Supportive Care in Cancer

, Volume 22, Issue 11, pp 3045–3052 | Cite as

Dealing with the financial burden of cancer: perspectives of older breast cancer survivors

  • Maria PisuEmail author
  • Michelle Y. Martin
  • Richard Shewchuk
  • Karen Meneses
Original Article



Financial burden among cancer survivors is often overlooked in survivorship care planning. Cancer survivors with limited incomes may be particularly affected. Yet, little data are available to address financial issues among them. Eliciting the survivors’ perspectives on how to deal with this financial burden is a first crucial step to identifying the means to provide this supportive care.


In this pilot study, three nominal group technique (NGT) sessions were conducted with a convenience sample of 23 older breast cancer survivors (age 52 to 83) recruited from a county safety net hospital and a Comprehensive Cancer Center. One single NGT question was posed in these sessions, namely “What could help women deal with the financial burden that cancer brings to them and their families?” Survivors responded in an iterative fashion and then ranked the most relevant responses.


The most relevant responses addressed the (1) need for affordable insurance; (2) need to have prompt information on treatment costs patients will face, insurance coverage, and agencies or programs that provide needed products and services; and (3) need to access social workers, navigators, support groups, or others knowledgeable about available resources. Survivors also suggested that physicians become aware of cancer costs and financial issues faced by patients and consider costs in their treatment plans.


Older survivors face financial challenges for which there are few available resources. They suggested several avenues to address cancer-related financial issues that may be considered in developing supportive interventions.


Survivorship Breast cancer Financial burden Financial toxicity Older women 



The authors wish to thank the breast cancer survivors who participated in this study and Dr. Chastity McDavid and Ms. Aquila Brown-Galvan for their contribution. This project was supported by the National Institutes of Aging (P30AG031054), the National Institute of Nursing Research (1R01NR011885), and the National Cancer Institute (5R01CA120638). The content is solely the responsibility of the authors and does not necessarily represent official views of the NIA.

Conflict of interest

The authors have no financial conflicts of interest to disclose and have full control of all primary data. The authors agree to allow the journal to review the data if requested.


