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FORCE’s eXamining the Relevance of Articles for Young Survivors (XRAYS) program is a reliable resource for breast cancer research-related news and information. XRAYS reviews new breast cancer research, provides plain-language summaries, and rates how the media covered the topic. XRAYS is funded by the CDC.

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Financial burden affects quality of life of cancer survivors

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XRAYS:  Making Sense of Cancer Headlines

Cancer-related financial burden can keep survivors from getting the care that they need, yet how this burden affects mental and physical help is still unknown. A recent study found that almost one-third of cancer survivors report having financial burden; those most likely to be affected were under age 65, female, members of racial or ethnic minority groups, and people who lack access to adequate insurance. (5/17/16)


This study is about:

How financial burden affects the quality of life of cancer survivors.

Why is this study important?

Financial burden from a cancer diagnosis and treatment has many consequences. We know that in some cases, it keeps survivors from the medical care they need, including missed follow-up visits, and potentially life-saving medications. But research is scarce on how financial burden affects a survivor’s physical and emotional quality of life.

Study findings: 

  1. Among 19.6 million cancer survivors, about 29% report having cancer-related financial burden and indicating at least one of these problems: 
    • outstanding loans or declared bankruptcy
    • worry about paying large medical bills
    • inability to cover cost of medical care visits
    • other financial sacrifices
  2. Cancer survivors with financial burden were more likely to be depressed, worry about cancer recurrence, and scored lower on measures of physical quality of life.

What does this mean for me?

This study indicates that cancer survivors with financial burden are more likely to have a lower overall quality of life and reduced physical and mental/emotional health. According to the study authors, “Decreasing the financial burden of cancer is a complex problem that requires integrated efforts from health care systems, patients, and providers.” Patients who have financial trouble should discuss this with their health care providers.

Questions to ask your health care provider:

  • I can’t afford my treatment. What other treatments are similarly or equally effective but less expensive?My insurance denied my __________________ (surgery, screening, treatment). 
  • What resources can help me to file an appeal?
  • Do you work with patient navigators, oncology social workers or financial counselors who can help me cope with the financial burden of my cancer care?
  • What organizations or patient assistance programs can help provide me with financial assistance?
  • What are the financial consequences of cancer treatment?



Study background:

Multiple research groups have looked at how much patients spend related to cancer. One group observed that lost income and out-of-pocket care expenses cost breast cancer patients an average of $1,455 per month. Another group found that the average cancer patient had estimated out–of-pocket costs of about  $4,727 per year. Previous studies have noted that 12% of all breast cancer patients are in debt four years after their diagnosis.

What remains unknown is how these financial problems affect the physical and mental health of cancer survivors. In March of 2016, Hrishikesh Kale and Norman Carroll from the Virginia Commonwealth University studied the quality of life of cancer survivors who were experiencing financial burden.

Researchers of this study wanted to know:

  1. the scope of cancer-related financial burden.
  2. whether there are predicators of who will experience financial burden due to cancer.
  3. how financial burden affects the mental and physical health of cancer survivors.  

Population(s) looked at in the study:

The study population represented 19.6 million cancer survivors through the 2011 Medical Expenditure Panel Survey (MEPS). The majority of this population was non-Hispanic white females who were diagnosed with cancer before age 65. This population included all cancers, but notably, 17% had breast cancer.

Study findings: 

  1. About 29% of 19.6 million cancer survivors report financial burden indicated by one or more of the following:
    • outstanding loans or declared bankruptcy
    • worry about paying large medical bills
    • inability to cover cost of medical care visits
    • other financial sacrifices
  2. Cancer survivors who are most likely to experience cancer-related financial burden were:
    • diagnosed before age 65.
    • female.
    • had difficulty obtaining, or were without access to health insurance.
    • diagnosed with liver, lung, esophageal, or pancreatic cancers.
    • members of a racial/ethnic minority group.
  3. Cancer survivors who had financial burden were more likely to:
    • be depressed, as measured by a patient health questionnaire.
    • worry about cancer recurrence (69% of survivors with financial burden were worried, compared to 35% of cancer survivors without financial burden).  
    • score lower on measures of physical quality of life.


The Medical Expenditure Panel Survey data does not include information about the cancer stage, severity, or treatment used, so researchers could not control for these factors. Nor could they control for psychiatric illness that preceded a cancer diagnosis. This is a limitation, because if cancer survivors had a history of psychiatric illness before their diagnoses, the patient depression found in this study cannot be attributed to financial burden. Finally, because patients self-reported information through surveys, some information may have been incorrect (for example, exaggerations, omission of critical information, or simply forgetting details).


This study suggests that cancer-related financial burden negatively affects the quality of survivors’ mental and physical health. Cancer survivors who experience financial burden should seek help—such as access to patient assistance programs and/or generic drugs, assistance with insurance appeals, and referral to organizations that may help provide financial assistance and/or support in navigating the health care and health insurance systems.

Posted 5/17/16

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Arozullah AM, Calhoun EA, Wolf M, et al. “The financial burden of cancer: estimates from a study of insured women with breast cancer.” J Support Oncol. 2004 May/June; 2:271-78.  

Davidoff AJ, Erten M, Shaffer T, et al. “Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer.” Cancer. 2013 Mar 15; 119(6): 1257-65.  

Kale HP and Carroll NV. “Self-Reported Financial Burden of Cancer Care and its Effect on Physical and Mental Health-Related Quality of Life Among U.S. Cancer Survivors.” Cancer. Published online first on March 14, 2016.  

Related Information and Resources

FORCE  Information: Paying for Cancer Treatment 

FORCE Information:  Health Insurance Appeals 

Be Empowered Webinar: Hereditary Cancer, Insurance, and Your Legal Rights (2015) 

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