Childhood Cancer Survivors, Financial Toxicity, and the Need for Multilevel Interventions

Sienna Ruiz, Melissa M. Hudson, Matthew J. Ehrhardt, Julia Maki, Nicole Ackermann, Erika A. Waters

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Financial toxicity occurs when patients, families, and households experience “financial burden and distress” as a result of their healthcare expenses.1,2 To date, most research on financial toxicity has focused on adult cancers3–5 or on the direct costs of cancer treatments6–8 (eg, related to the delivery of cancer care, medication, inpatient stays, etc). However, in the United States, childhood cancer survivors and their families are also at high risk for financial toxicity.9 Research has largely overlooked the approximately 480 000 childhood cancer survivors in the United States10 who potentially face decades more of indirect costs related to their childhood cancer than do adult cancer survivors11 (eg, through decreased wages or lost opportunities because of a longer period of disability or morbidity).12 Interventions for the financial toxicity of cancer have not been implemented widely,13 even though they can improve health-related quality of life14,15 and health outcomes, including mortality.16 Because childhood cancer survivors potentially have a much longer survivorship period than do adult survivors, the benefits of implementing interventions specifically for childhood cancer survivors could be especially important for addressing critical survivorship issues (eg, limitations in insurance coverage17–19 for services like onco-fertility,20 fewer opportunities for participation in clinical trials,21 challenges maintaining long-term employment,22,23 sustained psychological difficulties,22 familial impacts of financial toxicity,24 and late effects of cancer treatments, some of which may present many years after completion of therapy).25,26 Furthermore, financial toxicity can impact more pediatric conditions than just cancer, including but not limited to diabetes,27 birth defects,28 orthopedic injuries,29 and other illnesses.30–33 Thus, additional research is needed to establish the scope and consequences of financial toxicity to inform future interventions for pediatric populations who not only experience cancer but other financially toxic conditions as well. In this commentary, we describe how financial toxicity affects childhood cancer survivors and contributes to health inequities, and we call for multilevel interventions that can help improve this population’s economic and health outcomes.

Original languageEnglish
Article numbere2022059951
Issue number1
StatePublished - Jul 1 2023


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