Cancer, Work and Money: How a Diagnosis Hits Jobs and Household Finances

A cancer diagnosis costs money as well as health. Across 36 studies from the US, Europe and elsewhere, about a third of people after cancer were out of work, and their pooled risk of unemployment was 37% higher than that of healthy controls; and in eight Southeast Asian countries, almost half of people newly diagnosed who were followed up for a year had faced financial catastrophe in that time.

The costs arrive from two directions at once. Income falls, because treatment and its after-effects make work harder or impossible for a time, and sometimes for good. Spending rises, on travel to appointments, heating, everyday living and, in many countries, the treatment itself. How deep the hole goes depends heavily on where people live: on employment law, on sick pay, on whether care is free at the point of use, and on what support is offered. This piece sets out what the research shows about those gaps, country by country, and what would close them.

About a third of people after cancer were out of work, a 37% higher risk than their peers

The most widely cited synthesis remains a 2009 meta-analysis in JAMA that pooled 36 studies, 16 from the United States, 15 from Europe and 5 from other countries, covering 20,366 people after cancer and 157,603 healthy controls. Overall, 33.8% of people after cancer were unemployed, against 15.2% of controls, a pooled relative risk of 1.37 (95% CI 1.21 to 1.55)^[1]. The two raw percentages come from different mixes of studies, so the relative risk, which compares like with like within each study, is the better guide to the size of the gap.

The gap was not the same for every cancer. It was clearest after gastrointestinal cancers (48.8% against 33.4%, relative risk 1.44), cancers of the female reproductive organs (49.1% against 38.3%, relative risk 1.28) and breast cancer (35.6% against 31.7%, relative risk 1.28). For blood cancers and testicular cancer the review found no significantly higher unemployment^[1]. People in the US studies had about 1.5 times the unemployment risk of people in the European studies, but that difference disappeared once the authors adjusted for diagnosis, age and the background unemployment rate^[1]: a reminder that labour markets, not just illness, shape these figures.

Most people return to work, but many leave it later

Being out of work is only part of the picture. A review of 64 studies published between 2000 and 2009 found that, overall, 63.5% of people after cancer returned to work, with a range across studies from 24% to 94%. The mean time off work was 151 days. Between 26% and 53% lost their job or stopped working over the six years after diagnosis, and of those who lost a job, between 23% and 75% found work again^[4]. Those wide ranges are themselves a finding: they reflect different countries, cancers, ages and definitions of "work", and they mean no single return-to-work rate should be quoted as universal.

The same spread appears within one country. A systematic review of 13 Japanese studies published between 2005 and 2017 found return-to-work rates ranging from 53.8% to 95.2%, and judged most of the studies to be at high risk of bias, largely because 12 were cross-sectional^[5].

For people diagnosed in childhood, the effects can last into working life. A register study across Denmark, Finland and Sweden found that by age 30, 9.2% of people who had had cancer in childhood were unemployed for health reasons, with about 2.6 times the odds of health-related unemployment of population comparisons (odds ratio 2.57) and similar odds against their own siblings (2.50). There was no large difference in unemployment unrelated to health, or in the kind of jobs people held, and the effect was most marked after central nervous system tumours^[6]. The long-term and late effects of treatment, such as fatigue and changes in memory and concentration, are covered in our piece on life after treatment.

Money problems are common even where treatment is free to use

Researchers use the term "financial toxicity" broadly for the money problems, and the worry about money, that can follow a cancer diagnosis. A 2024 meta-analysis of 30 studies that all used the same questionnaire (the COST scale) put the pooled prevalence of financial toxicity among people with cancer at 48% (95% CI 38% to 58%), rising to 64% in studies from developing countries^[7]. These are pooled survey estimates from varied settings, not a census, but they show that money problems are a common part of having cancer, not a rare one.

