Michelle Tregear, PhD, a 16-year breast cancer survivor, serves as the chief programs officer for the National Breast Cancer Coalition (NBCC). Before joining the NBCC, she was a project director and senior researcher at AFYA Inc. and the ECRI Institute, where she directed dozens of federal contracts largely with the Department of Health and Human Services. Tregear holds a Doctorate of Philosophy in Psychology from the University of Colorado, Boulder. She has held postdoctoral fellowships at the University of Colorado, Boulder, Harvard Medical School, and the University of Pennsylvania. Tregear attended the 2025 ASCO Annual Meeting.
Every June, thousands of researchers, oncologists, patient advocates, and health care professionals gather in Chicago for the American Society of Clinical Oncology (ASCO) Annual Meeting. This year, one session struck a deeply personal chord, not because it revealed a breakthrough drug or a promising trial, but because it confronted a hard truth: for many patients, the cost of surviving cancer is financially devastating. This invisible yet deeply harmful burden has a name: financial toxicity.
More Than Just Medical Bills
Financial toxicity isn’t just about big hospital bills. It includes all the costs – medical and nonmedical – that pile up during cancer treatment, as well as indirect costs: lost income from missing work, out-of-pocket expenses for things insurance doesn’t cover, the cost of transportation and child care, even parking fees. And it brings more than economic hardship. There’s emotional trauma, shame, and fear that add to a patient’s suffering.
Alexandru Eniu, MD, PhD, a European oncologist, laid the groundwork by showing just how widespread the problem is. One in three breast cancer patients in high-income countries face financial toxicity. In low-income and middle-income countries, that number jumps to 80%. He called it a “cumulative toxicity” – one that gets worse over time and leads to real harm: treatment abandonment, reduced survival, and bankruptcy.
When the Cure Costs Too Much
Christopher Booth, MD, a Canadian health systems researcher and medical oncologist, turned the spotlight onto oncology itself. He posed a provocative question: Are we, as a field, partly to blame?
He described what he calls the “three buckets” of cancer treatments:
- Red bucket: truly transformative therapies that save or meaningfully extend lives
- Green bucket: treatments with modest but real benefits
- Blue bucket: expensive therapies that offer little to no improvement in survival or quality of life
Too many new treatments, Booth said, land in the blue bucket. Often approved based on surrogate endpoints like tumor shrinkage or progression-free survival, these drugs may not actually help people live longer or better – yet they are still priced in the hundreds of thousands of dollars.
“We need fewer blue-bucket drugs,” Booth said. “And we need to push hard for fair access to the red and green ones.”
Small Changes, Big Impact
Fumiko Chino, MD, a U.S.-based oncologist and financial toxicity researcher, brought the conversation to the clinic level. Her message was both practical and urgent: We can do better for patients – today.
She urged health care systems to implement universal screening for financial distress, integrate financial navigators into cancer clinics, and normalize conversations about cost. Patients, she emphasized, want these discussions – yet only a minority ever have them with their providers.
Her evidence is clear. In one study, more than half of patients who had cost conversations reported they helped reduce expenses – often by switching prescriptions, connecting with aid programs, or adjusting treatment schedules.
She also pointed out how everyday logistics add up: paid parking, lost work hours from poorly timed appointments, or the inability to access telemedicine – all of which could be easily addressed by clinic-level policy changes.
Experience: One Mother’s Wake-Up Call
Molly MacDonald, co-founder of The Pink Fund, closed the session with her personal story and a powerful reminder of what’s at stake. Diagnosed with early-stage breast cancer while raising five children alone, she quickly found herself spiraling into financial ruin. She lost her income, almost lost her home, and faced the gut-wrenching choice between treatment or work.
She founded The Pink Fund to ensure others wouldn’t face the same isolation and hardship. Since 2006, it has provided almost $10 million in direct support to people being treated for breast cancer, covering essentials like rent, car payments, and utilities.
Her organization also asked patients what they needed most. Their responses revealed major gaps in care:
- 58% were never screened for financial stress.
- 68% never received assistance from their care team.
- 83% said they would have preferred providers to initiate the conversation about cost.
- 45% wanted that conversation to happen at diagnosis.
Patients often delay treatment, skip medication, or even live in their cars simply because no one asked them if they needed help.
What You Can Do
Financial toxicity is a side effect that touches almost every person diagnosed with cancer. But it doesn’t have to be inevitable. Whether you’re a patient, caregiver, advocate, or health professional, there are real actions you can take:
- Ask about financial distress – for yourself or your loved ones.
- Support navigator programs and cost transparency initiatives.
- Challenge low-value treatments and call for fair pricing.
- Advocate for policies that prioritize real patient benefit and equitable access.
- Support organizations like The Pink Fund and Common Sense Oncology, which are driving real change.
Cancer is hard enough. No one should have to choose between medicine and mortgage, or treatment and groceries. When that happens, it’s not the patient who’s failed – it’s the system.
Show Sources
Photo Credit: DigitalVision/Getty Images
SOURCES:
ASCO Educational Book 25: “Financial Toxicity and Breast Cancer: Why Does It Matter, Who Is at Risk, and How Do We Intervene?”
