How cancer programs identify and address the financial burdens of rural cancer patients

Victoria Petermann, Whitney E. Zahnd, Robin C. Vanderpool, Jan M. Eberth, Catherine Rohweder, Randall Teal, Maihan Vu, Lindsay Stradtman, Elizabeth Frost, Erika Trapl, Sarah Koopman Gonzalez, Thuy Vu, Linda K. Ko, Allison Cole, Paige E. Farris, Jackilen Shannon, Jessica Lee, Natoshia Askelson, Laura Seegmiller, Arica WhiteJean Edward, Melinda Davis, Stephanie B. Wheeler

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: Financial toxicity is associated with negative patient outcomes, and rural populations are disproportionately affected by the high costs of cancer care compared to urban populations. Our objective was to (1) understand cancer programs’ perceptions of rural–urban differences in cancer patients’ experiences of financial hardship, (2) evaluate the resources available to cancer patients across the rural–urban continuum, and (3) determine how rural and urban health care teams assess and address financial distress in cancer patients. Methods: Seven research teams within the Cancer Prevention and Research Control Network conducted semi-structured interviews with cancer program staff who have a role in connecting cancer patients with financial assistance services in both rural and urban counties. Interviews were audio-recorded and transcribed. We identified themes using descriptive content and thematic analysis. Results: We interviewed 35 staffs across 29 cancer care programs in seven states, with roughly half of respondents from programs in rural counties. Participants identified differences in rural and urban patients’ experiences of financial hardship related to distance required to travel for treatment, underinsurance, and low socioeconomic status. Insufficient staffing was an identified barrier to addressing rural and urban patients’ financial concerns. Conclusions: Improved financial navigation services could mitigate the effects of financial toxicity experienced by cancer patients, particularly rural patients, throughout treatment and survivorship. Future research is needed to improve how cancer programs assess financial hardship in patients and to expand financial navigation services to better serve rural cancer patients.

Original languageEnglish
Pages (from-to)2047-2058
Number of pages12
JournalSupportive Care in Cancer
Issue number3
StatePublished - Mar 2022

Bibliographical note

Funding Information:
Stephanie B. Wheeler has received grant funding paid to her institution from Pfizer Foundation in the past 3 years. All other authors report no conflict of interests.

Funding Information:
This study was funded by the Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Numbers (U48-DP005017, U48-DP005053, U48-DP005014, U48-DP005030, U48-DP005013, U48-DP005006, U48-DP005021) from the Centers for Disease Control and Prevention. CHAI Core is funded by the UNC Gillings School of Global Public Health Nutrition Obesity Research Center through NIH (DK056350) and the UNC Lineberger Comprehensive Cancer Center through NCI (P30-CA16086). Victoria Petermann is supported by the Rita and Alex Hillman Foundation and the UNC Lineberger Cancer Control Education Program T32 (T32CA057726-27). Dr. Melinda Davis’s time was supported in part by a Cancer Prevention, Control, Behavioral Sciences, and Populations Sciences Career Development Award from the National Cancer Institute (K07CA211971). The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the Hillman Foundation, or the National Institutes of Health.

Funding Information:
Participants also discussed external resources they were aware of outside their cancer program. External resources described by participants across the rural–urban continuum included the American Cancer Society, transportation services, pharmaceutical assistance programs, foundations (public/private, local/state/national), local agencies, community-based cancer associations, outreach services, and support groups. Compared to their rural counterparts, participants from urban cancer programs more often mentioned connecting patients with resources through national societies and organizations (e.g., Leukemia and Lymphoma Society) and external resources to assist with non-medical costs such as utility bills, rent or mortgage payments, food, and gas. Participants from rural cancer programs more frequently mentioned utilizing financial assistance programs through churches, pharmaceutical patient assistance programs, and the Department of Social Services.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


  • Cancer
  • Financial assistance
  • Financial toxicity
  • Navigation
  • Oncology
  • Rural

ASJC Scopus subject areas

  • Oncology


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