When Zafar et al¹ first coined the term “financial toxicity” more than a decade ago, they introduced a profound conceptual shift—reframing the economic hardship associated with cancer care not as a regrettable but separate consequence of treatment, but as a clinical toxicity worthy of the same attention as neutropenia or neuropathy. Yet, despite widespread recognition of this issue, most interventions have remained focused on individual patient support rather than system-level solutions. The Financial Toxicity Tumor Board (FTTB) model described by Knight et al² represents a significant evolution in this landscape—a mature, institutional approach to treating financial burden with the same rigor and multidisciplinary consideration we apply to clinical decision-making.³

The FTTB model draws its strength from recognizing financial toxicity as a true side effect of treatment requiring clinical attention rather than merely an administrative issue. Just as we would never expect a patient experiencing severe physical toxicities to navigate those challenges alone with only a phone number for support services, the FTTB acknowledges that financial challenges demand integrated, team-based solutions involving both clinical and administrative stakeholders working in concert. This approach resonates with the original framing of financial toxicity and elevates institutional responsibility for addressing it.

Perhaps the most insightful evolution in the FTTB model was the pivot to disease-focused meetings. This seemingly administrative change reveals a deeper understanding of how financial concerns are inextricably linked to treatment decisions and disease management. By structuring financial toxicity discussions around disease areas, the team improved engagement, diversified case presentations, and brought new voices into the conversation. This approach naturally embeds financial considerations within the clinical decision-making framework rather than treating them as separate issues to be handled elsewhere. The resulting 94% resolution rate speaks to the effectiveness of this integrated approach.

The comprehensive nature of the FTTB model is equally noteworthy. Previous approaches to financial toxicity have often targeted specific aspects of the problem—medication assistance, insurance navigation, or payment plans.⁴ The 3-archetype system developed by Knight’s team (Immediate Assistance Required, System-Level Issue Identified, and Policy/Legislative Issue Identified) acknowledges the multidimensional nature of financial toxicity and prevents patients from falling through the cracks of fragmented support systems.² Particularly significant is the policy/legislative Issue archetype, which recognizes that many financial challenges stem directly from health care financing structures, market-based dynamics, and policy fragmentation in the US health care system.⁵ By creating a formal mechanism to identify and address these policy-level issues, the FTTB establishes an environment ripe for accelerating systemic change beyond individual institutions. This approach acknowledges what many have long recognized: true resolution of financial toxicity will ultimately require policy reform at state and federal levels. The FTTB model creates a structured pathway to document these policy gaps, formulate evidence-based solutions, and potentially influence legislative action through coordinated advocacy—transforming frontline clinical experiences into catalysts for broader health care reform.

The FTTB model fundamentally reorients our understanding of who experiences financial toxicity. Unlike traditional approaches that often implicitly target assistance based on assumptions about who might need help,⁶ this model recognizes financial toxicity as a systemic problem affecting patients across all insurance types and socioeconomic backgrounds. High deductibles, coverage limitations, network restrictions, and unexpected out-of-network costs create financial vulnerability regardless of income or insurance status. By embedding financial discussion into the clinical workflow for all patients through disease-focused tumor boards, the FTTB avoids the problematic assumption that only certain groups will face financial challenges. This universal approach acknowledges that anyone can experience financial toxicity—from the underinsured hourly worker to the well-insured executive with supposedly “good coverage.” The standardized process ensures all patients receive appropriate financial assessment and intervention as part of routine cancer care, not as a separate service requiring self-identification or referral.

The patient experience of financial toxicity extends well beyond numerical calculations of costs and benefits. Research consistently demonstrates the profound psychological impact of treatment-related financial distress, including anxiety, depression, and decreased quality of life.⁷ Patients report making medical decisions based on cost rather than clinical factors—cutting pills, skipping appointments, or depleting savings meant for their children’s education.⁸ By integrating financial concerns into clinical discussions, the FTTB model helps preserve patient dignity by treating these issues as legitimate medical concerns rather than personal failings or separate administrative matters. This approach recognizes that financial distress affects treatment outcomes and patient well-being as directly as physical side effects. When financial toxicity becomes a normal, expected topic within clinical settings, patients may feel less shame and isolation regarding these concerns, potentially improving disclosure of financial hardship and earlier intervention before financial devastation occurs.

Breaking down institutional silos represents another significant strength of this model. Health care systems are notoriously compartmentalized, with different departments operating in separate domains with distinct priorities and communication channels. The FTTB bridges these divides by bringing stakeholders together with decision-making authority—a crucial detail that transforms the board from a discussion forum into an action-oriented intervention. As health care becomes increasingly complex and specialized, models that successfully bridge these divides offer valuable lessons beyond the realm of financial toxicity.

Indeed, the potential applications of this approach extend far beyond cancer care. Across health care, patients face similar financial challenges related to chronic disease management, specialty pharmaceuticals, complex surgical procedures, and high-deductible insurance plans. The FTTB model could be adapted for conditions such as Alzheimer disease and related dementias, rheumatoid arthritis, diabetes, or end-stage renal disease—all characterized by high costs, complex treatments, and significant financial burden. Even primary care practices could implement modified versions focusing on chronic disease management and preventive care barriers.

Implementation of such models is not without challenges. The robust resources of a large academic cancer center may not be available in all settings. However, the core principles—multidisciplinary collaboration, decision-making authority, and structured follow-up—can be adapted to various contexts. Smaller institutions might begin with monthly rather than weekly meetings, focus on high-impact disease areas, or combine resources across departments. The archetype framework provides a useful starting point that can be tailored to local needs and resources.

Future research should examine patient-reported outcomes associated with this intervention. Although financial metrics are impressive—more than $392 million in medication assistance alone—we should also measure impacts on treatment adherence, quality of life, and psychological distress. Additionally, comparative effectiveness studies could help identify which components of the model drive the greatest benefits, allowing for more efficient implementation in resource-constrained settings.

As health care costs continue to increase and insurance benefits become increasingly complex, financial toxicity will likely worsen across the health care spectrum. The FTTB model offers a template for addressing these challenges in a manner that recognizes their clinical importance and system-level origins. By treating financial toxicity as a true side effect requiring coordinated intervention rather than an unfortunate but separate consequence of care, institutions can fulfill their commitment to comprehensive patient support.

Knight et al¹ have provided not just a description of their program but a roadmap for implementation. Health care leaders across specialties should consider how this approach might be adapted to address financial barriers in their own contexts. The FTTB demonstrates that with structured, collaborative effort, health care systems can mitigate the financial burden of treatment while creating more equitable access to care—a goal worthy of the same institutional commitment we give to clinical excellence.