percent, respectively, cited skipping medications or canceling a medical appointment in the past 3 months because of financial problems. The 2006 National Survey of U.S. Households Affected by Cancer also found that one in four families in which a member of the household had cancer in the past 5 years said the experience led the patient to use up all or most of his or her savings; 13 percent had to borrow money from their relatives to pay bills; and 10 percent were unable to pay for basic necessities such as food, heat, or housing. Seven percent took out another mortgage on their home or borrowed money, and 3 percent declared bankruptcy. Eight percent delayed or did not receive care because of the cost. As would be expected, the financial consequences were worse for those without health insurance: more than one in four delayed or decided not to get treatment because of its cost; 46 percent used all or most of their savings to pay for treatment; 41 percent were unable to pay for basic necessities; and 6 percent filed for bankruptcy (USA Today et al., 2006). About 5 percent of the 1.5 million American families who filed for bankruptcy in 2001 reported that medical costs associated with cancer contributed to their financial problems (Himmelstein et al., 2005).
Not surprisingly, members of the American Society of Clinical Oncology (ASCO), the Oncology Nursing Society (ONS), and the Association of Oncology Social Work (AOSW) report financial needs as a frequent subject of patient inquiries (Matthews et al., 2004). The American Cancer Society (ACS) and CancerCare both receive and respond to a large number of patient requests for financial assistance. In fiscal year 2006, 3,482 patients contacting CancerCare received $1,812,206 for unmet financial needs such as child care, home care, and living expenses. In the first 8 months of fiscal year 2007, 2,069 received $727,745 in such financial assistance. In fiscal year 2006, the ACS responded to 41,378 requests for financial assistance to help patients manage the costs of durable medical equipment (3,713), medications (13,013), prosthetics (128), rent (459), scholarships (2,141), utilities (657), wigs (1,674), other medical expenses (1,763), and other needs (17,830). Both agencies report that requests for financial assistance are one of the most common reasons people contact them, and often there are not enough resources to meet these needs.10,11
Financial needs can arise from the high costs of medical treatment, drugs, and other health support needs, such as medical supplies that are not covered by insurance and/or are beyond an individual’s income level. This financial stress is compounded when a patient suffers a job loss, is not working during periods of treatment, or lacks health insurance.