Introduction
Financial toxicity is defined as the objective and subjective
patient-level impact of the costs of cancer care and can afflict even
those with health insurance.1 It is linked to
decreased health-related quality of life (HRQOL), and increased symptom
burden, emotional distress, and mortality.2-8 In the
context of coronavirus disease 2019 (COVID-19), cancer survivors
(defined as such from the time of diagnosis) represent a particularly
vulnerable population that may be disproportionately affected by
financial burdens surrounding the pandemic. Cancer survivors already
spend more out-of-pocket (OOP) for medical care than patients with other
chronic illnesses.9 This is a pervasive pattern that
persists many years after diagnosis and completion of
treatment.8,9
Since December 2019, the pandemic has spread
rapidly,10,11 propagating economic disruption globally
and, in many cases, overwhelming healthcare
resources.12 Necessary physical distancing measures
have been established around the world to attenuate the propagation of
the virus, resulting in significant consequences for most businesses and
workers.13,14,15 Patients with cancer may take a
“double hit” from both costs of cancer care and financial strains
imposed by the pandemic related to 1) prolonged unemployment for both
cancer survivors and their caregivers; 2) the possibility of additional
disease burden from treatment delay or interruptions; and 3) increased
risk of COVID-19 infection (and its resulting health consequences). As
such, cancer survivors require particular consideration as we consider
the financial consequences and related subjective distress surrounding
COVID-19.