Worried man with paperwork

Cancer Patients Who Are Most Worried About Finances Shown to Have Worse Outcomes

‘Financial toxicity’ linked to lower survival, Roswell Park study in patients with head/neck cancers shows

  • Researchers asked patients about their concerns and quality of life
  • Study is first to show that financial stress predicts overall survival
  • Team exploring approaches to lessen the effects of stress on cancer patients

BUFFALO, N.Y. — Cancer treatment is likely to affect every aspect of a patient’s life — their activities, relationships, eating habits, mental health, physical health and comfort, financial wellbeing. And when financial concerns weigh heavily on an individual who is in treatment for cancer, they can affect the outcome of that treatment. New research from Roswell Park Comprehensive Cancer Center provides the first evidence that a cancer patient’s level of financial worry as they begin treatment predicts how likely it is that their treatment will be successful.

Hear more from Dr. Singh on the Roswell Park study that showed financial toxicity can significantly impact cancer patients' clinical outcomes.

“Does financial worry impact survival? The answer is, resoundingly, yes,” says study senior author Anurag Singh, MD, Professor of Oncology and Director of Radiation Research at Roswell Park. “The association we found was very strong, and very concerning. If you are worried about your finances, your risk of dying is roughly double.”

The researchers, who include first author Austin Iovoli, MD, a resident physician at Roswell Park, outline their findings in a new study in the journal Oral Oncology. They surveyed 284 patients treated for cancers of the head and neck about their quality of life both before and after undergoing treatment, then retrospectively reviewed their survey responses and their clinical outcomes. Head/neck cancer patients are among those most likely to face a greater level of financial concern because their cancers often require extensive, multimodal treatment, Dr. Singh notes.

Anurag Singh, MD
Dr. Anurag Singh

“We know head and neck cancer patients have the highest level of financial burden among any cancer patients because these are cancers where you can need surgery as well as extended courses of chemotherapy and radiation, along with substantial supportive care and rehabilitation,” he says. “Many patients are unwell enough they cannot go to work, which creates additional stress and uncertainty. And we now know that this financial toxicity affects not just their mental and emotional well-being but their physical health, how they respond to cancer treatment.”

The same 14.4% of patients who reported the most significant financial worry at the onset of treatment were those most likely to experience worse overall survival and worse cancer-specific survival. The researchers performed both multivariable and matched-pair analyses to adjust for potential confounding factors, but still found that patients with high financial toxicity at baseline were about twice as likely to experience a poor outcome.

The findings were inspired by earlier work led by Roswell Park Interim Chair of Immunology Elizabeth Repasky, PhD, a co-author on the new study, demonstrating that chronic stress can limit the effectiveness of cancer treatment.

Dr. Elizabeth Repasky

“These studies reveal the importance of stressful factors that are often hidden and beyond the control of the patient or caregiver in treatment outcome,” says Dr. Repasky, who is also the Dr. William Huebsch Professor in Immunology at Roswell Park.

“Financial toxicity could be a major unknown factor that could be affecting the results of even major clinical trials,” adds Dr. Singh. “We want everyone to be aware of these impacts. Doctors should consider how financial toxicity may be impacting their patients and do everything we can to improve our patients’ quality of life, and we want to encourage patients to take advantage of financial counseling and every other resource that can lessen their burden.”

Additional information about the free financial counseling and cost estimation services that Roswell Park offers to every patient is available here.


Roswell Park Comprehensive Cancer Center is a community united by the drive to eliminate cancer’s grip on humanity by unlocking its secrets through personalized approaches and unleashing the healing power of hope. Founded by Dr. Roswell Park in 1898, it is the only National Cancer Institute-designated comprehensive cancer center in Upstate New York. Learn more at www.roswellpark.org, or contact us at 1-800-ROSWELL (1-800-767-9355) or ASKRoswell@RoswellPark.org.

Media Contact

Annie Deck-Miller, Senior Media Relations Manager
716-845-8593; annie.deck-miller@roswellpark.org