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.