When someone mentions the word "toxicity" in relation to cancer treatment, they're usually referring to the negative physical side effects and complications that can result from therapies like radiation and chemotherapy. But researchers at the University of Chicago Medicine are raising awareness of another kind of toxicity patients face: financial toxicity , which refers to the stress, expense and instability caused by direct and indirect costs associated with healthcare.
In a recent study , the UChicago researchers looked at the relationship over time between financial toxicity, health-related quality of life, and psychological distress for patients with cancer and found that those facing greater financial toxicity had more psychological distress and lower quality of life.
"This study highlights that no matter where someone is in their cancer journey, financial toxicity remains relevant and can have very real and far-reaching consequences," said lead author Austin Wesevich, MD, MPH, MS , an oncologist at UChicago Medicine. "It isn't something that only emerges or has an impact when someone is first diagnosed; it's something patients carry with them for a long time. We need to do a better job of screening for it, and — importantly — finding ways to do something about it when screening uncovers issues."
Financial pressures create ripple effects
Experts at UChicago Medicine have led conversations about financial toxicity since the concept first gained recognition. The COmprehensive Score for financial Toxicity (COST) questionnaire, which is now the national gold standard patient-reported outcome measure for financial toxicity, was developed and validated at UChicago over a decade ago.
In the most recent study, Wesevich and his collaborators used the COST questionnaire and other rigorous tools to survey over 700 patients across multiple cancer types and treatment stages, circling back repeatedly over the subsequent six months to evaluate their levels of financial toxicity, psychological distress, and health-related quality of life at each time point. They found a significant association between higher financial toxicity and worse emotional and physical well-being.
"Cancer care has both direct and indirect costs, and it all takes a human toll," Wesevich said. "Sometimes the health effects are heartbreakingly obvious, like when we see a patient's cancer relapse after they had to pause or skimp on treatment due to cost or insurance issues. In other cases, the impact on someone's psychological state and health-related quality of life manifests in their inability to pay for healthy groceries, safe living conditions, or medications that would alleviate chronic pain or other conditions."
The researchers also noticed that financial toxicity tended to be higher in the earlier months of the year, which they hypothesize may be related to annual health insurance deductibles.
"I've noticed that my own patients make slightly different decisions about their cancer treatment after their deductible is met for the year, or when it becomes clear that they will meet their deductible that year," Wesevich said.
Can anything be done to address financial toxicity?
As a first step in applying the study's findings, Wesevich said healthcare institutions should incorporate screening for financial toxicity into cancer care on a routine basis, not just when patients are first diagnosed.
"We already do things like screening for depression annually — it would be fairly simple to add a few patient intake questions screening for financial toxicity within the first few months of every calendar year," he said.
The more difficult challenge is offering any solutions to patients who screen positive for financial toxicity. On the ground level, individual hospitals could hire more dedicated financial care navigators and social workers who can help in multiple ways, from explaining complex billing issues to identifying grants and community organizations that could provide financial relief. Wesevich also argues that physicians, like their patients, need to receive more up-front information about billing and treatment costs.
"When you go to a dentist or even a car mechanic, you often get a quote up front of what the work or procedure will cost and what your insurance will cover. But if as your oncologist I prescribe what I think is the best treatment for your cancer, I don't see a price tag in that medical chart," he said. "That opacity makes it very difficult as a physician to support your patients in their financial concerns."
While systemic change is never easy, Wesevich says there have been some positive shifts toward incorporating financial pressures and quality of life into holistic healthcare decision-making — a trend that he and his collaborators hope this recent study and future ones like it can accelerate.
"There's a growing recognition within the pharmaceutical industry and regulatory bodies that if the astronomical cost of a drug lowers patients' quality of life and causes psychological distress, that meaningfully undercuts the healing we're trying to offer patients," Wesevich said.
" Longitudinal Associations Between Financial Toxicity and Health-Related Quality of Life for Patients With Cancer " was published in JCO Oncology Practice in June 2025. Co-authors are Austin Wesevich, Rahul Dadwani, Donald Hedeker, Daniel W. Golden, Rohan R. Katipally, Monica Peek and Vineet Arora.