  1. 1.
    Fox M (2012) Medical bills drive many U.S. women into debt, report finds.
  2. 2.
    Bach P, Saltz LS, Wittes RE (2012) In cancer care, cost matters. The New York TimesGoogle Scholar
  3. 3.
    Lewis Dolan P (2011) Oncologists confront “financial toxicity” of cancer care. American Medical News (
  4. 4.
    Pollack A (2013) Doctors blast cost of cancer treatment. The Boston GlobeGoogle Scholar
  5. 5.
    National Research Council (2008) Cancer care for the whole patient: Meeting psychosocial health needs. The National Academies Press, Washington, DCGoogle Scholar
  6. 6.
    Arozullah AM, Calhoun EA, Wolf M, Finley DK, Fitzner KA, Heckinger EA, Gorby NS, Schumock GT, Bennett CL (2004) The financial burden of cancer: estimates from a study of insured women with breast cancer. J Support Oncol 2(3):271–278PubMedGoogle Scholar
  7. 7.
    Finkelstein EA, Tangka FK, Trogdon JG, Sabatino SA, Richardson LC (2009) The personal financial burden of cancer for the working-aged population. Am J Manag Care 15(11):801–806PubMedGoogle Scholar
  8. 8.
    Langa KM, Fendrick AM, Chernew ME, Kabeto MU, Paisley KL, Hayman JA (2004) Out-of-pocket health-care expenditures among older Americans with cancer. Value Health 7(2):186–194PubMedCrossRefGoogle Scholar
  9. 9.
    Pisu M, Azuero A, Meneses K, Burkhardt J, McNees P (2011) Out of pocket cost comparison between Caucasian and minority breast cancer survivors in the Breast Cancer Education Intervention (BCEI). Breast Cancer Res Treat 127(2):521–529PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS (2007) Overall quality of life and difficulty paying for ostomy supplies in the Veterans Affairs ostomy health-related quality of life study: an exploratory analysis. Med Care 45(9):891–895. doi: 10.1097/MLR.0b013e318074ce9b PubMedCrossRefGoogle Scholar
  11. 11.
    Ell K, Xie B, Wells A, Nedjat-Haiem F, Lee PJ, Vourlekis B (2008) Economic stress among low-income women with cancer: effects on quality of life. Cancer 112(3):616–625PubMedCrossRefGoogle Scholar
  12. 12.
    Institute of Medicine (2005) From cancer patient to cancer survivor: lost in transition. National Academy Press, Washington, DCGoogle Scholar
  13. 13.
    Baider L, Andritsch E, Uziely B, Ever-Hadani P, Goldzweig G, Hofmann G, Samonigg H (2003) Do different cultural settings affect the psychological distress of women with breast cancer? A randomized study. Eur J Cancer Care (Engl) 12(3):263–273CrossRefGoogle Scholar
  14. 14.
    Darby K, Davis C, Likes W, Bell J (2009) Exploring the financial impact of breast cancer for African American medically underserved women: a qualitative study. J Health Care Poor Underserved 20(3):721–728PubMedCrossRefGoogle Scholar
  15. 15.
    Mosavel M, Sanders K (2011) Needs of low-income African American cancer survivors: multifaceted and practical. J Cancer Educ Off J Am Assoc Cancer Educ 26(4):717–723. doi: 10.1007/s13187-011-0253-8 CrossRefGoogle Scholar
  16. 16.
    Sherwood PR, Donovan HS, Rosenzweig M, Hamilton R, Bender CM (2008) A house of cards: the impact of treatment costs on women with breast and ovarian cancer. Cancer Nurs 31(6):470–477. doi: 10.1097/01.NCC.0000339255.75947.a8 PubMedCrossRefGoogle Scholar
  17. 17.
    Pisu M, Azuero A, McNees P, Burkhardt J, Benz R, Meneses K (2010) The out of pocket cost of breast cancer survivors: a review. J Cancer Surviv 4(3):202–209. doi: 10.1007/s11764-010-0125-y PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Brown ML, Yabroff KR (2006) Economic impact of cancer in the United States. In: Schottenfeld D, Fraumeni JF (eds) Cancer epidemiology and prevention, 3rd edn. Oxford University Press, New YorkGoogle Scholar
  19. 19.
    Stump TK, Eghan N, Egleston BL, Hamilton O, Pirollo M, Schwartz JS, Armstrong K, Beck JR, Meropol NJ, Wong YN (2013) Cost concerns of patients with cancer. J Oncol Pract Am Soc Clin Oncol 9(5):251–257. doi: 10.1200/JOP.2013.000929 CrossRefGoogle Scholar
  20. 20.
    Davidoff AJ, Erten M, Shaffer T, Shoemaker JS, Zuckerman IH, Pandya N, Tai MH, Ke X, Stuart B (2013) Out-of-pocket health care expenditure burden for Medicare beneficiaries with cancer. Cancer 119(6):1257–1265. doi: 10.1002/cncr.27848 PubMedCrossRefGoogle Scholar
  21. 21.
