Financial Toxicity in Europe

As a phenomenon in the contemporary treatment and care of people with cancer, financial toxicity is not fully understood, and in Europe not widely recognized as a problem since patients are generally protected from catastrophic medical expenditures. Defined as the objective financial burden and subjective financial distress of patients with cancer, as a result of treatments using innovative drugs and concomitant health services, financial toxicity is, nonetheless, a challenge in Europe. The exposure to objective financial burden, if not due to direct medical costs, direct non-medical costs may be widely different to patient groups within countries, and patients across health systems but subjective financial distress may be equally high. In this paper, I discuss the nature of financial toxicity including coping by patients and how maladaptive coping leads to poor health and non-health outcomes. I also illustrate how selected health systems collectivize and assuming the bulk of costs of cancer treatment resulting to very low out-of-pocket expenditures for patients and their (potentially) unintended consequences. Given population aging, the burden of disease and high price of newer classes of therapies, dealing with financial toxicity in Europe is relevant to and imperative for patients, practitioners and policy-makers.