ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer

P M Carrera; G Curigliano; D Santini; L Sharp; R J Chan; M Pisu; F Perrone; S Karjalainen; G Numico; N Cherny; E Winkler; M L Amador; M Fitch; M Lawler; F Meunier; N Khera; G Pentheroudakis; D Trapani; C I Ripamonti

doi:10.1016/j.esmoop.2024.102992

ESMO expert consensus statements on the screening and management of financial toxicity in patients with cancer

ESMO Open. 2024 Apr 15;9(5):102992. doi: 10.1016/j.esmoop.2024.102992. Online ahead of print.

Authors

P M Carrera¹, G Curigliano², D Santini³, L Sharp⁴, R J Chan⁵, M Pisu⁶, F Perrone⁷, S Karjalainen⁸, G Numico⁹, N Cherny¹⁰, E Winkler¹¹, M L Amador¹², M Fitch¹³, M Lawler¹⁴, F Meunier¹⁵, N Khera¹⁶, G Pentheroudakis¹⁷, D Trapani², C I Ripamonti¹⁸

Affiliations

¹ German Cancer Research Center, Heidelberg, Germany; Healtempact: Health/Economic Insights-Impact, Hengelo, The Netherlands. Electronic address: pricivel.carrera@gmail.com.
² European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan.
³ Oncologia Medica A, Policlinico Umberto 1, La Sapienza Università di Roma, Rome, Italy.
⁴ Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
⁵ Caring Futures Institute, Flinders University, Adelaide, Australia.
⁶ University of Alabama in Birmingham, Birmingham, USA.
⁷ National Cancer Institute IRCCS G. Pascale Foundation, Naples, Italy.
⁸ Tampere University, Tampere, Finland.
⁹ Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
¹⁰ Shaare Zedek Medical Center, Jerusalem, Israel.
¹¹ National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and Heidelberg University Hospital, Heidelberg University, Medical Faculty, Department of Medical Oncology, Heidelberg, Germany.
¹² Spanish Association Against Cancer (AECC), Madrid, Spain.
¹³ Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
¹⁴ Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
¹⁵ European Initiative on Ending Discrimination against Cancer Survivors and Belgian Royal Academy of Medicine (ARMB), Brussels, Belgium.
¹⁶ Mayo Clinic, Phoenix, USA.
¹⁷ European Society for Medical Oncology, Lugano, Switzerland.
¹⁸ University of Brescia, Brescia, Italy.

Abstract

Background: Financial toxicity, defined as both the objective financial burden and subjective financial distress from a cancer diagnosis and its treatment, is a topic of interest in the assessment of the quality of life of patients with cancer and their families. Current evidence implicates financial toxicity in psychosocial, economic and other harms, leading to suboptimal cancer outcomes along the entire trajectory of diagnosis, treatment, supportive care, survivorship and palliation. This paper presents the results of a virtual consensus, based on the evidence base to date, on the screening and management of financial toxicity in patients with and beyond cancer organized by the European Society for Medical Oncology (ESMO) in 2022.

Methods: A Delphi panel of 19 experts from 11 countries was convened taking into account multidisciplinarity, diversity in health system contexts and research relevance. The international panel of experts was divided into four working groups (WGs) to address questions relating to distinct thematic areas: patients with cancer at risk of financial toxicity; management of financial toxicity during the initial phase of treatment at the hospital/ambulatory settings; financial toxicity during the continuing phase and at end of life; and financial risk protection for survivors of cancer, and in cancer recurrence. After comprehensively reviewing the literature, statements were developed by the WGs and then presented to the entire panel for further discussion and amendment, and voting.

Results and discussion: A total of 25 evidence-informed consensus statements were developed, which answer 13 questions on financial toxicity. They cover evidence summaries, practice recommendations/guiding statements and policy recommendations relevant across health systems. These consensus statements aim to provide a more comprehensive understanding of financial toxicity and guide clinicians globally in mitigating its impact, emphasizing the importance of further research, best practices and guidelines.

Keywords: assessment tools; cancer; financial toxicity; health insurance coverage; sociodemographic factors; survivorship.

Publication types

Practice Guideline