A cancer diagnosis brings many challenges, from navigating treatment decisions to managing daily life while undergoing care. Beyond the well-known physical and emotional aspects, financial concerns can also become a significant burden. Many patients and their families experience financial strain due to medical expenses, loss of income, and the cost of supportive care. Cancer-related financial hardship or financial toxicity—where the economic impact of treatment creates stress and difficult choices—can affect overall well-being and access to care.
A new article by Drs. Shankaran and Wheeler and their teams, published in the JCO Oncology Practice, thoroughly examines this pressing issue and offers a comprehensive review of interventions designed to ease the financial burden on cancer patients. By analyzing 44 studies covering 43 different programs, the researchers provide a crucial roadmap for tackling what has become a significant barrier to effective cancer care.
Financial toxicity isn’t just about out-of-pocket medical expenses. It encompasses three major domains: material burden, which includes medical bills, lost wages, transportation, and other direct costs; psychosocial distress, referring to the anxiety and stress related to financial insecurity; and behavioral reactions, such as skipping treatments, delaying care, or making lifestyle sacrifices to cover medical costs.
Recognizing that financial screening alone isn’t enough, the researchers examined real-world interventions designed to actively help patients manage these challenges. They categorized interventions into six major types: financial navigation programs, health insurance literacy programs, provider training interventions, specialty pharmacy assistance, hospital-based programs, and community assistance programs.
One of the most effective interventions identified was “financial navigation programs”. These programs, found in 17 studies, involve trained financial counselors who guide patients through insurance options, help them apply for assistance programs, and connect them with resources for covering costs. Some programs have even incorporated technology, such as mobile apps, to make the process more accessible.
Another key intervention was “specialty pharmacy assistance” programs, which were present in 11 studies. These programs help patients afford expensive medications by offering copay assistance, pharmaceutical discounts, and manufacturer support programs. Such interventions have been crucial in making high-cost treatments more accessible to those who might otherwise be forced to forgo life-saving drugs.
“Hospital-based” and “community assistance programs” were also effective in addressing non-medical financial stressors. Some hospitals have implemented dedicated financial hardship assistance funds, which have been shown to decrease missed appointments—a key factor in improving patient outcomes. Meanwhile, community-based programs, often run by nonprofits, provide temporary financial relief for costs like transportation, food, and housing.
Another critical area covered by the review was “health insurance literacy programs”. Many patients struggle to navigate the complex world of health insurance, leading to missed opportunities for coverage and benefits. Studies included in the review found that interventions aimed at educating patients about their insurance options led to better financial outcomes and reduced stress.
Perhaps one of the more novel approaches was “provider-focused interventions”, which aims to improve communication between doctors and patients regarding treatment costs. When providers are trained to discuss financial concerns openly, patients are more likely to receive the support they need.
The study concludes that financial hardship interventions should become a standard part of cancer care. Just as hospitals routinely screen for physical symptoms, they should also assess financial distress and offer immediate support. Instead of expecting patients to seek help on their own, financial support should be an integrated part of cancer treatment. Addressing financial toxicity is a public health issue. Patients who struggle financially are more likely to skip treatments, leading to worse health outcomes and higher long-term healthcare costs.
Despite this, many challenges remain. Many financial assistance programs are underfunded and difficult to scale, particularly those relying on community-based resources. Additionally, awareness remains low—many patients simply don’t know these programs exist. Future efforts should focus on integrating financial hardship interventions into routine cancer care, expanding insurance literacy programs, and ensuring that all patients—regardless of socioeconomic status—can access the resources they need. Policymakers must also step up, as broader social and policy changes will be required to address the systemic causes of financial toxicity in oncology.
This study was supported by grants from the National Cancer Institute and the American Cancer Society. Additional funding was provided by the Fred Hutch Cancer Center Public Health Sciences Division.
Fred Hutch/UW/Seattle Children’s Cancer Consortium member Dr. Veena Shankaran contributed to this work.
Wheeler, S. B., Thom, B., Waters, A. R., & Shankaran, V. 2025. Interventions to Address Cancer-Related Financial Hardship: A Scoping Review and Call to Action. JCO oncology practice, 21(1), 29–40.
Science Spotlight writer Darya Moosavi is a postdoctoral research fellow within Johanna Lampe's research group at Fred Hutch. Darya studies the nuanced connections between diet, gut epithelium, and gut microbiome in relation to colorectal cancer using high-dimensional approaches.
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