When Costs Eclipse Cure: Does Financial Toxicity Erode Survival Gains from Novel Cancer Therapies?

BACKGROUND. Novel cancer therapies have advanced oncology, but their high costs often lead to significant financial toxicity (FT) in patients, potentially undermining their clinical benefits. This preprint compares the hazard ratio (HR) for improvements in overall survival (OS) from FDA-approved cancer drugs with the OS detriment from FT, estimating the net effects on mortality. METHODS. The OS HRs were meta-analyzed from 234 randomized controlled trials (RCTs) supporting 374 FDA indications (2003–2021), yielding a pooled drug benefit HR of 0.73 (95% CI: 0.72–0.75). FT impacts were obtained from a 1) 2025 meta-analysis and 2) six clinical trials. For both, pooling HRs via random-effects modeling on insurance proxies was determined, as was pooling across the two. Multiplicative modeling assessed net HRs, which were also estimated alongside absolute death estimates in a 1,000-patient cohort (40% baseline mortality) with different prevalences of FT. RESULTS. Novel drugs avert 21 more deaths than standard (older) Tx alone (110 vs. 89), but FT reduces this edge to just 14 (HIC) or erodes it entirely (LMIC, where net gains shrink to <50% of potential). CONCLUSIONS. This analysis reveals that financial toxicity erodes 30–60% of novel therapies' OS benefits, translating to tens of thousands of excess global cancer deaths annually and widening survival inequities, particularly in LMICs (up to a 59% offset). These findings underscore the importance of interdisciplinary collaboration to advance value-based, equitable oncology.