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The Impact of Financial Toxicity and Employment on Cancer Patients and Their Families

January 15, 2025
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Author: Carol Wang, Ph.D., Director of Clinical Research, We Are Here



Financial toxicity, defined as the economic burden associated with cancer care, significantly affects cancer patients and their families. This impact extends beyond the immediate direct costs of treatment, affecting all aspects of a patient’s and their family’s lives, including indirect costs like lost income, employment stability, travel expenses, and caregiving needs1. As cancer treatments have evolved and extended, financial toxicity has become a critical factor influencing patient outcomes and quality of life.

Economic Strain and Healthcare Decision-Making

Cancer treatment often involves high out-of-pocket expenses, including co-pays, deductibles, and non-covered services such as transportation, home care, and specialized medications. Even with insurance, many patients face substantial medical bills that strain their finances. A study by Carrera et al. (2018) reported that cancer patients are 2.5 times more likely to experience bankruptcy compared to individuals without a cancer diagnosis2. Furthermore, a significant number of patients resort to borrowing money, depleting savings, or even selling assets to pay for treatment1. This economic strain forces many patients into difficult decisions, such as skipping doses, delaying or stopping treatment, or choosing less effective therapies due to cost concerns3. Such decisions can negatively affect treatment outcomes, potentially reducing survival rates and overall health.

Impact on Employment
Employment disruption is one of the most significant indirect consequences of financial toxicity for cancer patients and their caregivers. A meta-analysis systematic review by de Boer and colleagues (2020) found that nearly half of cancer patients were unable to work during treatment, and many experienced long-term employment difficulties even after recovery. Patients often face reduced work hours, unpaid medical leave, or job loss due to the physical and psychological toll of cancer and its treatment. This impact on employment is not limited to the patients themselves; caregivers also face considerable employment challenges. Caregivers often need to reduce work hours, shift to less demanding roles, or leave their jobs entirely to pay to provide support to their loved ones during cancer treatment5. This role adjustment disrupts their career trajectories and contributes to financial instability in the household.

The repercussions of employment loss extend beyond immediate financial strain, affecting the family’s long-term economic stability. Reduced income and employment disruptions can lead to depleted savings, increased debt, and a lack of retirement security, creating a cycle of financial stress that can persist long after the cancer diagnosis. For many families, this impact is felt in their ability to afford basic needs, paying for ongoing medical care, or saving for the future.

Data from our members reflect these broader trends:

57% of our members report struggling to consistently afford basic needs such as food, housing, and utilities.

This is particularly concerning given that 44% of our members report being insured through their employer, and 35.5% report being publicly insured. Despite having health insurance coverage, many still find themselves unprepared to handle the financial challenges that arise during cancer treatment. The limitations of insurance—such as high deductibles, copays, and uncovered services, combined with income loss due to employment disruptions, leave families in precarious financial positions.

Psychosocial Effects
The financial stress associated with cancer treatment can have profound psychosocial effects. Financial toxicity is linked to increased levels of anxiety, depression, and overall distress among patients and their families6.The psychological impact is often magnified when financial strain leads to difficult decisions, such as delaying or forgoing treatment, which can negatively impact survival rates and overall health outcomes3. For caregivers, the dual burden of financial stress and caregiving duties can be overwhelming, contributing to poor health outcomes and reducing their ability to provide effective support5. Families may also experience social isolation, as the financial burden limits their ability to engage in social activities or seek necessary psychosocial support services.

Alleviating Financial Toxicity Through the We Are Here Platform

The We Are Here platform aims to help alleviate financial toxicity among cancer patients. By providing personalized resource navigation, our goal is to help patients and their support teams get access to financial assistance, including grants, co-pay support, and other financial resources tailored to their specific needs. Additionally, we aim to connect our members with critical information on employment rights and supportive services that help manage employment challenges during cancer treatment. Through our AI-driven recommendations platform, we can streamline access to relevant financial counseling and support services, simplifying the overwhelming process of navigating complex systems. Over 50% of our members report lower levels of overwhelming feelings after their first interaction with the platform.  By integrating financial resources to help guide patients through their journey, our platform empowers patients to better manage their expenses and employment challenges by alleviating some of the financial burdens faced by cancer patients and their families.


 

About The Author: 

Dr. Wang is an accomplished social and health research scientist whose work focuses on community-based participatory methods and patient-centered outcomes. She earned her PhD from the University of Houston, where she was a Susan G. Komen Research Fellow at the University of Texas, MD Anderson Cancer Center, and completed a postdoctoral fellowship at MD Anderson through the CPRIT cancer prevention research training program. Her work has been funded by the American Association for Cancer Research, National Cancer Institute, American Psychological Association, and Susan G. Komen Foundation.


 

References

1 Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., & Abernethy, A. P. (2017). The financial toxicity of cancer treatment: A pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist, 18(4), 381-390.

2 Carrera, P. M., Kantarjian, H. M., & Blinder, V. S. (2018). The financial burden and distress of patients with cancer: Understanding and steppingup action on the financial toxicity of cancer treatment. CA: A Cancer Journal for Clinicians, 68(2), 153-165.

3 Kale, H. P., & Carroll, N. V. (2016). Self-reported financial burden of cancer care and its effect on physical and mental health-related quality of life among US cancer survivors. Cancer, 122(8), 283-289.

4 de Boer, A. G. E. M., Taskila, T., Ojajärvi, A., van Dijk, F. J. H., & Verbeek, J. H. A. M. (2020). Cancer survivors and unemployment: A meta-analysis and meta-regression. JAMA, 2(4), 187-199.

5 Mosher, C. E., Jaynes, H. A., Hanna, N., & Ostroff, J. S. (2013). Distressed family caregivers of lung cancer patients: An examination of psychosocial and practical challenges. Supportive Care in Cancer, 21(2), 431-437.

6 Gilligan, A. M., Alberts, D. S., Roe, D. J., Skrepnek, G. H., & DeWolfe, C. C. (2018). Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. American Journal of Medicine, 131(10), 1187-1199.e5.