    Shankaran V, Jolly S, Blough D, Ramsey SD (2012) Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. J Clin Oncol Off J Am Soc Clin Oncol 30(14):1608–1614. doi: 10.1200/JCO.2011.37.9511 CrossRefGoogle Scholar
  22. 22.
    Kent EE, Forsythe LP, Yabroff KR, Weaver KE, de Moor JS, Rodriguez JL, Rowland JH (2013) Are survivors who report cancer-related financial problems more likely to forgo or delay medical care? Cancer 119(20):3710–3717. doi: 10.1002/cncr.28262 PubMedGoogle Scholar
  23. 23.
    Lauzier S, Maunsell E, De Koninck M, Drolet M, Hebert-Croteau N, Robert J (2005) Conceptualization and sources of costs from breast cancer: findings from patient and caregiver focus groups. Psychooncology 14(5):351–360PubMedCrossRefGoogle Scholar
  24. 24.
    Timmons A, Gooberman-Hill R, Sharp L (2013) “It’s at a time in your life when you are most vulnerable”: a qualitative exploration of the financial impact of a cancer diagnosis and implications for financial protection in health. PLoS One 8(11):e77549. doi: 10.1371/journal.pone.0077549 PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Timmons A, Gooberman-Hill R, Sharp L (2013) The multidimensional nature of the financial and economic burden of a cancer diagnosis on patients and their families: qualitative findings from a country with a mixed public-private healthcare system. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 21(1):107–117. doi: 10.1007/s00520-012-1498-4 Google Scholar
  26. 26.
    Zafar SY, Abernethy AP (2013) Financial toxicity, Part I: a new name for a growing problem. Oncology 27(2):80–81, 149PubMedGoogle Scholar
  27. 27.
    Mathews M, Buehler S, West R (2009) Perceptions of health care providers concerning patient and health care provider strategies to limit out-of-pocket costs for cancer care. Curr Oncol 16(4):3–8PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Klimmek R, Snow D, Wenzel J (2010) Insurance-related and financial challenges reported by managed care enrollees with breast cancer. Clin J Oncol Nurs 14(5):598–606. doi: 10.1188/10.CJON.598-606 PubMedCrossRefGoogle Scholar
  29. 29.
    Bullock AJ, Hofstatter EW, Yushak ML, Buss MK (2012) Understanding patients’ attitudes toward communication about the cost of cancer care. J Oncol Pract Am Soc Clin Oncol 8(4):e50–e58. doi: 10.1200/JOP.2011.000418 CrossRefGoogle Scholar
  30. 30.
    Miller JJ, Frost MH, Rummans TA, Huschka M, Atherton P, Brown P, Gamble G, Richardson J, Hanson J, Sloan JA, Clark MM (2007) Role of a medical social worker in improving quality of life for patients with advanced cancer with a structured multidisciplinary intervention. J Psychosoc Oncol 25(4):105–119. doi: 10.1300/J077v25n04_07 PubMedCrossRefGoogle Scholar
  31. 31.
    American Cancer Society The Affordable Care Act: how it helps people with cancer and their families. Accessed 25 Apr 2013 from]. Atlanta GA
  32. 32.
    Davis C, Darby K, Likes W, Bell J (2009) Social workers as patient navigators for breast cancer survivors: what do African-American medically underserved women think of this idea? Soc Work Health Care 48(6):561–578. doi: 10.1080/00981380902765212 PubMedCrossRefGoogle Scholar
  33. 33.
    Hoey LM, Ieropoli SC, White VM, Jefford M (2008) Systematic review of peer-support programs for people with cancer. Patient Educ Couns 70(3):315–337. doi: 10.1016/j.pec.2007.11.016 PubMedCrossRefGoogle Scholar
  34. 34.
    Macvean ML, White VM, Sanson-Fisher R (2008) One-to-one volunteer support programs for people with cancer: a review of the literature. Patient Educ Couns 70(1):10–24. doi: 10.1016/j.pec.2007.08.005 PubMedCrossRefGoogle Scholar
  35. 35.
    Lauzier S, Levesque P, Mondor M, Drolet M, Coyle D, Brisson J, Masse B, Provencher L, Robidoux A, Maunsell E (2013) Out-of-pocket costs in the year after early breast cancer among Canadian women and spouses. J Natl Cancer Inst 105(4):280–292. doi: 10.1093/jnci/djs512 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Maria Pisu
    • 1
    Email author
  • Michelle Y. Martin
    • 1
  • Richard Shewchuk
    • 2
  • Karen Meneses
    • 3
  1. 1.Division of Preventive Medicine and Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Health Services AdministrationUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.School of Nursing and Comprehensive Cancer CenterUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations