The ripple effect: Cancer-related financial toxicity for family members and caregivers.

Abstract

Globally, the rising costs of cancer care have resulted in "financial toxicity" borne by patients. Financial toxicity includes the direct costs of care, the psychological distress associated with financing care, and harmful coping mechanisms such as omitting medications and treatment due to cost. In this piece, we draw attention to a manifestation of financial toxicity that is often underrecognized and "undertreated," that is, how financial toxicity affects patients' families and primary caregivers. We focus on the context of Southeast Asia, a diverse region of over 650 million people, where there exist common cultural threads in the importance placed on family and filial piety, including in the setting of disease and healthcare-related decision making. We describe how the psychosocial and financial burden of cancer is often shared to a great extent by family members in a region where cancer is often seen as a disease of the whole family. The ripple effects of financial toxicity associated with cancer should broaden providers' purview when treating patients; however, the same ripple effects imply that efforts to mitigate financial toxicity for patients with cancer may greatly benefit their families and caregivers as well. We therefore argue that future work in research, clinical care, and health policy must take a multi-pronged approach to mitigating family financial toxicity, and we suggest steps forward. While we draw attention to family financial toxicity in Southeast Asia, it is important to recognize that financial toxicity of cancer is a global concern and occurs in regions of the world with greater financial resources. Further research is needed to elucidate the complexities of financial toxicity in the context of regional cultures, socioeconomic milieus, and cancer care systems. Critically, work is needed to develop, evaluate, and implement policies and interventions that are responsive to the needs of the most vulnerable. This article is protected by copyright. All rights reserved.