Financial Toxicity of Cancer: From Hope to Coffin
She came from the remote hills of Jumla with one hope: to live. The journey to Kathmandu took days, filled with faith that Nepal's largest government hospital would offer her a second chance at life. She carried no wealth, no influential connections, only a health insurance card, a few clothes, and the unwavering support of her family. Like thousands of cancer patients from rural Nepal, she believed that reaching the hospital was the hardest part of the battle. She was wrong.
Doctors diagnosed her with advanced throat cancer that had already metastasized. They explained that she urgently needed a thyroidectomy, followed by chemotherapy and radiotherapy if she was to have any chance of survival. Her family listened carefully, determined to do everything possible to save her. However, as the days passed, they realized that surviving cancer required more than medical expertise; it required money they simply did not have.
For four weeks, she remained admitted to the hospital while her family struggled to arrange funds for the surgery. Her husband and relatives slept on hospital floors, benches, and crowded waiting areas because they could not afford accommodation. Every day became a battle against hunger and uncertainty. Sometimes they had enough money for only one plate of food, which two or three family members shared. They skipped meals so they could purchase medicines and investigations not covered by the hospital. While doctors fought the cancer inside her body, her family fought another relentless enemy—poverty.
The Government of Nepal provided NPR 100,000 in financial assistance for cancer treatment, and her local municipality contributed an additional NPR 5,000. These initiatives are invaluable and have helped many patients.
Yet for this family, the support was far from sufficient. The costs of surgery, diagnostic investigations, medicines, transportation, accommodation, food for caregivers, and the anticipated expenses of chemotherapy and radiotherapy quickly exceeded everything they could possibly afford. Every day they asked themselves the same heartbreaking question: "If we cannot even arrange money for today's meal, how will we pay for tomorrow's treatment?"
Gradually, cancer was no longer the family's only burden. Financial hardship became as devastating as the disease itself. The operation was delayed because the necessary funds could not be arranged. As the days turned into weeks, her condition deteriorated. The cancer continued to spread while time slipped away. Eventually, before she could receive the treatment that might have offered hope, she died.
Her death was not solely the consequence of metastatic cancer. It was also the consequence of catastrophic financial hardship. The doctors had the knowledge. The hospital had the expertise. Her family had hope. But hope alone cannot pay hospital bills, provide meals for caregivers, or finance life-saving treatment. Poverty became an invisible yet powerful co-diagnosis that no prescription could cure.
Sadly, her story is not unique. Across low- and middle-income countries, countless cancer patients experience what is known as financial toxicity—the severe financial burden resulting from cancer treatment. Beyond the direct medical expenses, families face transportation costs, accommodation, lost wages, food insecurity, repeated hospital visits, and the emotional distress of choosing between paying for treatment and meeting basic daily needs. For many, cancer is not only a medical crisis but also an economic catastrophe that pushes households deeper into poverty.
No family should have to decide whether to buy food for a caregiver or pay for a life-saving operation. No patient should lose the opportunity to receive treatment because their financial resources are exhausted before their medical options are. Cancer care must extend beyond surgery, chemotherapy, and radiotherapy. It must include financial protection, equitable access to treatment, and comprehensive support systems that ensure no patient's survival depends on the size of their wallet. Because in the end, cancer is difficult enough. No one should have to fight poverty at the same time.
Dinesh Raj Neupane is a Public Health Officer at the Diktel Rupakot Majhuwagadhi Municipality. Co-author Karishma Bhandari is a Public Health Officer at the Nepal Police Hospital.
