Promoting equitable access to financial services to end financial discrimination against cancer survivors in Europe: scientific and ethical reasons

BACKGROUND: Cancer incidence and prevalence of cancer survivors are rising. The European Cancer Information System projects 3.25 million new cases in the EU-27 by 2040 versus 2.74 million in 2022; currently, 23 million people live with a previous cancer diagnosis. Cancer survivors face physical, psychosocial, and economic sequelae. Financial toxicity (FT)-the objective and subjective economic burden of cancer-compromises adherence, quality of life, and survival outcomes. Furthermore, mandatory disclosure of a cancer history when seeking loans or insurance further increases FT. MATERIALS AND METHODS: We carried out a narrative review on FT prevalence, determinants, and interventions, and analyzed national 'right-to-be-forgotten' (RTBF) legislations across EU member states to assess their scientific rationale and economic impact. RESULTS: FT rates ranged from 41% to 48% for objective burden and from 7% to 39% for subjective strain, even in public health care systems. Socioeconomic vulnerability and incomplete social protection were the most consistent drivers of FT. Eleven trials of early financial navigation produced only modest, short-term improvements. Nine EU countries have enacted RTBF legislations. Common eligibility criteria include a minimum remission period (MRP) of 5-10 years for adults, a universal 5-year MRP for pediatric/adolescent cancers, and shorter MRPs (1-3 years) for very-low-risk entities. A significant variability exists between eligibility criteria across countries. Available data from countries where RTBF has been enforced for a longer period show high acceptance rate of survivors' loan insurance applications with acceptable solvency and minimal strain on the insurance system. CONCLUSIONS: FT is a prevalent, preventable aftermath among cancer survivors. Structural frameworks such as RTBF legislation can widen equitable access to credit with no major impact on the insurance market. The European Society for Medical Oncology therefore calls for EU-wide adoption of a unified 5-year MRP for RTBF access and for continuous research on the topic, including development of dynamic risk models to reflect contemporary oncology care while integrating socioeconomic data.