OBJECTIVE: Chemotherapy-induced toxicities (CIT) may have a significant impact on overall healthcare costs, however, there is limited research on the total costs associated with CIT, particularly indirect costs. The objective of this prospective study is to assess the cost of neurologic and hematologic toxicities in women with breast and gynecologic cancers. METHODS: Women experiencing CIT completed questionnaires that assessed health care utilization and patient and caregiver productivity loss. Direct medical costs were based on hospital cost-accounting data and indirect costs were based on Labor Force, Employment, and Earnings data. RESULTS: The average time in the study for hematotoxicity was 2.9 months and 5.5 months for the neurotoxicity group. The mean age for women in the study was 59.5 years with an average household income of $44,702. The mean direct medical costs for hematotoxicity were $2,172 (sd=$2,818, range=$0-$9,500) and $460 (sd=$1,920, range=$0-$3,500) for neurotoxicity. Patient related indirect costs for hematotoxicity averaged $2,778 (sd=$2,627, range=$291-$8,791) in lost wages compared to $12,460 (sd=$8,370, range=$169-$23,976) for neurotoxicity. Additionally, non-paid caregivers were needed 38% of the time for women with hematotoxicity and missed work 43.7% of the time for an average of 2.5 hrs/wk. While women with neurotoxicity required more help from informal caregivers (53.7%) incurring an average of four hours per week of lost wages. Paid workers were needed 44.5% (mean=6.75 hrs/wk) for hematotoxicity and 26.8% (mean=3.7hrs/wk) for neurotoxicity. CONCLUSIONS: Chemotherapy-induced hemato- and neurotoxicities have significant direct and indirect costs. Neurotoxicity appears to result in a disproportionate amount of indirect costs due in part to longer duration of neurotoxicity-related morbidities. Future research on the costs of CIT should include an assessment of the impact of indirect costs.