Tumours, 1,800 euro a year from patients for treatment and 16% of women leave their jobs

Obstacles in taking care, costs for transport from home to the hospital and extra visits, for drugs and supplements: the picture of financial toxicity taken for Italy by Aiom researchers

by Barbara Gobbi

7 November 2025

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5' min read

Translated by AI

Versione italiana

Key points

The "thermometer"
Death risk at +20%
The "toxicity"
By 2030 more than 4 mln live after diagnosis
The importance of regional networks
Too many cures excluded

5' min read

Translated by AI

Versione italiana

There is the enormous burden of the disease, which weighs on the patient as well as on the caregivers. Then there is the very heavy burden of what is summarised as 'financial toxicity' in oncology, namely the 1,800 euro a year that each person diagnosed with cancer has to face in our country. This is a very high figure which, when unpacked, takes the form of transport costs for visits and examinations in facilities even far from home, outlays for supplements and additional drugs, additional specialist visits, and even psychological support. A dramatic picture that unbalances and even sees entire households reduced to the pavement, in an already complicated condition in which 16% of women and 15% of men with cancer have to give up work following diagnosis.

The financial toxicity that leads to the impoverishment of millions of people and that Italy has tried to counter with avant-garde measures such as the law on oncological oblivion - still to be implemented in large part - is the other side of the coin, unfortunately the darkest, of an evolution that has seen cancer pathology as a whole become chronic, thanks above all to the enormous progress in therapies.

The "thermometer"

A success that, however, has among its 'victims' the household budgets of cancer survivors, as the picture drawn by the world's first tool capable of analysing the causes of financial toxicity, i.e. the financial crisis borne by patients generated by cancer and treatments, reveals. It is called Proffit (Patient Reported Outcome for Fighting Financial Toxicity) and it is a questionnaire that has received longitudinal validation, as highlighted in the study published in the Journal of Cancer Policy, which seals its value as a tool for measuring financial toxicity in a public health system. The study is presented in plenary session at the XXVII National Congress of the Italian Association of Medical Oncology (Aiom) in Rome.

Risk of death at +20%

"We have already shown, in a study of 3,760 citizens with cancer in Italy, that at the time of diagnosis 26% face financial problems and 22.5% worsen this condition during treatment," explains Francesco Perrone, President of Aiom. The latter also have a 20% higher risk of death in the following months and years. The impact of financial toxicity on patient survival in Italy is similar, but with opposite effects, to the benefit induced by some therapies approved by regulatory agencies. We therefore wondered what the causes of the financial difficulties were and why they might also affect patients in a universalistic system such as ours. Hence the Proffit questionnaire, which is available to the scientific community and has already been validated in English for application in the UK. It is useful in all contexts where there is a public health system'.

"In a private system like the US, where insurance covers 80 per cent of the cost of treatment, it is accepted as inevitable that those affected by cancer will face financial problems," says Massimo Di Maio, President-elect of Aiom. In the US, the risk of death for cancer patients who get into financial difficulty and declare bankruptcy is about 80 per cent higher than for those who do not suffer any setbacks in their wallets. A cancer diagnosis can bring entire families to their knees, with enormous direct and indirect costs. This should not be the case in Italy and other countries with universalistic systems, able to guarantee treatment for all'.

The "toxicity"

"Proffit is a questionnaire consisting of 16 statements on which patients are asked to agree or disagree: nine concern the causes of financial difficulties and seven measure their consequences," emphasises Laura Arenare, biostatistician of the Struttura Complessa Sperimentazioni Cliniche at the Istituto Nazionale Tumori Irccs Fondazione Pascale in Naples. "The longitudinal validation of the questionnaire is very important, because it will facilitate its use by the international scientific community. Proffit is able to appropriately estimate levels of financial toxicity, because it allows patients to have a voice in assessing their quality of life, without being influenced by clinicians. Significant territorial differences have also been highlighted, because cancer patients in southern regions face greater financial problems than those in the north'.

In 2030 more than 4 mln live post-diagnosis

In 2024, there were 390,100 new cancer diagnoses in Italy. A positive element, determined above all by progress in therapies, is the steady increase in the number of people living after diagnosis: in 2024 there were approximately 3.7 million and, according to estimates, they will exceed 4 million in 2030. "Half of the people who fall ill today are destined to get well, because they will have the same life expectancy as those who did not develop cancer," continues President Perrone. "This is positive news for patients, but it poses sustainability problems for the system and increased workloads for oncologists. The financial toxicity is not only caused by the loss of income, due to the possible exit from work. The Proffit questionnaires, filled in by patients, reveal causes that can be traced back to three major macro-areas and that can help us counter the phenomenon with wide-ranging actions. The first concerns the ability of the National Health Service to take charge. This aspect can be tackled by making the Regional Oncological Networks, which today are only active in about half of the Regions, truly functional throughout the territory. In this way, they can improve the quality of interaction between the patient and the health workers and the ability of the latter to talk to each other and build a welcoming network in which the patient feels taken care of from the moment of diagnosis'.

The importance of regional networks

"The second macro-area causing financial toxicity is the distance between home and the place of treatment and the resulting transport costs,' explains Massimo Di Maio. 'We do not necessarily mean the extreme cases of health migration from the South to the North. The average distance covered by patients is no more than 25 km, i.e. the distance separating the suburbs from the city centre, but this has to be tackled several times a month. It should be borne in mind that the structures of our healthcare system, especially for complex branches such as oncology, tend to be concentrated in large centres and less on the ground. This is why the Regional Oncology Networks and territorial medicine are the issues to work on'.

Too many cures excluded

'The third macro-area concerns the expenses that the National Health Service does not cover: supplementary drugs, supplements, specialist visits following diagnosis,' explains Elisabetta Iannelli, Secretary FAVO (Italian Federation of Voluntary Associations in Oncology). 'These costs can weigh significantly, especially on the weaker segments of the population. Added to this are the difficulties of work: many patients, particularly the self-employed or those who do not enjoy the protections of salaried employment, see their income drop dramatically at the same time as expenses rise. Cancer does not only entail direct treatment costs, but also indirect costs related to loss of working days, reduced productivity and, in some cases, the impossibility of maintaining professional activity. Our system guarantees access to anti-cancer drugs, but services such as physiotherapy, reconstructive surgery or dental care - necessary for many patients in active treatment - remain excluded. Even basic prostheses and aids, such as wigs or post-operative bras for breast cancer patients, remain the responsibility of patients. Talking about a 'return to life' after cancer also means considering these aspects: loss of income, indirect costs and uncovered expenses. It is on this ground that the institutions must be made aware, because recovery from cancer cannot be separated from the economic sustainability of daily life, otherwise the clinical victory risks becoming a social defeat'.