Today, the risk of experiencing financial difficulty after being diagnosed with cancer is no longer limited to the uninsured. The rapid rise in the cost of treating cancer, combined with health insurers’ increasing use of cost-sharing for covered services, is dramatically increasing the out-of-pocket costs faced by cancer patients and their families. The term “financial toxicity” has emerged from the recognition that rising out of pocket costs are forcing an ever growing number of insured cancer patients and families into financial distress during the course of treatment and follow-up care. In this lecture, Dr. Ramsey will review the concept of financial toxicity as a consequence of cancer care. He will review the evidence on the overall prevalence of the problem and the known and hypothesized risk factors for experiencing financial difficulty. He will close by discussing potential approaches that may reduce the risk of financial toxicity, including those directed at cancer patients and families as well as policy options. Interventions aimed at reducing financial toxicity should be implemented in the context of a research agenda directed at improving our understanding of the risks for developing financial toxicity as well as identifying the most effective ways to reduce those risks.