The rising costs of cancer care and subsequent medical financial hardship for cancer survivors and families are well documented in the United States. Less attention has been paid to employment disruptions and loss of household income after a cancer diagnosis and during treatment, potentially resulting in lasting financial hardship, particularly for working‐age adults not yet age‐eligible for Medicare coverage and their families. In this article, the authors use a composite patient case to illustrate the adverse consequences of cancer diagnosis and treatment for employment, health insurance coverage, household income, and other aspects of financial hardship. They summarize existing research and provide nationally representative estimates of multiple aspects of financial hardship and health insurance coverage, benefit design, and employee benefits, such as paid sick leave, among working‐age adults with a history of cancer and compare them with estimates among working‐age adults without a history of cancer from the most recently available years of the National Health Interview Survey (2019–2021). Then, the authors identify opportunities for addressing employment and health insurance coverage challenges at multiple levels, including federal, state, and local policies; employers; cancer care delivery organizations; and nonprofit organizations. These efforts, when informed by research to identify best practices, can potentially help mitigate the financial hardship associated with cancer.

This study describes the conception, development, and growth of the Triage Cancer Conference hosted by Triage Cancer, a national nonprofit organization providing free legal and financial education to the cancer community. We conducted a retrospective analysis of post-conference participant surveys. Descriptive statistics were calculated for participant demographics, and acceptability, feasibility, and appropriateness were evaluated. From 2016–2021, 1239 participants attended the conference and completed post-conference surveys. Participants included social workers (33%), nurses (30%), and cancer patients/survivors (21%), with representation from over 48 states. Among those who reported race, 16% were Black, and 7% were Hispanic. For acceptability, more than 90% of participants felt that the conference content, instructors, and format were suitable and useful. For feasibility, more than 90% of participants felt that the material was useful, with 93–96% reporting that they were likely to share the information and 98% reporting that they would attend another triage cancer event. Appropriateness was also high, with >80–90% reporting that the sessions met the pre-defined objectives. Triage Cancer fills an important gap in mitigating financial toxicity, and formal evaluation of these programs allows us to build evidence of the role and impact of these existing resources. Future research should focus on adding validated patient-reported outcomes, longer-term follow-up, and ensuring inclusion and evaluation of outcome metrics among vulnerable populations.

Few evidence-based trainings exist on how to equip healthcare providers, particularly nurses, with the skills to engage in cost of care conversations with patients/caregivers to mitigate the impact of cancer-related financial toxicity. This study evaluated a pilot training developed in collaboration with Triage Cancer® to prepare oncology nurses to identify and assist patients/caregivers facing financial and/or legal barriers to care. Ten pediatric oncology nurses completed the training and pre/post-surveys on behaviors related to financial and legal need screening, frequency and comfort level of answering questions, knowledge, and behavior changes, along with training evaluation questions. At baseline, six nurses reported never screening for financial needs and nine for legal needs. Following the training, seven nurses stated they were likely to screen for financial/legal needs. At six months post-training, nurses had referred 85 patients/caregivers to financial/legal navigation services. Comfort levels in answering financial/legal questions increased by 6.5 points and knowledge scores increased by 1.7 points post-training. Most nurses recommended this training to other healthcare providers who work with patients with cancer and their caregivers. This study highlights the importance of providing oncology nurses with resources to engage in cost of care conversations and oncology financial legal navigation programs to mitigate the impact of cancer-related financial toxicity.

The National Cancer Institute (NCI) awarded administrative supplements to 11 NCI-designated cancer centers to build capacity for financial navigation services and collect preliminary data to implement and evaluate financial navigation programs. Preliminary findings from the projects were shared during a virtual conference in October 2022. This paper reflects major themes from the conference, the now completed projects, and findings from scientific literature to propose a set of recommendations for addressing financial hardship as part of cancer care delivery. Recommendations include the following principles. Healthcare systems should implement financial hardship screening using validated, culturally appropriate tools, considering patient literacy and language needs. Screening programs should be universal with assessments repeated over time. Financial navigation services should be available to help patients manage direct and indirect costs of care, access financial assistance and navigate employment-related challenges. Financial navigators should receive specialized training to build their knowledge of healthcare billing, insurance, financial assistance, and patient advocacy while also preparing them to support patients and leverage local and regional resources. A multidisciplinary care team approach should be applied to developing and implementing financial hardship screening and navigation services. Finally, health systems should harmonize information technology and workflows across departments involved in screening and financial navigation service delivery and automate screening, referral, and care team notification processes. Future research should address outstanding knowledge gaps, including the optimal interval for screening, how to identify patient needs early to mitigate downstream financial hardship, and the ideal components and timing of financial navigation for different settings and populations.

Purpose: To evaluate the impact of a virtual oncology financial and legal navigation (OFLN) intervention on cancer-related financial toxicity (FT) and health-related quality of life (QOL) in pediatric and adolescent and young adult (PAYA) cancer patients and caregivers, as well as to assess the intervention’s acceptability and feasibility. Methods: A single-arm trial was conducted in a PAYA oncology clinic between March 2024 and May 2025. Pre- and post-intervention surveys included the Comprehensive Score for Financial Toxicity (COST), Patient-Reported Outcomes Measurement Information System global health, anxiety and depression scales, National Comprehensive Cancer Network’s Distress Thermometer, and intervention acceptability, appropriateness, and feasibility of measures. Results: The majority (36 patients and 88 caregivers) identified as female (73%), non-Hispanic White (85%), rural residents (61%), with incomes above the federal poverty level (71%). Participants reported moderate levels of FT at baseline with a mean COST of 20.9 (SD = 11.14) for patients and 19.3 (SD = 10.12) for caregivers and high levels of anxiety, depression, and distress. Among caregivers, there was a significant (P = .01) post-intervention increase in COST (indicating decreased FT). Almost all patients reported decreases in subjective stress and anxiety (94%) and feeling better prepared to navigate financial/legal issues. Participants rated the intervention highly across implementation outcomes of acceptability (76%), appropriateness (76%), and feasibility (75%), which was also supported by 89% enrollment and 95% retention rates. Conclusion: Findings demonstrate that virtual OFLN has the potential to increase access to supportive care services, especially in rural communities. Additional research supporting scalability and uptake for widespread implementation is needed. ClinicalTrials.gov ID: NCT07409662