Currently, more than 18 million cancer survivors reside in the United States, 1 and many, along with their families, face significant hardship even years after treatment has been completed. Financial hardship, in particular, can stem not only from the costs of cancer treatment but from opportunity costs associated with travel to appointments, childcare, and missed work and subsequent lost wages. 2,3 Elsewhere in JAMA Network Open, Sadigh et al 4 report findings from a prospective longitudinal cohort study of 451 patients with nonmetastatic colorectal cancer, recruited from community oncology practices in the National Cancer Institute Community Oncology Research Program (NCORP) who, at enrollment, had not yet started curative-intent chemotherapy or radiation therapy. Patients completed surveys at baseline and 3, 6, 12, and 24 months later to assess financial worry, nonadherence to medical care due to cost, and material financial hardship. Material financial hardship was categorized as minor (decreased spending on food, clothing, or leisure) or major (withdrawing money from retirement or savings accounts, borrowing money to pay for cancer care, or patient or family working more to pay for cancer care). Among the cohort, nonadherence to care did not change over time: 8.8% of patients reported cost-related nonadherence at baseline, compared with 9.2% at 24 months. Material hardship was more common and decreased over time: 57.6% of patients reported material hardship at baseline, compared with 35.0% at 24 months. The authors 4 concluded that early screening and referral to assistance interventions might mitigate hardship, and that to be most effective, these should continue beyond diagnosis and treatment into the survivorship period.The prospective, longitudinal nature of this study sets it apart from much of the extant literature about the financial toxicity of cancer. Moreover, this study was conducted exclusively in community oncology practices, leveraging the NCORP and acknowledging the need to conduct studies of financial toxicity in the context in which they are perhaps most relevant. After all, more than half of patients with cancer receive their care in the community, yet only 50% of NCORP practices offer any financial navigator services. 5 Compared with studies of longitudinal financial hardship in metastatic cancer, 6 the results of this study by Sadigh et al 4 may be considered encouraging because material hardship was substantially improved at 24 months compared with baseline. However, one-third of the patients in this current study still reported material hardship 2 years after their cancer diagnosis. 4 These findings confirm previous studies that financial hardship is a persistent problem for some patients and their families, even after curative-intent treatment of their cancer.This study 4 has a few notable limitations that suggest that the proportion of patients with longterm financial hardship may be even higher. First, despite enrolling among 172 practices nationally, the baseline study sample does n...
