Journal of Cancer Survivorship

, Volume 13, Issue 1, pp 10–20 | Cite as

Financial toxicity is more than costs of care: the relationship between employment and financial toxicity in long-term cancer survivors

  • Alison PearceEmail author
  • Bianca Tomalin
  • Billingsley Kaambwa
  • Nicole Horevoorts
  • Saskia Duijts
  • Floortje Mols
  • Lonneke van de Poll-Franse
  • Bogda Koczwara



The aim of this study was to examine the relationship between employment and financial toxicity by examining the prevalence of, and factors associated with, financial toxicity among cancer survivors.


We conducted a secondary analysis of a sub-sample from the Dutch Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship (PROFILES) registry. Descriptive statistics, bivariate analysis and logistic regression were used.


A total of 2931 participants with diverse cancer types were included in the analysis with a mean age of 55 years (range 18 to 65). Nearly half (49%) of participants were employed at the time of the survey, and 22% reported financial toxicity. Those who were not employed were at greater risk of financial toxicity (27% vs 16%, p < 0.001), and this did not vary according to time since diagnosis. The odds of reporting financial toxicity were greater for participants who were male, younger, unmarried, with low education, low socioeconomic status, or without paid employment. Those with basal cell carcinoma had lower risk of financial toxicity, while those with haematological or colorectal cancer had highest risk of financial toxicity.


This research confirms that unemployment is significantly associated with financial toxicity and that those with limited financial resources are most at risk.

Implications for cancer survivors

Increased awareness of financial toxicity and its associated factors among clinicians may result in improved screening and appropriate referrals for support services. The implementation of effective multidisciplinary return to work interventions, as part of standard cancer survivorship care, may reduce financial toxicity among cancer survivors.


Cancer Survivorship Financial toxicity Cost Employment Work 



This paper draws on data of the PROFILES registry.


Alison Pearce is supported by a University of Technology Sydney Chancellor’s Postdoctoral Research Fellowship. Saskia Duijts was supported by funding from the Dutch Cancer Society KWF fellowship (VUP 2013-5866). Bogda Koczwara is supported by the National Breast Cancer Foundation Fellowship.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Health Economics Research and EvaluationUniversity of Technology SydneyBroadwayAustralia
  2. 2.Flinders Centre for Innovation in CancerFlinders UniversityAdelaideAustralia
  3. 3.Health Economics UnitFlinders UniversityAdelaideAustralia
  4. 4.Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
  5. 5.Department of ResearchThe Netherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands
  6. 6.Department of Public and Occupational Health, Amsterdam Public Health Research InstituteAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
  7. 7.Department of General PracticeUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
  8. 8.Division of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands

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