Systems where treatment is free at the point of use protect people from medical bills, not from lost income or the everyday costs of being ill. In the UK, a 2020 online survey of 1,329 adults with a cancer diagnosis, run by Macmillan Cancer Support and Truth, and weighted to the population of people living with cancer by age, gender, region, cancer type and time since diagnosis, found that 83% had experienced some financial impact. Three in four (75%) lost income, by an average of £747 a month for those affected; 54% saw day-to-day living costs rise, by an average of £389 a month; 28% faced extra travel costs to appointments and 17% higher fuel bills. For those affected, the combined impact averaged £891 a month at their most financially difficult time, and 39% were severely affected^[3]. This is a charity survey reported in a press release rather than a peer-reviewed study, and Macmillan notes that the figure cannot be compared directly with its earlier estimates because the method changed.

Evidence from Italy suggests that money problems are linked to outcomes as well as to wellbeing. Researchers pooled data from 16 clinical trials in lung, breast and ovarian cancer. At the start, 26% of the 3,670 people taking part reported financial difficulties, and this was linked to worse quality of life, but not to survival. Of the 2,735 who completed later questionnaires, 616 (22.5%) developed financial difficulties during treatment, and this group had a 20% higher risk of death over follow-up (hazard ratio 1.20, 95% CI 1.05 to 1.37)^[8]. This is an association among trial participants, who may not represent everyone with cancer, and it cannot show that money problems themselves shortened lives; worsening finances may also signal worsening illness. But it is a signal that health services cannot treat money as someone else's problem.

How money worries sit alongside emotional wellbeing and family life is covered in our pieces on mental health with and after cancer and on carers and families.

In the United States, hardship falls hardest on people of working age

The US has some of the deepest national survey data on the financial side of cancer. In the National Health Interview Survey for 2013 to 2016, adults aged 18 to 49 with a cancer history were more likely than those without one to report material financial hardship from medical care, such as problems paying medical bills: 43.4% against 30.1%. The gap narrowed with age, to 32.8% against 27.8% at 50 to 64 and 17.3% against 14.7% at 65 and over^[9]. An earlier national survey, the 2011 Medical Expenditure Panel Survey, found the same age pattern among 1,202 adults after cancer: material hardship was reported by 28.4% of those aged 18 to 64 against 13.8% of those aged 65 and over, and psychological financial hardship by 31.9% against 14.7%^[10].

Hardship was also linked to survival. In national survey data for 1997 to 2014, linked to death records to the end of 2015, 29.6% of people after cancer aged 18 to 64 and 11.0% of those aged 65 to 79 reported problems affording care, or delaying or going without care because of cost, in the previous year. Hardship was associated with a modestly higher risk of death (hazard ratio 1.17 at 18 to 64 and 1.14 at 65 to 79). Among the younger group, the association weakened and was no longer statistically clear once health insurance status was taken into account (hazard ratio 1.09, 95% CI 0.97 to 1.24), which suggests that insurance status accounts for part of the association^[11].

At the extreme, money problems become bankruptcy. Studying adults diagnosed with cancer in Washington State between 1995 and 2009, researchers found that people with cancer were 2.65 times more likely to go bankrupt than people without cancer, and that younger people with cancer had two to five times the bankruptcy rate of those aged 65 or over^[12]. In a follow-up study of the same population, people who filed for bankruptcy after a cancer diagnosis had a higher risk of death than matched people with cancer who did not file (adjusted hazard ratio 1.79, 95% CI 1.64 to 1.96)^[13]. The authors describe severe financial distress as a risk factor for death, not a proven cause.

In Southeast Asia, almost half of people followed for a year had faced financial catastrophe

The starkest evidence comes from a study that measured out-of-pocket medical costs directly. The ACTION study followed 9,513 adults newly diagnosed with cancer between March 2012 and September 2013 at hospitals in Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Thailand and Vietnam. Their mean age was 52, and 64% were women. It defined financial catastrophe as out-of-pocket medical costs at or above 30% of annual household income. Complete one-year outcome data were available for 6,787 of them (71%); those with incomplete data were slightly younger, more often men and less likely to have a high income. Among the 6,787, a year after diagnosis 29% had died, 48% had experienced financial catastrophe, and just 23% were alive with no financial catastrophe^[2].

