Skip to main content
Log in

The financial coping strategies of US cancer patients and survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript



Coping behaviors may play a mediating role in producing the negative health outcomes observed in financially burdened cancer patients and survivors.


Exploratory factor and latent class analysis of survey data.


A total of 510 people completed the survey, ages ranged from 25 to over 75 [over half greater than 55 years old (57.8%)]. Most respondents identified as female (64.7%), white (70.8%), or African American (18.6%). A four-factor model of financial coping was revealed: care-altering, lifestyle-altering, self-advocacy, and financial help-seeking. Respondents grouped into three financial coping classes: low burden/low coping (n = 212), high self-advocacy (n = 143), and high burden/high coping (n = 155). African American respondents were at far greater odds than white respondents of being in the high burden/high coping class (OR = 5.82, 95% CI 3.01–6.64) or the self-advocacy class (OR = 1.99, 95% CI 1.19–2.80) than the low burden/low coping class. Compared to respondents aged 65 years and older, those 35–44 were more likely in the high burden/high coping class (OR = 12.27, 95% CI 7.03–19.87) and the high self-advocacy class (OR = 7.08, 95% CI 5.89–8.28) than the low burden/low coping class.


One-third of respondents were in the high burden/high coping class. Age and race/ethnicity were significantly associated with class membership. Some coping strategies may compromise health and well-being. Program and policy interventions that reduce the odds that patients will use strategies that undermine treatment outcomes and increase patient use of protective strategies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from CancerCare. Restrictions apply to the availability of these data, which were used under license for this study. Data are available from the authors with the permission of Ellen Miller-Sonet (


  1. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH (2018) Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer. Am J Med 131(10):1187–1199

    Article  PubMed  Google Scholar 

  2. Fenn KM, Evans SB, McCorkle R, DiGiovanna MP, Pusztai L, Sanft T et al (2014) Impact of financial burden of cancer on survivors’ quality of life. J Oncol Pract 10(5):332–338

    Article  PubMed  Google Scholar 

  3. Zafar SY, McNeil RB, Thomas CM, Lathan CS, Ayanian JZ, Provenzale D (2015) Population-based assessment of cancer survivors’ financial burden and quality of life: a prospective cohort study. J Oncol Pract 11(2):145–150

    Article  PubMed  Google Scholar 

  4. Dusetzina SB, Winn AN, Abel GA, Huskamp HA, Keating NL (2014) Cost sharing and adherence to tyrosine kinase inhibitors for patients with chronic myeloid leukemia. J Clin Oncol 32(4):306–311

    Article  PubMed  Google Scholar 

  5. Neugut AI, Subar M, Wilde ET, Stratton S, Brouse CH, Hillyer GC, Grann VR, Hershman DL (2011) Association between prescription co-payment amount and compliance with adjuvant hormonal therapy in women with early-stage breast cancer. J Clin Oncol 29(18):2534–2542

    Article  PubMed  PubMed Central  Google Scholar 

  6. Lathan CS, Cronin A, Tucker-Seeley R, Zafar SY, Ayanian JZ, Schrag D (2016) Association of financial strain with symptom burden and quality of life for patients with lung or colorectal cancer. J Clin Oncol 34(15):1732–1740

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Holland JC, Andersen B, Breitbart WS, Compas B, Dudley MM, Fleishman S et al (2010) Distress management. J Natl Compr Cancer Netw 8(4):448–485

    Article  CAS  Google Scholar 

  8. Meeker CR, Geynisman DM, Egleston BL, Hall MJ, Mechanic KY, Bilusic M, Plimack ER, Martin LP, von Mehren M, Lewis B, Wong YN (2016) Relationships among financial distress, emotional distress, and overall distress in insured patients with cancer. J Oncol Pract 12(7):e755–e764

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34(9):980–986

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Zafar YS (2016) Financial toxicity of cancer care: it’s time to intervene. J Natl Cancer Instit 108(5):djv370

    Article  Google Scholar 

  11. Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR (2017) Financial hardships experienced by cancer survivors: a systematic review. JNCI: J Natl Cancer Instit 109(2):djw205

    Article  Google Scholar 

  12. Jagsi R, Pottow JA, Griffith KA, Bradley C, Hamilton AS, Graff J et al (2014) Long-term financial burden of breast cancer: experiences of a diverse cohort of survivors identified through population-based registries. J Clin Oncol 32(12):1269–1276

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bestvina CM, Zullig LL, Rushing C, Chino F, Samsa GP, Altomare I et al (2014) Patient-oncologist cost communication, financial distress, and medication adherence. J Oncol Pract 10(3):162–167

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) 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

    Article  PubMed  PubMed Central  Google Scholar 

  16. Huntington SF, Weiss BM, Vogl DT, Cohen AD, Garfall AL, Mangan PA, Doshi JA, Stadtmauer EA (2015) Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study. Lancet Haematol 2(10):e408–e416

    Article  PubMed  Google Scholar 

  17. Irwin B, Kimmick G, Altomare I, Marcom PK, Houck K, Zafar SY, Peppercorn J (2014) Patient experience and attitudes toward addressing the cost of breast cancer care. Oncologist 19(11):1135–1140

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zullig LL, Peppercorn JM, Schrag D, Taylor DH Jr, Lu Y, Samsa G, ... Zafar SY (2013) Financial distress, use of cost-coping strategies, and adherence to prescription medication among patients with cancer. J Oncol Pract 9(6S)60s–63s

  19. Nipp RD, Zullig LL, Samsa G, Peppercorn JM, Schrag D, Taylor DH Jr, Abernethy AP, Zafar SY (2016) Identifying cancer patients who alter care or lifestyle due to treatment-related financial distress. Psycho-oncology 25(6):719–725

    Article  PubMed  Google Scholar 

  20. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer publishing company

  21. Folkman S, Lazarus RS (1988) Coping as a mediator of emotion. J Pers Soc Psychol 54(3):466–475

    Article  CAS  PubMed  Google Scholar 

  22. CancerCare. (2016). CancerCare patient access and engagement report. CancerCare.

    Google Scholar 

  23. de Souza JA, Kung S, O’Connor J, Yap BJ (2017) Determinants of patient-centered financial stress in patients with locally advanced head and neck cancer. J Oncol Pract 13(4):e310–e318

    Article  PubMed  Google Scholar 

  24. Hastert TA, Banegas MP, Hamel LM, Reed AR, Baird T, Beebe-Dimmer JL, Schwartz AG (2019) Race, financial hardship, and limiting care due to cost in a diverse cohort of cancer survivors. J Cancer Surviv 13(3):429–437

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hershman DL, Tsui J, Wright JD, Coromilas EJ, Tsai WY, Neugut AI (2015) Household net worth, racial disparities, and hormonal therapy adherence among women with early-stage breast cancer. J Clin Oncol 33(9):1053–1059

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Yabroff KR, Dowling EC, Guy GP Jr, Banegas MP, Davidoff A, Han X et al (2016) Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J Clin Oncol 34(3):259–267

    Article  PubMed  Google Scholar 

  27. Wheeler SB, Spencer JC, Pinheiro LC, Carey LA, Olshan AF, Reeder-Hayes KE (2018) Financial impact of breast cancer in black versus white women. J Clin Oncol 36(17):1695–1701

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ekwueme DU, Zhao J, Rim SH, de Moor JS, Zheng Z, Khushalani JS, Han X, Kent EE, Yabroff KR (2019) Annual out-of-pocket expenditures and financial hardship among cancer survivors aged 18–64 years—United States, 2011–2016. Morb Mortal Wkly Rep 68(22):494–499

    Article  Google Scholar 

  29. Murphy CC, Harlan LC, Warren JL, Geiger AM (2015) Race and insurance differences in the receipt of adjuvant chemotherapy among patients with stage III colon cancer. J Clin Oncol 33(23):2530–2536

    Article  PubMed  PubMed Central  Google Scholar 

  30. Karanth S, Fowler ME, Mao X, Wilson LE, Huang B, Pisu M et al (2019) Race, socioeconomic status, and health-care access disparities in ovarian cancer treatment and mortality: systematic review and meta-analysis. JNCI Cancer Spectrum 3(4):pkz084

    Article  PubMed  PubMed Central  Google Scholar 

  31. Krimphove MJ, Cole AP, Fletcher SA, Harmouch SS, Berg S, Lipsitz SR et al (2019) Evaluation of the contribution of demographics, access to health care, treatment, and tumor characteristics to racial differences in survival of advanced prostate cancer. Prostate Cancer Prostatic Dis 22(1):125–136

    Article  PubMed  Google Scholar 

  32. Knight TG, Deal AM, Dusetzina SB, Muss HB, Choi SK, Bensen JT, Williams GR (2018) Financial toxicity in adults with cancer: adverse outcomes and noncompliance. J Oncol Pract 14(11):e665–e673

    Article  Google Scholar 

  33. Rim SH, Guy GP Jr, Yabroff KR, McGraw KA, Ekwueme DU (2016) The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review. Exp Rev Pharmacoecon Outcomes Res 16(5):579–589

    Article  Google Scholar 

  34. Weaver KE, Rowland JH, Bellizzi KM, Aziz NM (2010) Forgoing medical care because of cost: assessing disparities in healthcare access among cancer survivors living in the United States. Cancer 116(14):3493–3504

    Article  PubMed  Google Scholar 

  35. Banegas MP, Guy GP Jr, de Moor JS, Ekwueme DU, Virgo KS, Kent EE, Nutt S, Zheng Z, Rechis R, Yabroff KR (2016) For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Aff 35(1):54–61

    Article  Google Scholar 

  36. Ramsey S, Blough D, Kirchhoff A, Kreizenbeck K, Fedorenko C, Snell K, Newcomb P, Hollingworth W, Overstreet K (2013) Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff 32(6):1143–1152

    Article  Google Scholar 

  37. 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 30(14):1608–1614

    Article  PubMed  Google Scholar 

  38. Azzani M, Roslani AC, Su TT (2015) The perceived cancer-related financial hardship among patients and their families: a systematic review. Support Care Cancer 23(3):889–898

    Article  PubMed  Google Scholar 

  39. Tucker-Seeley RD, Yabroff KR (2016) Minimizing the “financial toxicity” associated with cancer care: advancing the research agenda. JNCI: J Natl Cancer Instit 108(5):djv410

    Article  Google Scholar 

  40. Gany FM, Shah SM, Changrani J (2006) New York City’s immigrant minorities: reducing cancer health disparities. Cancer 107(S8):2071–2081

    Article  PubMed  Google Scholar 

  41. Gordon LG, Merollini KM, Lowe A, Chan RJ (2017) A systematic review of financial toxicity among cancer survivors: we can’t pay the co-pay. Patient Patient-Cent Outcomes Res 10(3):295–309

    Article  Google Scholar 

  42. Yabroff KR, Zhao J, Zheng Z, Rai A, Han X (2018) Medical financial hardship among cancer survivors in the United States: what do we know? What do we need to know? Cancer Epidemiol Prevent Biomark 27(12):1389–1397

    Article  Google Scholar 

  43. Longo CJ, Fitch MI, Banfield L, Hanly P, Yabroff KR, Sharp L (2020) Financial toxicity associated with a cancer diagnosis in publicly funded healthcare countries: a systematic review. Support Care Cancer 28:4645–4665.

    Article  PubMed  Google Scholar 

  44. Himmelstein, D. U., Lawless, R. M., Thorne, D., Foohey, P., & Woolhandler, S. (2019). Medical bankruptcy: still common despite the Affordable Care Act.

    Google Scholar 

  45. Wikelius K, O’Toole A (n.d.) Medicaid buy-in: state of play. Retrieved of August 28, 2019 from

  46. Johnson M, Kishore S, Berwick DM (2020) Medicare for All: an analysis of key policy issues: a discussion of design issues and options raised by pending Medicare for All legislation and proposals. Health Aff 39(1):133–141

    Article  Google Scholar 

  47. Blinder VS, Gany FM (2020) Impact of cancer on employment. J Clin Oncol Off J Am Soc Clin Oncol 38(4):302–309

    Article  Google Scholar 

  48. Gibson M, Hearty W, Craig P (2020) The public health effects of interventions similar to basic income: a scoping review. Lancet Public Health 5(3):e165–e176

Download references

Code availability

R code used for these analyses is available upon request from the authors.


Postdoctoral Fellowship in Psycho-Oncology [MSKCC Strategy & Innovation]; Cancer Center Support Grant (Population Science Research Program) [P30 CA008748-51, NCI]; American Cancer Society Doctoral Training Grant [129554-DSW-16-071-01-SW, ACS].

Author information

Authors and Affiliations



Dr. Doherty conceptualized and wrote 90% of the manuscript, Dr. Garder assisted in conceptualizing and editing, and Ms. Finik designed, conducted, and wrote up the statistical approach, results, and tables.

Corresponding author

Correspondence to Meredith Doherty.

Ethics declarations

Ethics approval

Ethical approval was provided by the Human Research Protection Program (HRPP) of Hunter College, City University of New York determined that this study, a secondary analysis of de-identified survey data, did not meet the requirements for human subjects research and was therefore exempt from IRB review (IRB File #2017-0067).

Consent to participate

Under the informed consent terms of the original study, reviewed and approved by the Human Research Protection Program (HRPP) of Hunter College, City University of New York, respondents provided written consent to participate.

Consent for publication

Under the informed consent terms of the original study, reviewed and approved by the Human Research Protection Program (HRPP) of Hunter College, City University of New York, participants permitted the researchers to use their responses for the purposes of ongoing research.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Doherty, M., Gardner, D. & Finik, J. The financial coping strategies of US cancer patients and survivors. Support Care Cancer 29, 5753–5762 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: