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Many Cancer Survivors Struggle to Pay For Care

The population of cancer survivors in the US is growing, and many struggle to pay health care costs. A study led by the Centers for Disease Control and Prevention (CDC) finds one-fourth of survivors have problems paying medical bills and one-third worry about them. Not surprisingly, people without health insurance have a harder time than those with insurance.

Researchers from the CDC, the American Cancer Society, and the National Cancer Institute looked at data from the 2011–2016 Medical Expenditure Panel Survey to estimate annual out-of-pocket expenses and financial hardship among cancer survivors aged 18 – 64 years compared with people who have never had cancer. The report was published June 7, 2019 in Morbidity and Mortality Weekly Report.

The study found cancer survivors spend more money and a larger proportion of family income in annual out-of-pocket medical costs than people without a cancer history. Survivors spent an average $1,000 in 2016, while those without a cancer history spent $622. Cancer survivors were more likely to spend more than 20% of annual family income. Survivors with no insurance coverage spent less out-of-pocket than survivors with insurance, but their spending made up a larger proportion of family income.

Financial hardship was split into 2 categories. Material hardship, reported by 25.3% of survivors, was measured through questions that asked whether they had ever had to borrow money, go into debt, file for bankruptcy, or been unable to pay their share of health care costs. Researchers measured psychological hardship, reported by 34.3%, with questions that asked survivors whether they worried about large medical bills.

The percentage of survivors who reported either type of financial hardship was higher among minority racial/ethnic groups than among whites, and highest for people ages 40–49 years. Survivors who were not insured were more likely to report financial hardship than those with insurance.


The number of cancer survivors is expected to increase in the next decade, and the costs of cancer-related care are likely to go up as well. The report reflects growing evidence that financial hardship may negatively affect survivors’ health and well-being.

The authors call for efforts at the provider, practice, employer, payer, state, and federal levels to develop strategies to help cancer survivors with costs. These may include screening for financial hardship not only when cancer is diagnosed but also throughout a survivor’s care, including discussions about the financial consequences of treatments in shared treatment decision-making, and linking patients and survivors to available resources.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Annual Out-of-Pocket Expenditures and Financial Hardship Among Cancer Survivors Aged 18–64 Years — United States, 2011–2016. Published June 7, 2019 in Morbidity and Mortality Weekly Report. First author Donatus U. Ekwueme, PhD, Centers for Disease Control and Prevention, Atlanta, Ga.