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Financial Toxicity: Time to start grading the financial burden of care?

By Lisa Schulmeister, MN, RN, ACNS-BC, OCN, FAAN
In an “Art of Oncology” column in the Journal of Clinical Oncology, Nandita Khera, MBBS, MPH from the Mayo Clinic in Phoenix, AZ, proposes that financial toxicity is an important effect of cancer treatment that can be as devastating as other adverse medical events. Khera also asserts that agreement on a standardized grading system for financial toxicity would make it easier to compare financial adverse event reporting within studies and across groups and treatment modalities. At a minimum, Khera views a financial toxicity scale as an important first step in communication about the cost of care.

As with other NCI toxicity grading criteria, four grades of financial toxicity are proposed. Grade I is lifestyle modification, defined as deferral of large purchases or reduced spending on vacation or leisure activities because of medical expenditures and/or use of assistance programs to meet the cost of care. Grade 2 is temporary employment loss, selling stocks or using investments to pay for care, and/or use of savings or retirement funds for medical treatment and its costs. Grade 3 is mortgaging or refinancing the home, permanent job loss, and/or inability to pay for necessities such as food and utilities. Grade 4 is the need to sell the home, bankruptcy declaration, stopping treatment, and/or consideration of suicide because of the financial burden of care.

As with other toxicity scales, it’s likely that a patient’s financial toxicity grade may change over time. The proposed scale is measurable and has clearly defined criteria. The next step is to use the scale in practice and begin to measure and document the financial toxicity of cancer treatment. Further information may be found at htttp://
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