Most patients with metastatic colorectal cancer face financial hardship after diagnosis – Healio

Contributors to financial hardship.

March 28, 2022

2 min read

The authors report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Shih reports consultant fees, travel and accommodations from Pfizer Inc. and serving on the advisory board for AstraZeneca in 2019. Yabroff reports an advisory board role with the Flatiron Health Equity Advisory Board. Bradley reports no relevant financial disclosures.

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More than 70% of patients with metastatic colorectal cancer bore financial hardships within the first year of diagnosis despite most having health insurance, according to study results published in Journal of the National Cancer Institute.


“Evidence has increasingly highlighted the economic burden of cancer treatment on patients and its potentially devastating consequences to their well-being,” Joseph M. Unger, PhD, SWOG Cancer Research Network health services researcher and biostatistician at Fred Hutchinson Cancer Research Center, told Healio.

Contributors to financial hardship.

Data derived from Shankaran V, et al. J Natl Cancer Inst. 2022;doi:10.1093/jnci/djab210.

However, prior research has not prospectively examined the financial impact of cancer treatment among a diverse national cohort of newly diagnosed patients with cancer. For this reason, Unger and colleagues sought to assess financial hardship among patients with metastatic colorectal cancer.


The cooperative group-initiated prospective cohort study included 380 patients (median age, 59.9 years; 77.7% white) with metastatic colorectal cancer who completed quarterly questionnaires for 1 year. Most patients (98%) had health insurance and 56.5% had an annual income of $50,000 or less.

Researchers estimated cumulative incidence of major financial hardship, defined as one or more of the following: increased debt, new loans from family and/or friends, selling or refinancing a home, or 20% or more income decline. Investigators used multivariate Cox regression to assess the association between patient characteristics and major financial hardship and linear regression to assess the association between major financial hardship and quality of life.

Key findings

Results showed a 71.3% (95% CI, 65.7-76.1) cumulative incidence of major financial hardship at 1 year, with new debt (57.6%), 20% or more income decline (26.6%) and new loans from family or friends (26%) found to be the largest contributors.

Researchers observed no statistically significant association between major financial hardship and age, race, marital status or income, whereas income less than $100,000 and total assets less than $100,000 both appeared associated with greater major financial hardship.

Of note, patients with major financial hardship at 3 months had decreased social functioning and quality of life at 6 months, according to the researchers.


Joseph M. Unger, PhD

Joseph M. Unger

“These findings highlight the importance of economic support and financial counseling of patients with cancer so that patients can better focus on their disease and treatment, and not be hindered by treatment choices over financial concerns,” Unger said. “The study team has launched an intervention trial, SWOG S1912CD, to examine whether the proactive use of financial navigation can help alleviate financial hardship for patients with cancer.”

Robin Yabroff

K. Robin Yabroff

Medical financial hardship after cancer diagnosis and subsequent treatment is often considered a condition that only affects households without health insurance coverage or with very low income, K. Robin Yabroff, PhD, MBA, scientific vice president of health services research at American Cancer Society, Ya-Chen Tina Shih, PhD, researcher in the department of health services research in the division of cancer prevention and population sciences at The University of Texas MD Anderson Cancer Center, and Cathy J. Bradley, PhD, associate dean for research at Colorado School of Public Health, wrote in an accompanying editorial.

“This study demonstrates that financial hardship is widespread and may be experienced by many Americans diagnosed with cancer — nearly 1.9 million people in 2021 alone,” they wrote. “Financial hardship will persist and perhaps worsen until it is addressed by providers, cancer centers, payers and policymakers. Future interventions and policy initiatives require rigorous research to assess these activities, whether practice-based screening and connection to resources or policies limiting out-of-pocket exposure, that ensure the remarkable advancements in cancer care are widely accessible without inflicting financial ruin for patients and their families.”


Shankaran V, et al. J Natl Cancer Inst. 2022;doi:10.1093/jnci/djab210.
Yabroff KR, et al. J Natl Cancer Inst. 2022;doi:10.1093/jnci/djab211.

For more information:

Joseph M. Unger, PhD, can be reached at Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N, M3-C102, Seattle, WA 98109; email:

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