Income was strongly linked to both outcomes. People whose household income was low relative to their country's average (under 75% of the national mean) had 5.86 times the odds of financial catastrophe of those with a high income (over 125% of the mean), and 5.52 times the odds of having died. The income gap in financial catastrophe was widest in the upper-middle-income countries, Malaysia and Thailand (odds ratio 13.75), and narrower, though still present, in the lower-middle-income countries (1.97)^[2]. More than half of participants (54%) had already experienced economic hardship in the year before their diagnosis, meaning they had been unable to make a necessary household payment, such as for food or housing, or had needed help to do so; many started from a fragile position^[2]. The 64% prevalence of financial toxicity found in developing-country studies in the 2024 meta-analysis points the same way^[7].

The same income gradient runs through cancer outcomes in wealthier countries too, as our piece on deprivation and cancer sets out. Money problems after diagnosis add to a disadvantage that often began long before it.

What the evidence asks of us

The figures point to gaps in employment protection, in income support and in the way services are organised, not to anything people with cancer are doing wrong. Several responses are supported by evidence or already agreed internationally.

• Make work support part of cancer care. In 2017 the World Health Assembly, in resolution WHA70.12, urged countries to promote early detection of patients' needs and access to rehabilitation, "including in relation to work"^[14]. A 2024 Cochrane review of 15 randomised trials (1,477 people) found that physical and multidisciplinary programmes likely increase return to work compared with usual care (risk ratio 1.23 for each, moderate-certainty evidence). Psycho-educational programmes on their own probably made little or no difference, and the evidence on purely vocational programmes was very uncertain^[15].
• Close the evidence gap outside rich countries. Every trial in that Cochrane review was carried out in a high-income country, and most involved breast or prostate cancer^[15]. Funders should support trials of work support in low- and middle-income countries, for a wider range of cancers.
• Protect people at work in law, and make sure they know it. In Great Britain, the Equality Act 2010 lists cancer as a disability in its own right^[16], so the Act's protections for disabled people apply to people with cancer. Legal protection only helps when people and employers know it exists, and comparable protections differ from country to country.
• Ask about money as routinely as about symptoms. With pooled estimates suggesting around half of people with cancer experience financial toxicity^[7], and an Italian trial analysis linking new financial difficulties to survival^[8], cancer services have reason to screen for financial difficulty and refer people promptly to welfare, benefits and debt advice.
• Remove out-of-pocket costs where they cause catastrophe. The same resolution calls for "equitable and affordable access to cancer care"^[14]. ACTION showed what happens without it: three in four of those followed up had died or faced financial catastrophe within a year of diagnosis^[2].

For the wider picture across the library, see the Cancer research library.

Language: this piece says "people with cancer", "people after cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. "Survivor" appears only in the titles of cited studies. Terms such as "financial toxicity", "financial catastrophe", "relative risk", "odds ratio" and "hazard ratio" are used in the sense the cited source defines them.

Why we're publishing this

Many cancer charities, support groups and hospices help people with money and work, through welfare and benefits advice, grants and support in dealing with employers. This piece brings the published research together in one place, with its sources, so that they can make the case to employers, health services, funders and governments that financial harm is a predictable part of a cancer diagnosis and should be planned for, not left to chance and to charity. The gaps it describes sit in employment protection, income support and the cost of care, not in the people affected.

How to read this data

Most of the evidence here comes from surveys and observational studies. They show how common unemployment and money problems are, and what they are associated with; they cannot prove that one thing caused another. The links between financial hardship and survival in the Italian, US and Southeast Asian studies are associations that may partly reflect how ill people were. Relative risks and hazard ratios compare risks; odds ratios compare odds, and are larger than relative risks when an outcome is common, as financial catastrophe was in ACTION. Definitions differ: "financial toxicity", "material hardship" and "financial catastrophe" are measured in different ways and should not be compared as if they were one figure. Some sources are old: the unemployment meta-analysis dates from 2009 and the return-to-work review from 2011, and labour markets and employment law have changed since. The evidence gathered here is heavily weighted towards the United States and Europe; we found little comparable data from Africa, South Asia or Latin America, and the Macmillan figures come from a charity survey, not a peer-reviewed study. This piece reports research findings at population level and is not financial or employment advice for any individual.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

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