We like to talk about breakthroughs in oncology—immunotherapy, targeted therapies, precision medicine, antibody-drug conjugates, and new combinations that can extend lives. Cancer has always been frightening because of what it can do to the body. Increasingly, Americans have another fear to contend with: What is cancer going to do to my finances?
We talk considerably less about whether ordinary Americans can afford to receive it. The data suggest a disturbing answer: for a large percentage of patients, cancer care is not truly affordable—even when they have health insurance.
Cancer has become a financial disease, too
The National Cancer Institute calls the phenomenon “financial toxicity”: the financial problems caused by the cost of medical care. It isn’t simply an inconvenience. Financial toxicity can lead patients to accumulate debt, spend down savings, cut household expenses, and even alter their medical care because they cannot afford it.
Consider the scale of cancer economics in America.
The American Cancer Society reported that U.S. cancer-related medical costs were estimated at $208.9 billion in 2020. Costs borne by patients were estimated at $21.1 billion, including approximately $16.2 billion in out-of-pocket expenses and another $4.9 billion representing patients’ time.
ACS also noted that the estimate likely understated today’s burden because treatment costs have continued to grow and many prescription cancer medicines carry annual list prices exceeding $100,000.
Here’s the number that should get everyone’s attention: 47%
In a 2024 American Cancer Society Cancer Action Network survey of 1,284 cancer patients and survivors diagnosed or treated within the previous seven years, 47% reported having medical debt related to their cancer.
Among those with cancer-related medical debt:
- 49% had carried more than $5,000 in debt.
- 69% had carried the debt for more than a year.
- 35% had been carrying cancer-related debt for more than three years.
- 49% said their credit score had declined.
- 30% experienced difficulty qualifying for loans.
- 18% considered bankruptcy, while another 6% actually filed for bankruptcy.
Those numbers alone should force us to reconsider what “affordable” means in American healthcare. But there is an even more important statistic.
Ninety-eight percent of the patients who accumulated cancer-related medical debt were insured when the debt occurred.
They weren’t primarily people who made the mistake of going without insurance. They had insurance.
Health insurance doesn’t necessarily mean affordable healthcare
That could very well be cancer’s most dangerous myth when it comes to the national health care discussion.
Americans like to think of health care in two categories: those who have insurance and those who do not. What gets left out of that discussion is a large segment of the population that falls into both categories at one time or another: insured but unable to afford being sick.
Even if a family scrupulously pays thousands of dollars in premiums every year, they can still face deductibles, copays, coinsurance, specialty drug cost sharing, out-of-network charges, transportation costs, and lost wages if cancer enters the picture.
The American Cancer Society doesn’t shrink from that reality, acknowledging that cancer costs can include treatment as well as medicines, deductibles, travel, and other out-of-pocket costs. Cancer also doesn’t wait until families pay off their mortgage, send their kids through college, and put thousands of dollars in an emergency fund. Cancer happens to 35-year-olds. Cancer happens to parents. Cancer happens to those making six figures.
One study by ACS CAN discovered that of surveyed households making over $125,000 a year, 37% still could not afford their cancer care without going into medical debt. Let that erase any thought that financial toxicity is only an issue for low-income families.
Working-age Americans may be particularly vulnerable
But cancer doesn’t just create expenses. It can threaten the income you need to pay those expenses. Treatment can involve surgery, chemotherapy, radiation, imaging, lab work, doctors’ appointments, and recovery time. You might cut your hours, take unpaid time off, or lose your job.
According to the National Cancer Institute, working Americans undergoing cancer treatment missed an estimated 22 additional days of work per year compared with those not undergoing cancer treatment.
An American Cancer Society study found that almost 60% of working-age cancer survivors experienced some form of financial hardship, such as difficulty paying medical bills, financial hardship, or delaying/foregoing care due to cost.
See how that works? You get cancer. You incur more medical expenses. You might lose the ability to earn a living. Your household income drops. And if your health insurance is connected to your job, your battle with cancer can disrupt your job and threaten your family’s health insurance – the very thing you need to treat your cancer. That’s not just financial toxicity. That’s how America pays for serious illness failing us.
When cost begins influencing treatment, we have crossed a dangerous line
Financial toxicity would be bad enough if its ramifications ended with empty bank accounts. They don’t. Among survey respondents represented in the 2024 ACS CAN survivorship poll who carried cancer-related medical debt, 25% said they skipped or delayed healthcare. 27% went without enough food.
The National Cancer Institute notes that when confronted with financial toxicity, patients may skip doses of medications, take less medicine than is prescribed, or fail to fill prescriptions at all. Higher copays are linked to lower adherence to medications. Suddenly, affordability is not just a personal finance issue. It’s now a clinical one, too. We can engineer wonderful new medicines, but if patients can’t afford to take them as directed, their efficacy becomes nil.
The cancer innovation paradox
That’s where pharma, payers, employers, hospitals, and policy makers alike need to face some tough truths. We are in the midst of what is likely the most scientifically revolutionary era in the history of cancer medicine. Oncologists are understanding cancer at the molecular level and identifying disease drivers. Drug developers are tailoring treatments for ever-smaller patient cohorts. Immunotherapies are transforming the treatment of many forms of cancer.
Cancers that were once considered terminal are now being managed for years on end. This is incredible. But all of these scientific advancements mean little if patients can’t afford them. Without intervention, we’re going to reach a point where we have the drugs to treat patients, but patients won’t be able to afford the financial burden of cancer. And this issue will not resolve itself as more drugs are brought to market.
As the NCI points out, cancer patients are living longer – but with increasingly expensive chemotherapy and biological therapies. Prices north of $10,000/month for individual drugs and biologic agents are becoming the norm. So maybe we need to start measuring the success of oncology innovation by a different standard. Approval alone is not enough. Clinical efficacy is not enough. Coverage should not be good enough. The question we should be asking is this: Can patients access these treatments and stay on them without ruining their financial well-being?
Maybe affordability should become an oncology outcome
Oncology cares about progression-free survival. Overall survival. Response rates. Adverse events. Quality of life. Financial toxicity deserves a seat at that table too. How about if we start routinely asking our cancer patients: Can you afford this treatment? Have you drained your savings account? Have you taken out a loan? Have you skipped medication due to cost? Have you missed an appointment because it cost too much? Are you having to decide between buying chemo and buying groceries? Those aren’t admin questions. They might be clinically relevant questions. And financial navigation is showing it can help. The NCI recently covered research where cancer patients and caregivers enrolled in a financial navigation program saved an average of about $2,500 each. Financial navigation shouldn’t be a band-aid we apply after someone is already buried in bills. It needs to be part of our cancer-care planning moving forward.
So, how many of us can afford cancer?
There isn’t a single percentage that answers the question for every American. Cancer type, stage, treatment, insurance design, income, assets, employment and family circumstances all matter. But we know enough to say this:
When nearly half of surveyed cancer patients and survivors report cancer-related medical debt—and 98% of those accumulating that debt had insurance—we cannot credibly say that cancer care is broadly affordable simply because Americans are insured.
And the definition of affordability needs to change. A treatment isn’t affordable merely because an insurer eventually pays most of the bill. It’s affordable when patients can obtain the recommended treatment, adhere to it, and continue paying for food, housing, transportation, and the rest of their lives without being pushed into long-term debt.
America has invested enormous amounts of money, intelligence, and scientific talent into answering one question: How do we help more people survive cancer?
It’s time to put equal urgency behind another:
Can people afford to survive it?
Because curing cancer while financially devastating the patient shouldn’t qualify as a complete healthcare success.
