Introduction

The financial cost of cancer creates a significant burden and negatively impacts many people in Australia. This burden disproportionately affects socioeconomically disadvantaged populations creating healthcare inequity. The financial burden of cancer can affect anyone 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, due to cost.

Financial toxicity is the negative patient-level impact of direct out-of-pocket costs for medical treatment, indirect costs, such as accommodation and travel (especially for people living in regional, rural, and remote areas), or a change in financial circumstances due to the impact of cancer care (Figure 1). Financial toxicity can cause both physical and psychological harm, and affect decision-making leading to suboptimal cancer outcomes.³ This can occur as a result of both the objective financial burden of cancer and 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 depending on an individual’s circumstances – they may be low or high, once-off or frequent, and can accumulate over time. The impact of these costs may be exacerbated by a loss of income due to a change in capacity to work following a cancer diagnosis, which impacts household finances.⁵ This can influence an individual’s decisions affecting their care, including delaying acting on symptoms, completing a referral, or foregoing recommended treatment, testing, or care.^{6, 7} It can also lead to long-term financial instability, resulting from drawing upon savings, increasing credit, or accessing superannuation to pay for medical and daily living expenses, which can result in a poorer financial position even after treatment has been completed.⁸

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

Government healthcare funding decisions and policies aimed at reducing the financial burden of cancer care may influence demand for social welfare services, such as income support,⁹ delivering benefits beyond the immediate outcomes for people affected by cancer for the broader Australian society.¹⁰

Although this section is focused on the financial cost of cancer, not all costs related to cancer are financial. Cancer can have a long-lasting social and emotional impact not only on the people affected but also on the broader Australian community. The ability to work, progress a career, maintain stable social and family relationships, and be present for life milestones, are challenges that people with cancer may face and continue to experience during survivorship.⁹