Introduction

The financial cost of cancer creates a significant burden and negatively impacts many people in Australia. This burden disproportionately affects socioeconomically disadvantaged populations, promoting inequity in healthcare access. However, the financial burden from cancer can affect anyone and at any time.^{1, 2} Living in a country with universal healthcare and a publicly-funded social security system, Australians affected by cancer should not be financially ruined, receive sub-optimal care or be unable to obtain healthcare because of the financial impact of cancer.

Financial toxicity is the negative patient-level impact of the financial costs of cancer. Illustrated in Figure 1, it is the combined impact of direct out-of-pocket costs for medical treatment, indirect costs such as accommodation and travel costs (especially for people living in regional, rural and remote areas), and the changing financial circumstances of an individual and their household resulting in loss of income due to cancer. These financial burdens can cause both physical and psychological harms, affecting decisions which can lead to suboptimal cancer outcomes.³ Financial toxicity includes both the objective financial burden of cancer and the subjective financial distress experienced as a result of a cancer diagnosis.⁴

Figure 1. Financial toxicity in cancer care.³

Out-of-pocket costs can vary significantly depending on individual circumstances – they may be low or high, once-off or frequent, and can accumulate over time. The impact of out-of-pocket costs can be exacerbated by loss of income due to changes in work capacity following a cancer diagnosis, which affects the broader family and household alongside the person with cancer.⁵ This can influence decisions affecting the care received, contributing to delays to acting on symptoms, completing a referral or even foregoing recommended treatment, testing, or care.^{6, 7} Similarly, the effect of long-term financial instability that may arise from drawing upon savings, increasing credit, and accessing superannuation early to pay for medical and daily living expenses, can leave families in poor financial positions long after treatment has been completed.⁸

All Australians affected by cancer should be adequately supported to make informed choices about their cancer treatment and healthcare. However, some people feel they have no choice about where they receive care or how much they must pay. Many Australians believe that all expenses related to their cancer treatment and care will be covered by their private health insurance or the public healthcare system, only to realise as treatment progresses that this is not the case.⁷ This can lead to significant financial burden and stress in addition to the emotional, physical, and practical challenges of experiencing cancer treatment.⁷

Government healthcare funding decisions and policy settings to reduce the financial, mental and emotional burden for people affected by cancer can influence demand for social welfare services such as income support.⁹ Thus, effectively addressing the financial costs of cancer will deliver benefits beyond the immediate outcomes for people affected by cancer, benefiting the broader Australian society.¹⁰ 

While this section is focused on the financial cost of cancer, not all costs related to a cancer diagnosis are financial. Cancer can have a long-lasting social and emotional impact on the people affected by cancer, and the broader Australian community. The ability to work, progress a career, maintain stable social and family relationships, and be present for life milestones are immediate human challenges that people with cancer face. In addition, these challenges can continue into survivorship.⁹