remains at the forefront of medical innovation and treatment options for serious and complex conditions such as cancer, costs for cancer care are extremely high and continue to increase. Modern healthcare does not come without a price, and medical expenses can have a profound economic impact on American households. Nearly half of bankruptcy filings are in some way a result of medical expenses. While recent healthcare initiatives have increased access to care, many remain underinsured while facing increasing copayments and deductibles. For many, the out of pocket (OOP) cost for treatment represents a significant portion of their income. Such a large and often unanticipated financial burden not only contributes to non-adherence to medications, but also reduced spending on essentials such as food and clothing. Cancer patients, because of the complexity of care and high cost of treatment are especially sensitive, with an estimated 20-50% of oncology patients facing difficulty in paying medical bills. The American Society for Clinical Oncology (ASCO) has recognized the runaway cost of cancer care and has developed a Cost of Care task force to address patient financial well-being. While ASCO is at the forefront of the much needed movement, their impact has been limited. Surprisingly, many physicians are unaware that the task force even exists. The cost of care and financial burden for radiation oncology patients is largely unknown. The use of radiation therapy for treatment, either as stand-alone therapy or part of a multimodal approach, is efficacious for many different types of cancer. In fact, radiation therapy is an important treatment modality for many of the most common cancer types, including prostate, breast, and lung. To date, there are no studies addressing OOP cost or other forms of financial burden and its sequelae on patients who received radiation therapy as a part of their cancertreatment. Likewise, there are no financial toxicity tools validated for use in radiation oncology. Given the large role radiation therapy plays in modern cancer treatment, it is important for the field to develop and utilize financial toxicity tools. We hypothesize that radiation oncologists do not routinely screen for financial toxicity, and that a significant percentage of patients encounter financial burden as a result of radiation treatment. Here, we aim to identify demographic trends in patients facing financial burden, as well as gauge physician understanding of treatment costs and their willingness to adopt use of financial toxicity tools. Strategically developed physician surveys and post-treatment patient surveys will be used, utilizing a prospective, non-interventional observational study approach. This is an ongoing study as of April 2016, which we are optimistic will reveal much needed information on the financial toxicity of radiation therapy. Preliminary data will be presented, showing some intriguing trends in both the physician and patient surveys