Financial Burden of Drugs Prescribed for Cancer-Associated Symptoms

Arjun Gupta, Leonce Nshuti, Udhayvir S. Grewal, Ramy Sedhom, Devon K. Check, Helen M. Parsons, Anne H. Blaes, Beth A. Virnig, Maryam B. Lustberg, Ishwaria M. Subbiah, Ryan D. Nipp, Sydney M. Dy, Stacie B. Dusetzina

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


PURPOSE: The financial toxicity of anticancer drugs is well-documented, but little is known about the costs of drugs used to manage cancer-associated symptoms.

METHODS: We reviewed relevant guidelines and compiled drugs used to manage seven cancer-associated symptoms (anorexia and cachexia, chemotherapy-induced peripheral neuropathy, constipation, diarrhea, exocrine pancreatic insufficiency, cancer-associated fatigue, and chemotherapy-induced nausea and vomiting). Using GoodRx website, we identified the retail price (cash price at retail pharmacies) and lowest price (discounted, best-case scenario of out-of-pocket costs) for patients without insurance for each drug or formulation for a typical fill. We describe lowest prices here.

RESULTS: For anorexia and cachexia, costs ranged from $5 US dollars (USD; generic olanzapine or mirtazapine tablets) to $1,156 USD (brand-name dronabinol solution) and varied widely by formulation of the same drug or dosage: for olanzapine 5 mg, $5 USD (generic tablet) to $239 USD (brand-name orally disintegrating tablet). For chemotherapy-induced peripheral neuropathy, costs of duloxetine varied from $12 USD (generic) to $529 USD (brand-name). For constipation, the cost of sennosides or polyethylene glycol was <$15 USD, whereas newer agents such as methylnaltrexone were expensive ($1,001 USD). For diarrhea, the cost of generic loperamide or diphenoxylate-atropine tablets was <$15 USD. For exocrine pancreatic insufficiency, only brand-name formulations were available, range of cost, $1,072 USD-$1,514 USD. For cancer-associated fatigue, the cost of generic dexamethasone or dexmethylphenidate was <$15 USD, whereas brand-name modafinil was more costly ($1,284 USD). For a 4-drug nausea and vomiting prophylaxis regimen, costs ranged from $181 USD to $1,430 USD.

CONCLUSION: We highlight the high costs of many symptom control drugs and the wide variation in the costs of these drugs. These findings can guide patient-clinician discussions about cost-effectively managing symptoms, while promoting the use of less expensive formulations when possible.

Original languageEnglish (US)
Pages (from-to)140-147
Number of pages8
JournalJCO Oncology Practice
Issue number2
StatePublished - Feb 1 2022

Bibliographical note

Publisher Copyright:
© 2021 by American Society of Clinical Oncology.


  • Antineoplastic Agents/economics
  • Drug Costs
  • Drugs, Generic/economics
  • Financial Stress
  • Humans
  • Neoplasms/drug therapy
  • Pharmacies

PubMed: MeSH publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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