We don't travel; we don't do anything now because it's a dollar100,000 illness. And it sucks, What are you going to do? Caught between a rock and a hard spot." A 67-year-old, insured woman with metastatic breast cancer-let's call her "Janet"-recently described how her life changed due to costs of cancer care. We all hear about the cost of care at every turn; healthcare reform is at the forefront of the national debate. The debate is carried on in medical journals, which are flooded by editorial pieces on how to bend the cost curve. Indeed, this journal has recently published commentaries on the rising cost of cancer treat-mental] healthcare financing,[2] and the value of care.[3] But where in this mix is Janet? Buried somewhere in the sheaves of dire projections and cost trends, her daily experience with the cost of cancer treatment is lost. However, Janet's experience does not fall on deaf ears. Oncologists who treat patients daily listen to similar life-altering, cost-related complaints, along with reports of fatigue, nausea, and pain. However, to date most of us have not considered financial distress in the same vein as chemotherapy-induced tox-icity, nor do we have the training to alleviate that distress. In this, the first part of a two-part series, we will describe the patient-level impact of the cost of cancer care, what we call "financial toxicity." In Part II we will consider potential interventions to alleviate financial toxicity.
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